Pediatric Obesity

Overweight and obesity in childhood is associated with negative physical and psychological effects. It has been proposed that obesity increase the risk for developing cognitive deficits, dementia and Alzheimer's disease and that it may be associated with marked differences in specific brain structure volumes. The purpose of this study was a neurobiopsychological approach to examine the association between overweight and obesity, brain structure and a paediatric neuropsychological assessment in Mexican children between 6 and 8 years of age. We investigated the relation between the body mass index (BMI), brain volumetric segmentation of subcortical gray and white matter regions obtained with magnetic resonance imaging and the Neuropsychological Assessment of Children standardized for Latin America. Thirty-three healthy Mexican children between 6 and 8 years of age, divided into normal weight (18 children) and overweight/obese (15 children) groups. Overweight/obese children showed ...

Parents demonstrate an important influence on adolescent obesity and dietary behavior; yet, family-based obesity interventions continue to exhibit limited success among adolescents. To further inform family-based approaches for adolescent obesity treatment, we examined the perceptions of adolescent females with obesity and their mothers of the influences experienced within the parent-adolescent relationship that affect everyday dietary practices. We conducted six focus group interviews (three adolescent female and three mother) among 15 adolescent (12-17 years old) females with obesity and 12 of their mothers. Content analysis techniques were used to analyze the transcribed interviews. Adolescent females with obesity discussed a diverse set of parental influences (controlling, supporting and cultivating, overlooking and tempting, acquiescing, providing, attending, and not providing and avoiding) on their daily dietary practices. Among mother focus groups, mothers discussed specific ...

Overweight and obesity in childhood is associated with negative physical and psychological effects. It has been proposed that obesity increase the risk for developing cognitive deficits, dementia and Alzheimer's disease and that it may be associated with marked differences in specific brain structure volumes. The purpose of this study was a neurobiopsychological approach to examine the association between overweight and obesity, brain structure and a paediatric neuropsychological assessment in Mexican children between 6 and 8 years of age. We investigated the relation between the body mass index (BMI), brain volumetric segmentation of subcortical gray and white matter regions obtained with magnetic resonance imaging and the Neuropsychological Assessment of Children standardized for Latin America. Thirty-three healthy Mexican children between 6 and 8 years of age, divided into normal weight (18 children) and overweight/obese (15 children) groups. Overweight/obese children showed ...

Purpose:This study examined the effects of a five-week intervention combining vigorous interval training (VIT) with diet among twenty-four obese adolescents. Fourteen girls and ten boys (aged 14–15) schooled in a pediatric rehabilitation center participated. Methods:The VIT intensity was targeted and remained above 80% of maximal heart rate (HR) and over six kilocalories per minute. Pre- and postintervention measures were body composition (BMI, weight, body fat percentage), physical self-perceptions (PSP), physical fitness (6-min walking distance and work) and its associated physiological responses (HRpeak and blood lactate concentration). A series of two-way analyses of variance or covariance controlling for weight loss were used to examine the changes. Results:Significant improvements were found in body composition, physical fitness and PSP (endurance, activity level, sport competence, global physical self-concept and appearance). In addition, boys presented higher levels of perce...

Background: Brain-derived neurotrophic factor (BDNF) plays important roles in the central regulation of food intake and body weight control. However, little is known about the role of BDNF in childhood obesity. Objective: To investigate the relationship between plasma levels of BDNF and anthropometric factors, metabolic derangements due to obesity, adipocytokine levels and birth weight in obese Japanese children. Subjects and methods: Sixty-six obese Japanese children aged from 5 to 15 years old were enrolled. The age-matched control group consisted of 32 non-obese healthy children. The plasma levels of BDNF and adipocytokines (leptin and adiponectin) were assayed using ELISA techniques. Results: The mean BMI Z-scores were −0.67, +2.15 and +3.39 for the non-obese control children, obese (BMI ≥ 90th percentile, <99th percentile) and morbidly obese (BMI ≥ 99th percentile), respectively. The plasma levels of BDNF were significantly decreased in the morbidly obese children compared with the levels in the obese and non-obese control children (507 ± 33 pg/ml vs. 626 ± 46 pg/ml, 621 ± 35 pg/ml, p < 0.05). Univariate linear regression analysis showed that the plasma level of BDNF was positively correlated with birth weight (r = 0.264, p < 0.05) and inversely * e64 S. Araki et al. correlated with the BMI Z-score (r = −0.314, p < 0.05). Multivariate forward stepwise linear regression analysis revealed that the birth weight and BMI Z-score are independent predictors of the plasma BDNF level. Conclusion: The plasma level of BDNF, which is decreased in morbidly obese children, is associated with birth weight and the BMI Z-score. Our results suggest that BDNF may play important roles in the development and pathophysiology of childhood obesity.

