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Obesity Prevention and Intervention in Children and Adolescents

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Children's Health".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 49407

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Dr. Stephanie Partridge

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Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
Interests: obesity and overweight; public health; nutrition and metabolism; digital health; prevention of obesity; chronic diseases; food accessibility and consumption; behavioral science
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Special Issue Information

Dear Colleagues,

Obesity is among the most significant health challenges facing today’s 1.8 billion children and adolescents. The prevalence of obesity has increased globally over the last four decades, with an estimated 42 million children under the age of 19 being overweight or obese. Obesity risk factors, such as suboptimal diet and physical inactivity, are well established during childhood and adolescence, making these life stages critical periods for the development of lifelong health trajectories. Obesity is also a visible risk factor associated with stigma and discrimination. Stigmatisation threatens mental and physical health, generates health inequalities, and interferes with intervention efforts. Moreover, there is an inequitable distribution of overweight and obesity, with a higher prevalence in children and adolescents from low socioeconomic backgrounds. There is a critical need for effective and inclusive interventions which support all children and adolescents, including vulnerable groups, to improve risk factors and lead healthy lives.

In this Special Issue on “Obesity Prevention and Intervention in Children and Adolescents”, we are seeking unpublished works, including but not limited to (i) interventions targeting individuals or families for the prevention and management of overweight and obesity; and (ii) interventions targeting environment or policy change. Papers reporting on formative research of intervention design, primary and secondary outcome data or process evaluation data will be considered. We will consider studies utilising new digital technologies, those targeting vulnerable population groups, traditional clinical trials, observational studies, systematic reviews and meta-analyses.

Dr. Stephanie Partridge
Guest Editor

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

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Childhood
Adolescent health
Overweight and obesity
Intervention
Behavioural sciences
Nutrition
Physical activity

Published Papers (12 papers)

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Research

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19 pages, 1166 KiB

Open AccessArticle

Healthy Living and Co-Production: Evaluation of Processes and Outcomes of a Health Promotion Initiative Co-Produced with Adolescents

by Sabina De Rosis, Francesca Pennucci, Guido Noto and Sabina Nuti

Int. J. Environ. Res. Public Health 2020, 17(21), 8007; https://doi.org/10.3390/ijerph17218007 - 30 Oct 2020

Cited by 12 | Viewed by 3141

Abstract

Co-production is an approach to designing, delivering, and evaluating public services through strict collaboration among professionals and the people using services with an equal and reciprocal relationship. Health promotion initiatives that include education services rarely use the co-production approach. Nevertheless, the value of co-production is widely recognized, although it is considered a normative good, and scarce and mixed evidence is available in literature. The purpose of this paper is to provide evidence supporting the hypothesis that a co-production approach, applied to an intervention for preventing obesity, can be effective and efficient. To this end, an evaluation of the processes, outputs meant as intermediate results, and behavioral and economic outcomes of a public health-promotion initiative co-produced and co-delivered with adolescents (beFood) was conducted. Mixed methods were used, including field-observations, two self-reported questionnaires, and an opportunity–cost analysis that compared beFood to traditional approaches of public health promotion. The co-production model was successfully implemented and appears to be effective—more than 5000 adolescents were reached by only 49 co-producer adolescents, who reported behavioral changes (e.g., eating better and practicing more physical activity). The cost analysis showed that the co-production approach was also efficient, producing relevant savings and potentially making available more than 3000 h of professionals’ time. This research can support a re-thinking of public institutions’ organization, public initiatives’ design, and public servants’ role. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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12 pages, 321 KiB

Open AccessArticle

Association between Sleep Timing and Weight Status among 14- to 19-Year-Old Adolescents in Wuhan, China

by Xinge Zhang, Yanan Chen, Rui Zhang, Justin B. Moore, Haotian Ruan, Jialin Fu, Guiyu Qin, Xinru Yu, Zeyu Hou, Qin Cheng, Xiaoyu Hu, Siqi Zhang and Rui Li

Int. J. Environ. Res. Public Health 2020, 17(16), 5703; https://doi.org/10.3390/ijerph17165703 - 7 Aug 2020

