A Coordinated School Health Approach to Obesity Prevention among Appalachian Youth: Middle School Student Outcomes from the Winning With Wellness Project

The Winning With Wellness (WWW) project was a school-based obesity prevention program that was developed to promote healthy eating and physical activity in youth residing in rural Appalachia. The project was based on the Coordinated School Health model (Centers for Disease Control and Prevention (CDC), 2013a) and used a community-based participatory research approach with an emphasis on feasibility and sustainability. The purpose of this study was to examine self-reported health outcomes for middle school students across the course of the intervention. Sixth grade middle school students (N = 149; 52% girls) from four schools in Northeast Tennessee completed a survey assessing demographic factors and health behaviors as well as the Pediatric Quality of Life Inventory (PedsQL, Varni, Seid, & Kurtin, 2001) at baseline and follow-up, approximately 9-months after project implementation. Across the course of the intervention there were no statistically significant changes from baseline to follow-up in fruit and vegetable consumption, physical activity, or screen time. Further, there were no statistically significant changes in health-related quality of life (HRQoL). The lack of change in health behaviors is similar to a recent study also emphasizing sustainability (Neumark-Sztainer, Story, Hannan, & Rex, 2003). Unlike in the current study, Palacio-Vieira and colleagues (2008) found HRQoL to significantly decline with age in a population-based sample of Spanish youth. It will be important to examine whether or not obesity interventions may ameliorate this effect as well as to test the feasibility and school/structural support for sustained intervention implementation at a level that promotes lifestyle change

Reflections from an Undergraduate Student Peer Facilitator in the Team Up for Healthy Living School-Based Obesity Prevention Project

Team Up for Healthy Living was a cluster-randomized trial to evaluate a cross-peer school-based obesity prevention program in Southern Appalachia. Undergraduate students from the disciplines of Kinesiology, Nutrition, and Public Health were trained as peer facilitators to deliver an 8-week curriculum in high school Lifetime Wellness classes. The focus of the curriculum was on improving diet and physical activity with an additional emphasis on enhancing leadership and communication skills. Control group participants received their regularly scheduled Lifetime Wellness curriculum. The current article is about the experiences of an undergraduate kinesiology student participating as a peer-facilitator in the Team-Up for Healthy Living trial. A brief overview of the program and peer facilitator training is followed by this students reflections on both personal development and student outcomes

Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

Objective: To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Method: Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. Results: The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. Conclusion: This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record (c) 2016 APA, all rights reserved

The Prevalence of Psychosocial Concerns in Pediatric Primary Care Serving Rural Children in Pediatric Primary Care Serving Rural Children

Objectives: To examine the prevalence of parent-reported emotional and behavior problems in pediatric primary care clinics serving rural Appalachia using methods commensurate with studies of broader samples. Methods: Parents presenting to pediatric primary care clinics completed a rating scale (Pediatric Symptom Checklist) of psychosocial problems for their child. Results: Approximately 21% of all rating scales were in the clinically significant range. Across all parents, 63% identified the child’s physician as their most common source of help. In contrast, mental health professionals had been sought out by only 24% of the sample. Conclusions: These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents’ frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings

The Relation between Weight and Psychosocial Concerns among Youth Presenting in Rural Pediatric Primary Care

This preliminary study examined the relation between weight and parent-reported psychosocial concerns among youth presenting to pediatric primary care clinics serving rural Appalachia. Parents of youth presenting for a sick or well child visit completed a demographic questionnaire and the Pediatric Symptom Checklist in the waiting area prior to their office visit. Standardized body mass index (zBMI) were computed based on information retrieved. Psychosocial concerns, specifically attention difficulties, were found to be significantly and negatively correlated with zBMI. Higher zBMI was found in youth with clinically significant (versus non-significant) internalizing scores and clinically non-significant (versus significant) attention difficulty scores. Additional research is needed to understand the complex relationship between weight and psychosocial concerns among youth presenting to rural pediatric primary care. An understanding of the relation between these factors may facilitate prevention/intervention efforts

Executive Function as a Moderator of Obesity in Infancy

Childhood overweight and obesity have experienced epidemic growth in recent years. Excessive adiposity presents challenges to orthopedic, neurological, pulmonary, gastroenterological, endocrinal, and social development. Thus, the time course of weight development in early childhood is of special public health concern. A major goal of childhood obesity research is to identify mechanisms contributing to excess weight gain. In infancy, executive function has been identified as one possible contributor. Unfortunately, no studies have yet examined infant obesity risk with respect to executive function development. In this study, we present the first evidence that executive function may be linked to obesity risk in infancy. Thirty middle-class, primarily White infants visited the lab of the ETSU Program for the Study of Infancy at 18 and 21 months of age. Measures of infant weight and recumbent length were taken at both ages. Weightfor-length BMI z-scores were derived from international growth curves published by the World Health Organization. Executive function was measured at the 21-month visit, using the Multilocation Search Task. In this task, infants are shown the location of a cracker in one of five drawers. Once infants select the correct drawer on three successive trials, the cracker is moved to a new drawer in plain view of the child, and the child is asked to find the cracker again. The location of the cracker is changed on two more trials. Children’s perseverating responses to the old cracker location is viewed as an inverse measure of executive function. Results showed that from 18 to 21 months of age, BMI z-scores decreased significantly [t(30) = 2.63, p = .013]. This finding suggests that on average, infant BMI scores decreased across the three-month period. To explore whether executive function performance varied as a function of infant BMI, we divided our sample into two BMI groups via median split. A mixed-design ANOVA revealed that infants with the greatest decreases in BMI from 18 to 21 months (i.e., the “Hi Decrease” group), showed the greatest gains in performance across the three trials of the executive function task [F(2, 25) = 5.29, p = .012]. Specifically, by Trial 3 of the multilocation search task, Hi Decreasers were making an average of 0.57 perseverative errors, whereas the Lo Decreasers were making an average of 2.231 perseverative errors. These results are consistent with expectations. To the extent that executive function capacity helps regulate weight gain, it stands to reason that infants with greater executive function capacity would be advantaged in regulating their eating behaviors. Although we recognize that there are likely multiple contributors to infant and child obesity, findings from the present study supports the possibility that one of these contributors may be executive function. To our knowledge, this is the first study documenting a link between executive function and infant BMI