The high prevalence of childhood obesity is a concern for policy makers and health professionals, leading to a focus on early prevention. The beliefs and perspectives of parents about early childhood obesity, and their views and opinions about the need for weight management interventions for this age group are poorly understood. A formative qualitative focus group study with parents of pre-school children took place in eight community-based locations throughout North-East Scotland to explore their ideas about the causes of early childhood obesity, personal experiences of effective weight management strategies, and views about the format and content of a possible child-orientated weight management programme. Study participants were recruited via pre-school nurseries. Thirty-four mothers (median age 37 years) took part in the study, but only two believed their child had a weight problem. Participants (who focussed primarily on dietary issues) expressed a strong sense of personal respo...

Obesity has been characterized as a disease. Strategies to change the incidence and prevalence of this disease include a focus on changing physical and social environments, over and above individual-level strategies, using a multilevel or systems approach. We focus our attention on evidence published between 2008 and 2013 on the effectiveness of interventions in nutrition environments, i.e., environmental interventions designed to influence the intake of healthful foods and amount of energy consumed. An overarching socioecological framework that has guided much of this research was used to characterize different types of environmental strategies. Intervention examples in each area of the framework are provided with a discussion of key findings and related conceptual and methodological issues. The emphasis in this review is on adults, but clearly this literature is only one part of the picture. Much research has been focused on child-specific interventions, including environmental in...

Background Obesity in pediatric and adolescent population has reached a universal pandemic. This study aimed to summarize the literature on the longest available outcome of bariatric surgery in morbidly obese adolescents. Methods A systematic review was conducted to pool available data on the longest available (>3 years) weight loss and comorbidity resolution outcome in adolescent bariatric surgery. Results A total of 14 studies reporting the result of bariatric surgery after 3 years in 950 morbidly obese adolescents were included. Preoperative age and BMI ranged from 12 to 19 years and from 26 to 91 kg/m 2 , respectively. Females were the predominant gender (72.8%). Laparoscopic roux-en-Y gastric bypass (n = 453) and adjustable gastric banding (n = 265) were the most common bariatric procedure performed. The number of patients at the latest follow-up was 677 (range from 2 to 23 years). On average, patients lost 13.3 kg/m 2 of their BMI. Among comorbidities, only diabetes mellitus resolved or improved dramatically. Of 108 readmissions, 91 led to reoperation. There was a weight regain < 5 kg/m 2 between 5 and 6 years of follow-up. Removal, exchange, or conversion of the previous band constituted the majority of the revisional procedures. Three deaths were reported. No long-term data was obtainable on nutritional deficiency or growth status of adolescents who underwent a bariatric procedure. Conclusion Although bariatric surgery is a safe and effective procedure in the treatment of adolescent morbid obesity, longterm data is scarce regarding its nutritional and developmental complication in this growing population of patients.

Background: Children obesity is a risk factor for several dysfunctions and diseases, with negative effects on the morphology of the locomotor system, plantar pressure and body stability. A relationship between postural control and sensorimotor information has been assumed. However, there is few data on the effects of children obesity on the availability of sensorial information from the foot during standing. Methods: Twenty obese and twenty non-obese children were evaluated for foot sensitivity and plantar pressure during unipedal and bipedal stance. Data were compared between obese and non-obese participants, between foot regions and between legs. Findings: Obese children experiences higher plantar pressure and have lower foot sensitivity than non-obese. Additionally, obese children had similar sensitivity for different foot regions, as compared to the non-obese. Interpretation: Children obesity negatively influences foot sensitivity. Bipedal stance seemed more sensitive to differentiate between obese and non-obese. Higher plantar pressure and lower foot sensitivity in obese children may affect performance of weight bearing activities, contribute to higher risk of foot injuries and have potential implication for children footwear design and clinical physical examination.