Viewed by 2247

Abstract

This study examined the cross-sectional and longitudinal association of sleep timing with weight status in 14- to 19-year-old adolescents in Wuhan, China. A prospective school-based study was conducted in Wuhan, China between 28 May and 29 September 2019. Data on sociodemographic information, academic performance, diet, mental health status, physical activity, sleep characteristics, body weight, and height were collected. A linear regression model and binary logistic regression model were performed. A total of 1194 adolescents were included in the analysis. Adolescents who woke up before 05:45 had higher body mass index (BMI) Z-score (odds ratio (OR) with 95% confidence interval (CI) = 1.28 (1.05, 1.57), p = 0.02) and higher odds of overweight/obesity (odds ratio (OR) with 95% confidence interval (CI) = 1.74 (1.10, 2.76), p = 0.02) at baseline after fully adjustment for covariates, compared with those who woke up after 05:45. Longitudinal data showed a nonsignificant association between waking up time and change in BMI Z-score (p = 0.18). No association of bedtime with weight status was observed in this sample after full adjustment (p > 0.1). Earlier waking up time might contribute to overweight and obesity in adolescents; however, more data are needed to test and elucidate this relationship. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

10 pages, 649 KiB

Open AccessArticle

Is BMI a Valid Indicator of Overweight and Obesity for Adolescents?

by Viktoryia Karchynskaya, Jaroslava Kopcakova, Daniel Klein, Aleš Gába, Andrea Madarasova-Geckova, Jitse P. van Dijk, Andrea F. de Winter and Sijmen A. Reijneveld

Int. J. Environ. Res. Public Health 2020, 17(13), 4815; https://doi.org/10.3390/ijerph17134815 - 4 Jul 2020

Cited by 35 | Viewed by 7320

Abstract

Background: Overweight and obesity are mostly monitored via the Body Mass Index (BMI), based on self-reported or measured height and weight. Previous studies have shown that BMI as a measure of obesity can introduce important misclassification problems. The aim of this study was to assess the validity of overweight and obesity classification based on self-reported and on measured height and weight versus the proportion of body fat as the criterion. Methods: We used data on 782 adolescents (mean age = 13.5, 55.8% boys) from the Health Behaviour in School-Aged Children (HBSC) study conducted in 2018 in Slovakia. We obtained self-reported (height and weight) and objective measures (height, weight) and the proportion of fat (as the criterion measure) measured via bioimpedance body composition analysis (BIA) with an InBody 230 from the adolescents. Results: Both measured and self-reported BMI indicated overweight and obesity with relatively low sensitivity (66–82%), but high specificity (90–92%). The superior accuracy of measured BMI in comparison to self-reported BMI was confirmed by the area under the curve (AUC) based on the receiver operating characteristics (ROC) curves (AUC measured/self-reported: 0.94/0.89; p < 0.001). The misclassification of overweight and obesity was significantly higher when using self-reported BMI than when using measured BMI. Conclusion: Both self-reported and measured BMI as indicators of overweight and obesity underestimate the prevalence of adolescents with overweight and obesity. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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16 pages, 569 KiB

Open AccessArticle

Effects of the Healthy Children, Healthy Families, Healthy Communities Program for Obesity Prevention among Vulnerable Children: A Cluster-Randomized Controlled Trial

by Jina Choo, Hwa-Mi Yang, Sae-Young Jae, Hye-Jin Kim, Jihyun You and Juneyoung Lee

Int. J. Environ. Res. Public Health 2020, 17(8), 2895; https://doi.org/10.3390/ijerph17082895 - 22 Apr 2020

Cited by 7 | Viewed by 3582

Abstract

Background: We aimed to examine whether the Healthy Children, Healthy Families, and Healthy Communities Program, consisting of multi-level strategies for obesity prevention tailoring the context of socioeconomically vulnerable children based on an ecological perspective, would be effective on improving their healthy lifestyle behaviors and obesity status. Methods: Participants were 104 children (and 59 parents) enrolled in public welfare systems in Seoul, South Korea. Based on a cluster-randomized controlled trial (no. ISRCTN11347525), eight centers were randomly assigned to intervention (four centers, 49 children, 27 parents) versus control groups (four centers, 55 children, 32 parents). Multi-level interventions of child-, parent-, and center-level strategies were conducted for 12 weeks. Children’s healthy lifestyle behaviors and obesity status were assessed as daily recommended levels and body mass index ≥85th percentile, respectively. Parents’ parenting behaviors were measured by the Family Nutrition and Physical Activity scale. Results: Compared to the control group, the intervention group showed significant improvements in total composite scores of healthy-lifestyle behaviors—including 60-min of moderate physical activity—but not in obesity status among children. Moreover, the intervention group showed significant improvements in parenting behaviors among parents. Conclusion: The multi-level strategies for obesity prevention based on an ecological perspective may be effective for promoting healthy lifestyles among socioeconomically vulnerable children. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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10 pages, 878 KiB