Childhood obesity is a significant problem in the United States, yet current childhood obesity prevention programming approaches have limited efficacy. Self-regulation is a set of processes (e.g., cognitive control, emotion coping) that organize behavior in order to achieve a goal. As such, self-regulation may shape health behaviors and over time, long-term health outcomes. Obesityprevention approaches that incorporate a focus on the cognitive and behavioral mechanisms that underlie self-regulation early in the lifespan may therefore lead to better outcomes. Executive functioning (EF) is a central aspect of self-regulation; skills include attention, working memory, and inhibitory control. Deficits in these areas are associated with higher weight status in children. The current paper reviews the development of EF from childhood to adolescence, identifies socialcontextual influences on EF development, presents how different aspects of EF relate to behaviors known to be associated with increased risk for childhood obesity, and considers how EF-weight associations may change across development. Implications for intervention, including the need to consider the direction of association and possibility of bidirectional associations, the multiple potential pathways between EF and weight status, and a brief review of EF-enhancement intervention approaches are discussed.

This study aimed to evaluate the association of neck circumference (NC) with obesity to determine the sex-specific and age-specific optimal cut-off points of this measure in association with obesity in a national sample of the Iranian paediatric population. This survey on weight disorders was conducted among a national sample of Iranian children and adolescents, aged 6-18 years. Using the area under the curve (AUC) of the receiver operator characteristic curves, we evaluated the association of NC with general and abdominal obesity. This national survey was conducted among 23 043 school students (50.8% boys) with a mean age (SD) of 12.55 (3.31) years. A significant association was documented between NC and other anthropometric measures in both sexes and in the whole population. In all age groups and genders, NC performed relatively well in classifying participants to overweight (AUC: 0.67 to 0.75, p&lt;0.001), general obesity (AUC: 0.81 to 0.85, p&lt;0.001) and abdominal obesity (AUC...

Obesity and being overweight in a child significantly affects his or her healthy development hence there is an understandable focus in the occupational therapy literature on the physical health and difficulties in motor function related to obesity. However, this emphasis somewhat overshadows the psychosocial issues of growing-up obese or overweight. The objective of this paper is to apprise readers of the salient multiple psychosocial sequelae associated with childhood obesity including weight bias and victimization. A conceptual systems framework that supports a multifaceted approach to the occupational and developmental challenges on a population and/or individual level is discussed.

Marketing that targets children with energy-dense, nutrient-poor foods is a likely contributor to the childhood obesity crisis. High-sugar ready-to-eat cereals are the packaged food most frequently promoted in child-targeted food advertising on television. The authors combined content analysis of product nutritional quality and messages presented in cereal television advertisements with syndicated data on exposure to those ads. The analysis quantifies children's exposure to specific products and messages that appear in advertisements and compares it with adult exposure. Children viewed 1.7 ads per day for ready-to-eat cereals, and 87% of those ads promoted high-sugar products; adults viewed half as many ads, and ads viewed were equally likely to promote high-and low-sugar cereals. In addition, the messages presented in high-sugar ads viewed by children were significantly more likely to convey unrealistic and contradictory messages about cereal attributes and healthy eating. For example, 91% of high-sugar cereal ads viewed by children ascribed extraordinary powers to these products, and 67% portrayed healthy and unhealthy eating behaviors. Given children's vulnerability to the influence of advertising, the emotional and mixed messages used to promote high-sugar cereals are confusing and potentially misleading.

During childhood and adolescence, a game could be an effective educational tool to learn healthy eating habits. We developed Kaledo, a new board game, to promote nutrition education and to improve dietary behavior. A two-group design with one pre-treatment assessment and two post-treatment assessments was employed. A total of 3,110 subjects (9-19 years old) from 20 schools in Campania, Italy, were included in the trial. In the treated group, the game was introduced each week over 20 consecutive weeks. Control group did not receive any intervention. The primary outcomes were (i) score on the "Adolescent Food Habits Checklist" (AFHC), (ii) scores on a dietary questionnaire, and (iii) BMI z-score. At the first postassessment (6 months), the treated group obtained significantly higher scores than the control group on the AFHC (14.4 (95 % confidence interval (CI) 14.0 to 14.8) vs 10.9 (95 % CI 10.6 to −11.2); F(1,20)=72.677; p<0.001) and on four sections of the dietary questionnaire: "nutrition knowledge" (6.5 (6.4 to 6.6) vs 4.6 (4.5 to 4.7); F(1,16)=78.763; p<0.001), "healthy and unhealthy diet and food" (11.2 (11.0 to 11.4) vs 10.4 (10.3 to 10.6); F(1,32)=21.324; p<0.001), "food habits" (32.4 (32.0 to 32.8) vs 27.64 (27.3 to 28.0); F(1,26)=195.039; p<0.001), and "physical activity" (13.4 (13.2 to 13.7) vs 12.0 (11.8 to 12.6); F(1,20)=20.765; p<0.001). Moreover, the treated group had significantly lower BMI z-score with respect to the controls at the first (0.44 (0.42 to 0.46) vs 0.58 (0.56 to 0.59), F(1,18)= 16.584, p=0.001) and at the second (18 months) (0.34 (0.30 to 0.38) vs 0.58 (0.54 to 0.62), F(1,13)=7.577; p=0.017) postassessments. Conclusion: Kaledo improved nutrition knowledge and dietary behavior over 6 months and had a sustained effect on the BMI z-score. Therefore, it may be used as an effective tool in childhood and adolescence obesity prevention programs.

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched...

Introduction: L'objectif de ce travail etait d'étudier la prévalence du surpoids et de l'obésité chez un groupe d'enfants d'âge scolaire, habitant la ville de Sfax en Tunisie, et identifier les facteurs favorisant la prise pondérale. Méthodes: Il s'agossait d'une enquête descriptive transversale était réalisée en 2011 sur un échantillon représentatif d'élèves recrutés dans 11 écoles primaires publiques. Des informations concernant les caractéristiques sociodémographiques, les habitudes alimentaires et le comportement sédentaire pour chaque élève ont été précisées au moyen d'un questionnaire. Résultats: Nous avons colligé 1529 élèves, âgés entre 9 et 12 ans et se répartissant en 787 garçons (51,14%) et 747 filles (48,86%). Selon les seuils de référence de l'IOTF, la fréquence de l'obésité était de 2,4% et celle du surpoids était de 6,3%. L'obésité était significativement associée à l'obésité parentale, un niveau socioéconomique élevé, la prise de plus de deux goûters par jour et à l'activité sédentaire. Conclusion: L'identification des facteurs de risque du surpoids et de l'obésité infantile permettrait de dépister les enfants à risques afin de leur proposer des mesures de prévention adaptées. Ces mesures de prévention devraient inclure non seulement des appro ches individuelles, mais aussi l'environnement social et physique de l'enfant.

Objective . The purpose of the current study was to develop a psychometrically sound, parent-report measure of family and child behaviors related to obesity in children between 5-and 12-years-old. Methods . Item generation, item selection, and initial exploratory factor analysis yielded a 27-item measure called the Family Health Behavior Scale (FHBS). Results . The FHBS contains four subscales measuring health-promoting family behaviors, obesogenic behaviors, meal-time routines, and family physical activity habits. Parent ratings on the FHBS were shown to predict their child ' s weight classifi cation. The FHBS also demonstrated adequate internal consistency and temporal stability. Conclusions . The results of the study suggest that the FHBS is a promising measure of family eating and physical activity habits related to obesity in children.

One major contributor to the problem of childhood overweight and obesity is the over-consumption of foods high in fat, salt and sugar, such as snack foods. The current study aimed to examine young children&#39;s snack intake and the influence of feeding strategies used by parents in the context of general parenting style. Participants were 611 mothers of children aged 2-7 years who completed an online questionnaire containing measures of general parenting domains and two particular feeding strategies, restriction and covert control. It was found that greater unhealthy snack intake was associated with higher restriction and lower covert control, while greater healthy snack intake was associated with lower restriction and higher covert control. Further, the feeding strategies mediated the association between parental demandingness and responsiveness and child snack intake. These findings provide evidence for the differential impact of controlling and positive parental feeding strategi...