Open AccessArticle

Exploring Mediation Roles of Child Screen-Viewing between Parental Factors and Child Overweight in Taiwan

by Yi-Ching Lin, Meng-Che Tsai, Carol Strong, Yi-Ping Hsieh, Chung-Ying Lin and Clara S. C. Lee

Int. J. Environ. Res. Public Health 2020, 17(6), 1878; https://doi.org/10.3390/ijerph17061878 - 13 Mar 2020

Cited by 9 | Viewed by 2856

Abstract

Children’s screen-viewing behavior is influenced by parents’ own screen-viewing hours and the parental rules set for screen-viewing time. However, whether childhood obesity is associated with these three factors has not been widely investigated in Chinese populations. We examined the relationships between parental rules, parental screen-viewing, child screen-viewing and child overweight. Questionnaires were distributed to 1300 parents who had children studying in two elementary schools in an eastern Taiwanese City (Yi-Lan). We collected the data (the final response rate was 77.7%) on children’s health states, the length of screen-viewing time, and whether parental rules of screen-viewing time have been set (n = 1005). Models using structural equation modeling, with controlling of age, gender, and physical activity of the participants, were carried out, to examine the mediated effect of child screen-viewing. The results of model testing showed that child screen-viewing could be a mediator in the associations between parental rule and child overweight (parental rule: coefficient = −0.18, p < 0.001); and between parent screen-viewing and child overweight (parent screen-viewing: coefficient = 0.072, p < 0.001). These findings suggested that parental factors (rules and little screen viewing time) effectively decreased the level of children’s screen-viewing time, and the child screen-viewing time could mediate the association between parental factors and child overweight in the Chinese population. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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15 pages, 889 KiB

Open AccessArticle

Interaction of the CMTM7 rs347134 Polymorphism with Dietary Patterns and the Risk of Obesity in Han Chinese Male Children

by Qi Zhu, Kun Xue, Hong Wei Guo, Fei Fei Deng and Yu Huan Yang

Int. J. Environ. Res. Public Health 2020, 17(5), 1515; https://doi.org/10.3390/ijerph17051515 - 26 Feb 2020

Cited by 5 | Viewed by 2480

Abstract

A genome-wide association study (GWAS) in the Han Chinese population had found that single nucleotide polymorphism (SNP) on the CMTM7 gene rs347134 was significantly associated with Body Mass Index (BMI). In the present study, the association of the rs347134 SNP with obesity and its interaction with dietary patterns (DPs) were explored in Han Chinese children. This cross-sectional study group included 1292 children, in whom obesity-related indicators were evaluated, the rs347134 SNP was genotyped by improved Multiple Ligase Detection Reaction (iMLDR), and the DPs were identified by principal component factor analysis. The GG genotype exhibited higher odds of general overweight/obesity (P = 0.038) and central obesity (P = 0.039) than AA + GA genotypes in boys. Four DPs of boys were identified: healthy balanced (HBDP), nuts and sweets-based (NSDP), animal food-based (AFDP), and wheaten and dairy-based (WDDP). Boys with the GG genotype were significantly more inclined to AFDP (P = 0.028) and had a shorter sleep duration (P = 0.031). Significant interactions were observed; boys with the GG genotype displayed a higher LDL in AFDP (P = 0.031) and higher FBG in NSDP (P = 0.038), respectively. Our findings indicate for the first time that the GG genotype of CMTM7 rs347134 is potentially a novel obesity risk factor for Han Chinese male children and is associated with dietary patterns more or less. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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17 pages, 341 KiB

Open AccessArticle

Sources and Determinants of Discretionary Food Intake in a Cohort of Australian Children Aged 12–14 Months

by Claire Coxon, Gemma Devenish, Diep Ha, Loc Do and Jane A. Scott

Int. J. Environ. Res. Public Health 2020, 17(1), 80; https://doi.org/10.3390/ijerph17010080 - 20 Dec 2019

Cited by 18 | Viewed by 3273

Abstract

Despite recommendations to the contrary, consumption of discretionary (energy-dense, nutrient-poor) foods begins for some children early in the weaning period, and the proportion of children consuming discretionary foods increases markedly in the second year of life. The purpose of this study was to determine intake and sources of discretionary foods in a cohort of 828 Australian toddlers (mean age: 13.1mo), and to identify determinants of discretionary food intake. At approximately 12 months of age, 3 non-consecutive days of dietary intake data were collected using a 24-h recall and 2-day food record, and the percentage total energy derived from discretionary foods was estimated. Linear regression was used to identify associations between discretionary food intake and socio-demographic determinants (mother’s age, level of education, country of birth, pre-pregnancy body mass index, socioeconomic position, parity, age of child when mother returned to work, and child’s sex) and age at which complementary foods were introduced. The average energy intake of children in this cohort was 4040 (±954.7 SD) kJ with discretionary foods contributing an average of 11.2% of total energy. Sweet biscuits, and cakes, muffins, scones and cake-type desserts contributed 10.8% and 10.2% of energy intake from discretionary foods, respectively. Other key contributors to energy intake from discretionary foods included sausages, frankfurters and saveloys (8.3%), vegetable products and dishes where frying was the main cooking technique (8.6%), butter (7.3%), and finally manufactured infant sweet or savory snack foods (9.3%). Higher intakes of discretionary food were associated with children having two or more siblings (p = 0.002), and being born to younger mothers (<25 years) (p = 0.008) and mothers born in Australia or the United Kingdom (p < 0.001). Parents, in particular young mothers and those with larger families, need practical guidance on how much of, and how often, these foods should be eaten by their children. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

17 pages, 542 KiB

Open AccessArticle

‘Not to Be Harsh but Try Less to Relate to ‘the Teens’ and You’ll Relate to Them More’: Co-Designing Obesity Prevention Text Messages with Adolescents

by Stephanie R. Partridge, Rebecca Raeside, Zoe Latham, Anna C. Singleton, Karice Hyun, Alicia Grunseit, Katharine Steinbeck and Julie Redfern

Int. J. Environ. Res. Public Health 2019, 16(24), 4887; https://doi.org/10.3390/ijerph16244887 - 4 Dec 2019

Cited by 8 | Viewed by 5024

Abstract

Text messages remain a preferred way for adolescents to communicate, and recent evidence suggests adolescents would like access to digital healthcare options. However, there is limited evidence for text messages to engage adolescent populations in obesity prevention behaviors. We aimed to co-design a bank of text messages that are evidence-based, acceptable, and engaging for adolescents. An established iterative mixed methods process, consisting of three phases, was used to develop the text message program. The first bank of 145 text messages was drafted based on current evidence, behavior change techniques, and input from researchers and health professionals. A survey was then administered to adolescents and professionals for review of text message content, usefulness, understanding, and age-appropriateness. An adolescent research assistant collaborated with the research team on all three phases. Forty participants (25 adolescents and 15 professionals) reviewed the initial bank of 145 text messages. On average, all reviewers agreed the text messages were easy to understand (13.6/15) and useful (13.1/15). In total, 107 text messages were included in the final text message bank to support behavior change and prevent obesity. This study may guide other researchers or health professionals who are seeking to engage adolescents in the co-design of health promotion or intervention content. Effectiveness of the text message program will be tested in a randomized controlled trial. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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Review

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33 pages, 610 KiB

Open AccessFeature PaperReview

Effectiveness of Lifestyle Interventions for Prevention of Harmful Weight Gain among Adolescents from Ethnic Minorities: A Systematic Review

by Nematullah Hayba, Samiha Elkheir, Jessica Hu and Margaret Allman-Farinelli

Int. J. Environ. Res. Public Health 2020, 17(17), 6059; https://doi.org/10.3390/ijerph17176059 - 20 Aug 2020

Cited by 7 | Viewed by 3010

Abstract

The escalating obesity among adolescents is of major concern, especially among those from an ethnic minority background. The adolescent period offers a key opportunity for the implementation of positive lifestyle behaviours as children transition to adulthood. The objective of this review was to examine the effectiveness of lifestyle interventions for adolescents and their impact in ethnic and racial minorities for the prevention of overweight and obesity. Seven electronic databases were searched from 2005 until March 2019 for randomized controlled trials of lifestyle programs conducted in this population. The main outcome was change in Body Mass Index (BMI) z-score (kg/m²) or change in BMI and secondary outcomes were changes in physical activity and diet. Thirty studies met the inclusion criteria. Seven studies reported and/or conducted subgroup analysis to determine if ethnic/racial group affected weight change. None demonstrated an overall decrease in BMI z-score. However, six of the seven demonstrated changes in secondary measures such as fruit and vegetable intake and screen time. Results did not differ by ethnic/racial group for primary and secondary outcomes. Overweight and obesity prevention among adolescents from ethnic minorities is an area that needs further research. There is a lack of interventions that include analyses of effectiveness in ethnic minorities. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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26 pages, 10312 KiB

Open AccessFeature PaperReview

Effectiveness of Family-Based Behavior Change Interventions on Obesity-Related Behavior Change in Children: A Realist Synthesis

by Gemma Enright, Margaret Allman-Farinelli and Julie Redfern

Int. J. Environ. Res. Public Health 2020, 17(11), 4099; https://doi.org/10.3390/ijerph17114099 - 8 Jun 2020