Evidence suggests that at a population level, childhood and adolescent obesity increase the long-term risk of chronic diseases such as type 2 diabetes and CVD. At an individual level, however, the metabolic consequences of obesity in youth vary immensely. Despite comparable BMI, some adolescents develop impaired glucose tolerance while others maintain normal glucose homeostasis. It has been proposed that the variation in the capacity to store lipid in the subcutaneous adipose tissue (SAT) may partially discriminate metabolically healthy from unhealthy obesity. In positive energy balance, a decreased capacity to expand SAT may drive lipid accumulation to visceral adipose tissue, liver and skeletal muscle. This state of lipotoxicity is associated with chronic low-grade inflammation, insulin resistance and dyslipidaemia. The present review examines the differential adipose tissue development and function in children and adolescents who exhibit metabolic dysregulation compared with those who are protected. Additionally, the role of manipulating dietary fat quality to potentially prevent and treat metabolic dysfunction in obesity will be discussed. The findings of the present review highlight the need for further randomised controlled trials to establish the effect of dietary n-3 PUFA on the metabolic phenotype of obese children and adolescents. Furthermore, using a personalised nutrition approach to target interventions to those at risk of, or those with established metabolic dysregulation may optimise the efficacy of modifying dietary fat quality.

The increasing prevalence of obesity among the world's children and youth was the impetus for an international conference convened in Toronto, Canada, to examine issues related to physical activity and obesity in children (24-27 June 2007). The goal of the conference was to assimilate, interpret, and share scientific evidence with key stakeholders to develop recommendations concerning effective physical activity policies and programs to address obesity in children. The conference was attended by approximately 1000 delegates from 33 countries who gathered to listen to the invited speakers and to share information on promising practices related to the promotion of physical activity with the aim of reducing the burden of obesity in children. The major topics addressed at the conference included the biological and behavioural causes of obesity, current and past levels of physical activity and sedentarism in children, the role of the social, family, and built environments in addressing the physical activity deficit, and the role of legislation and industry in promoting physical activity. Promising physical activity interventions among children were presented, and important research, policy, and practice recommendations to address the issue of physical inactivity and obesity were provided.

Recent evidence suggests that childhood obesity is increasing in children who are developing typically as well as in children with developmental disabilities such as autism spectrum disorders (ASDs). Impairments specific to autism as well as general environmental factors could lead to an imbalance between the intake and expenditure of energy, leading to obesity. In this article, we describe the mechanisms by which autism-specific impairments contribute to obesity. The evidence on exercise interventions to improve physical fitness, address obesity, and reduce autism-specific impairments in children and adolescents with ASDs is discussed. Limited evidence is currently available for exercise interventions in individuals with ASDs. Therefore, literature on other pediatric developmental disabilities and children who are developing typically was reviewed to provide recommendations for clinicians to assess physical activity levels, to promote physical fitness, and to reduce obesity in chil...

Rates of childhood obesity are increasing, and it is essential to identify the active components of interventions aiming to prevent and manage obesity in children. A systematic review of behaviour change interventions was conducted to find evidence of behaviour change techniques (BCTs) that are most effective in changing physical activity and/or eating behaviour for the prevention or management of childhood obesity. An electronic search was conducted for randomised controlled trials published between January 1990 and December 2009. Of 4309 titles and abstracts screened, full texts of 135 articles were assessed, of which 17 published articles were included in this review. Intervention descriptions were coded according to the behaviour-specific CALO-RE taxonomy of BCTs. BCTs were identified and compared across obesity management (n ¼ 9) vs prevention (n ¼ 8) trials. To assess the effectiveness of individual BCTs, trials were further divided into those that were effective (defined as either a group reduction of at least 0.13 body mass index (BMI) units or a significant difference in BMI between intervention and control groups at follow-up) vs non-effective (reported no significant differences between groups). We reliably identified BCTs utilised in effective and non-effective prevention and management trials. To illustrate the relative effectiveness of each BCT, effectiveness ratios were calculated as the ratio of the number of times each BCT was a component of an intervention in an effective trial divided by the number of times they were a component of all trials. Results indicated six BCTs that may be effective components of future management interventions (provide information on the consequences of behaviour to the individual, environmental restructuring, prompt practice, prompt identification as role model/position advocate, stress management/emotional control training and general communication skills training), and one that may be effective in prevention interventions (prompting generalisation of a target behaviour). We identified that for management trials, providing information on the consequences of behaviour in general was a feature of non-effective interventions and for prevention trials, providing information on the consequences of behaviour in general, providing rewards contingent on successful behaviour and facilitating social comparison were non-effective. To design effective behaviour change programmes for the prevention and management of childhood obesity, we would recommend utilising the BCTs identified as effective in this review.

This study assessed the prevalence and consistency of high values of weight, height, and BMI considered to be biologically implausible (BIV) using cut points proposed by WHO among 8.8 million low-income children (13.7 million observations). Cross-sectional and longitudinal analyses were performed among 2- to 4-year-olds who were examined from 2008 through 2011. Overall, 2.7% of the body size measurements were classified as BIVs; 95% of these BIVs were very high. Among the subset of children (3.6 million) examined more than once, most of those who initially had a high weight or BMI BIV also had a high BIV at the second examination; odds ratios were &gt;250. Based on several alternative classifications of BIVs, the current cut points likely underestimate the prevalence of obesity by about 1%. Many of the extremely high values of body size currently flagged as BIVs are unlikely to be errors. Increasing the z-score cut points or using a percentage of the maximum values in the National H...

Parents play a critical role in developing and shaping their children&#39;s physical activity (PA) and sedentary behaviours, particularly in the early years of life. The aim of this systematic review is to identify current literature investigating associations of parental influences with both PA and screen time in young children. This systematic review was conducted in November 2013 using 6 electronic databases covering research literature from January 1998 to November 2013. Thirty articles that met inclusion criteria were identified. These studies covered five important aspects of parenting: (1) parenting practices; (2) parents&#39; role modelling; (3) parental perceptions of children&#39;s PA and screen viewing behaviours; (4) parental self-efficacy; and (5) general parenting style. Findings suggest that parents&#39; encouragement and support can increase children&#39;s PA, and reducing parents&#39; own screen time can lead to decreased child screen time. Improving parenting pract...

We sought to determine early life factors that predict body mass index (BMI) and overweight/obesity of children aged 2 years. A longitudinal and prospective analysis was conducted with 330 first-time mothers and their newborns. Children&#39;s weight and length were measured at 2 years. Main factors of interest included reported infant feeding practices, children&#39;s fruit/vegetable consumption, and television (TV) time. Maternal demographic data, weight and height, and smoking status were collected by face-to-face interview at baseline. Multiple linear and logistic regression models were run to determine factors that predicted BMI or overweight/obesity of children aged 2 years, respectively. At age 2 years, 242 remained in the study (retention rate 73%). Mean (SD) BMI of children was 16.87 kg/m(2) (1.62), with 14% classified as overweight/obese. Factors predicting lower child BMI were longer breastfeeding duration, less TV viewing time, and lower child&#39;s birth weight as well a...

Objective. In a recent study meal frequency was inversely related to childhood obesity. To assess an inverse association between meal frequency and childhood obesity with particular focus on breakfast consumption. Methods. Anthropometric data on 4 642 children aged 5 to 6 years were obtained in 5 Bavarian public health offices (Germany) during the obligatory school entry health examination in 2004/2005. An extensive questionnaire on risk factors for childhood obesity was answered by their parents. Obesity was defined according to sex-and age-specific body mass index (BMI) cut-off points, recommended by the International Obesity Task Force. Main exposures were meal frequency and breakfast consumption.

Despite emerging efforts to investigate the infl uence parents have on their children ' s weight status and related dietary and activity behaviors, reviews regarding the role of general parenting are lacking. We performed a systematic review regarding the relationship between general parenting and these weight-related outcomes to guide observational research. In total, 36 studies were included. Discrepancies across studies were found, which may be explained by differences in conceptualization of parenting constructs. Overall, however, results suggest that children raised in authoritative homes ate more healthily, were more physically active and had lower BMI levels, compared to children who were raised with other styles (authoritarian, permissive/indulgent, uninvolved/ neglectful). Findings of some moderation studies indicate that general parenting has a differential impact on children ' s weightrelated outcomes, depending on child and parental characteristics. These fi ndings underline the importance of acknowledging interactions between general parenting and both child and parent characteristics, as well as behavior-specifi c parenting practices.