Cited by 34 | Viewed by 9140

Abstract

Effective treatment interventions for childhood obesity involve parents, are multicomponent and use behavior change strategies, but more information is needed on the mechanisms influencing behavioral outcomes and the type of parental involvement that is efficacious in behavioral treatment interventions with school-age children. This review aimed to understand key characteristics of programs that contribute to dietary and physical activity behavioral outcomes, and through which key mechanisms. This was a systematic review with narrative synthesis following PRISMA guidelines and realist analysis using RAMESES guidelines to explain outcome patterns and influence of parental involvement. Overall, the findings contribute to understanding the complex relationship between family barriers to behavior change, strategies employed in treatment interventions and behavioral outcomes. Implications for enhancing future policy and practice include involving parents in goal setting, motivational counselling, role modeling, and restructuring the physical environment to promote mutual empowerment of both parents and children, shared value and whole-family ownership in which intrinsic motivation and self-efficacy are implicit. These characteristics were associated with positive dietary and physical activity behavior change in children and may be useful considerations for the design and implementation of future theory-based treatment interventions to encourage habitual healthy diet and physical activity to reduce childhood obesity. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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Other

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10 pages, 492 KiB

Open AccessProtocol

Adolescent Participation in Research, Policies and Guidelines for Chronic Disease Prevention: A Scoping Review Protocol

by Mariam Mandoh, Seema Mihrshahi, Hoi Lun Cheng, Julie Redfern and Stephanie R. Partridge

Int. J. Environ. Res. Public Health 2020, 17(21), 8257; https://doi.org/10.3390/ijerph17218257 - 9 Nov 2020

Cited by 7 | Viewed by 3532

Abstract

Adolescents (10–24 years old) account for 23% of the global population. Physical inactivity, suboptimal dietary intake, overweight, and obesity during adolescence are risk factors associated with chronic disease development into adulthood. Research, policies, and guidelines that seek to prevent chronic disease risk factor development rarely engage adolescents in planning and decision-making processes. The aims of this review are to investigate (i) how adolescents currently participate in research, policy, and guidelines for reduction of chronic disease risk factors, and (ii) provide recommendations to optimize adolescent participation in future research, policy, and guideline decision making for chronic disease prevention. A systematic scoping review of the health peer-review research, policy, and guidelines, using Arksey and O’Malley’s six-stage framework, will be conducted. Participatory outcomes will be assessed based on the Lansdown-UNICEF conceptual framework for measuring adolescent participation. Classified as consultative, collaborative, or adolescent-led according to the degree of influence and power adolescents possess in the decision- making processes. Consultation with adolescents via digital surveys and focus groups will provide further information, perspective, and insight. Qualitative data will be analyzed by descriptive numerical summary and qualitative content analytical techniques. The title of this protocol is registered with Joanna Briggs Institute and Open Science Framework, doi:10.17605/OSF.IO/E3S64. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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15 pages, 332 KiB

Open AccessCommentary

Elements of Effective Population Surveillance Systems for Monitoring Obesity in School Aged Children

by Louise L. Hardy and Seema Mihrshahi

Int. J. Environ. Res. Public Health 2020, 17(18), 6812; https://doi.org/10.3390/ijerph17186812 - 18 Sep 2020

Cited by 2 | Viewed by 2928

Abstract

The continuing high prevalence of child overweight and obesity globally means that it remains the most common chronic health condition in children. Population-based child obesity surveillance systems are critical for monitoring trends in obesity and related behaviours, and determining the overall effect of child obesity prevention strategies. Effective surveillance systems may vary in methods, scope, purpose, objectives, and attributes, and our aim was to provide an overview of child obesity surveillance systems globally, and to highlight main components and other types of survey data that can enhance our understanding of child obesity. Measures of adiposity, including body mass index and waist circumference are essential, but effective surveillance must also include measures of weight-related behaviours, including diet, physical activity, sedentary time, and sleep. While objective measures are desirable, the variability in psychometrics and rapid evolution of wearable devices is potentially problematic for examining long-term trends over time and how behaviours may change. Questionnaires on self-reported behaviours are often used but also have limitations. Because the determinants of obesity are not only functioning at the individual level, some measures of the broader environmental and commercial determinants, including the built and food environments, are useful to guide upstream policy decisions. Full article

(This article belongs to the Special Issue Obesity Prevention and Intervention in Children and Adolescents)

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