The prevention of childhood obesity is a global priority. However, a range of complex social and environmental influences is implicated in the development of obesity and chronic disease that goes beyond the notion of individual choice. A population-level approach recognises the importance of access to and availability of healthy foods outside the home. These external food environments, in restaurants, supermarkets, and in school, or recreation and sports settings, are often characterised by energy dense, nutrient-poor food items that do not reflect the current nutritional guidelines for health. In addition, our understanding of these broader influences on nutritional intake is still limited. Particularly, lacking is a clear understanding of what constitutes the food environment, as well as robust measures of components of the food environment across different contexts. Therefore, this review summarises the literature on food environments of relevance to childhood obesity prevention, with a focus on places where children live, learn and play. Specifically, the paper highlights the approaches and challenges related to defining and measuring the food environment, discusses the aspects of the food environment unique to children and reports on environmental characteristics that are being modified within community, school and recreational settings. Results of the review show the need for a continued focus on understanding the intersection between individual behaviour and external factors; improved instrument development, especially regarding validity and reliability; clearer reported methodology including protocols for instrument use and data management; and considering novel study design approaches that are targeted at measuring the relationship between the individual and their food environment.

Purpose: To describe the physical activity (PA) levels of children attending after-school programs, 2) examine PA levels in specific after-school sessions and activity contexts, and 3) evaluate after-school PA differences in groups defined by sex and weight status. Methods: One hundred forty-seven students in grades 3-6 (mean age: 10.1 T 0.7, 54.4% male, 16.5 % overweight (OW), 22.8% at-risk for OW) from seven after-school programs in the midwestern United States wore Actigraph GT1M accelerometers for the duration of their attendance to the program. PA was objectively assessed on six occasions during an academic year (three fall and three spring). Stored activity counts were uploaded to a customized data-reduction program to determine minutes of sedentary (SED), light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) physical activity. Time spent in each intensity category was calculated for the duration of program attendance, as well as specific after-school sessions (e.g., free play, snack time). Results: On average, participants exhibited 42.6 min of SED, 40.8 min of LPA, 13.4 min of MPA, and 5.3 min of VPA. The average accumulation of MVPA was 20.3 min. Boys exhibited higher levels of MPA, VPA, and MVPA, and lower levels of SED and LPA, than girls. OW and at-risk-for-OW students exhibited significantly less VPA than nonoverweight students, but similar levels of LPA, MPA, and MVPA. MVPA levels were significantly higher during free-play activity sessions than during organized or structured activity sessions. Conclusion: After-school programs seem to be an important contributor to the PA of attending children. Nevertheless, ample room for improvement exists by making better use of existing time devoted to physical activity.

Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-...

Background: Childhood overweight/obesity and inadequate physical activity burden Western countries, and now, pose a growing threat to the health of children in low and middle income countries. Behavioural transitions toward more sedentary lifestyles coupled with increased consumption of high calorie foods has resulted in rising proportions of overweight/obesity and decreasing levels of physical activity in school-aged children. The objective of this study was to determine the prevalence and to investigate factors associated with overweight/obesity and physical activity in Kenyan children aged 9 to 11 years. Methods: Body composition and physical activity measures of participating children were accomplished by anthropometric assessment, accelerometry, and administration of questionnaires related to diet and lifestyle, and the school and neighbourhood environments. Data collection was conducted in the city of Nairobi as part of a larger International Study of Childhood Obesity, Lifestyle and Environment.

Objective: To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. Design: Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. Participants: A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95). Main Outcomes Measured: Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). Analysis: Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity ($ 60 min/d), (2) screen time (# 2 h/d), (3) fruit and vegetable intake ($ 5 servings/d), and (4) sugar-sweetened beverage avoidance. Results: Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). Conclusions and Implications: Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.

Given the emerging global childhood obesity epidemic and the specter of a generation of children who will have a shorter life expectancy than that of their parents, recent research has focused on factors that influence children&#39;s weight status and obesogenic behaviors (i.e., eating, physical activity, and screen media use). Parents act as primary socializing agents for children, and thus growing evidence supports the role of parenting styles and practices in children&#39;s obesity-related behaviors and weight. Studying these processes in children and adolescents is important for several reasons. First, diet and physical activity behaviors and weight status track from childhood and adolescence into adulthood. Furthermore, diet and physical activity behaviors and weight status confer significant risk for cancer, diabetes, cardiovascular disease, and other chronic diseases. The purpose of this article is to describe the scientific gaps that need to be addressed to develop a more in...