A community intervention reduces BMI z-score in children: Shape Up Somerville first year results

Objective: The objective was to test the hypothesis that a community‐based environmental change intervention could prevent weight gain in young children (7.6 ± 1.0 years). Research Methods and Procedures: A non‐randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio‐demographically‐matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before‐, during‐, after‐school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before‐ and after‐school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z‐score. Results: At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z‐score in the intervention and the two control communities, respectively. In the intervention community, BMI z‐score decreased by ?0.1005 (p = 0.001, 95% confidence interval, ?0.1151 to ?0.0859) compared with children in the control communities after controlling for baseline covariates. Discussion: A community‐based environmental change intervention decreased BMI z‐score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.     

A Pilot Randomized Controlled Trial of a Clinic and Home‐Based Behavioral Intervention to Decrease Obesity in Preschoolers

We evaluated the efficacy of a 6‐month clinic and home‐based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family‐based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one‐time PC session. Eighteen children aged 2–5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post‐treatment) BMI z (?0.59 ± 0.17), BMI percentile (?2.4 ± 1.0), and weight gain (?2.7 kg ± 1.2) than PC and this difference was maintained at follow‐up (month 12). LAUNCH parents also had a significantly greater weight loss (?5.5 kg ± 0.9) at month 6 and 12 (?8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.     

Parental obesity moderates the relationship between childhood appetitive traits and weight

Objective:

In this study, the independent and combined associations between childhood appetitive traits and parental obesity on weight gain from 0 to 24 months and body mass index (BMI) z‐score at 24 months in a diverse community‐based sample of dual parent families (n = 213) were examined.

Design and Methods:

Participants were mothers who had recently completed a randomized trial of weight loss for overweight/obese postpartum women. As measures of childhood appetitive traits, mothers completed subscales of the Children's Eating Behavior Questionnaire, including Desire to Drink (DD), Enjoyment of Food (EF), and Satiety Responsiveness (SR), and a 24‐h dietary recall for their child. Heights and weights were measured for all children and mothers and self‐reported for mothers' partners. The relationship between children's appetitive traits and parental obesity on toddler weight gain and BMI z‐score were evaluated using multivariate linear regression models, controlling for a number of potential confounders.

Results:

Having two obese parents was related to greater weight gain from birth to 24 months independent of childhood appetitive traits, and although significant associations were found between appetitive traits (DD and SR) and child BMI z‐score at 24 months, these associations were observed only among children who had two obese parents. When both parents were obese, increasing DD and decreasing SR were associated with a higher BMI z‐score.

Conclusions:

The results highlight the importance of considering familial risk factors when examining the relationship between childhood appetitive traits on childhood obesity.     

A pediatric weight management program for high-risk populations: a preliminary analysis

Objective: To determine whether a multidisciplinary pediatric weight management program effectively improves BMI, BMI z‐score, and cardiovascular risk factors (CVRFs) in high‐risk populations. Methods and Procedures: A retrospective chart review was performed on children seen in the NEW Kids Program at the Children's Hospital of Wisconsin, a family‐based clinic that treats pediatric obesity using medical management, nutrition education, behavioral intervention, and physical activity. Inclusion criteria were program participation for ≥9 months and >4 visits. Analyses were performed to identify factors associated with pre‐ to postintervention changes in BMI, BMI z‐score, and CVRF laboratory values. Results: A total of 66 patients met inclusion criteria; the mean age was 11 years (s.d. ± 3.4), 56% were racial/ethnic minorities, 45% were Medicaid recipients, 48% resided in impoverished communities, and 38% had a BMI ≥40 kg/m². Of the 66 patients, 91% had more than one weight‐related comorbidity, 88% had CVRFs, and the preintervention mean BMI was 37 kg/m². After the intervention, there was an overall increase in absolute BMI, but a small, yet significant decrease in BMI z‐score (mean ?0.03 ± 0.16; P < 0.05). There were significant pregroup to postgroup improvements in total cholesterol, low‐density lipoprotein, and triglycerides levels (P < 0.05). Insurance coverage, race/ethnicity, gender, age, and initial BMI were not significantly associated with changes in BMI or BMI z‐score. Discussion: A multidisciplinary pediatric weight management program can improve the weight status of high‐risk populations, including minorities, Medicaid recipients, patients with multiple comorbidities and CVRFs, and the severely obese.     

Obesity Prevention in Preschool Native‐American Children: A Pilot Study Using Home Visiting

Objective : To determine whether maternal participation in an obesity prevention plus parenting support (OPPS) intervention would reduce the prevalence of obesity in high‐risk Native‐American children when compared with a parenting support (PS)‐only intervention. Research Methods and Procedures : Forty‐three mother/child pairs were recruited to participate. Mothers were 26.5 ± 5 years old with a mean BMI of 29.9 ± 3 kg/m². Children (23 males) were 22 ± 8 months old with mean weight‐for‐height z (WHZ) scores of 0.73 ± 1.4. Mothers were randomly assigned to a 16‐week OPPS intervention or PS alone. The intervention was delivered one‐on‐one in homes by an indigenous peer educator. Baseline and week 16 assessments included weight and height (WHZ score and weight‐for‐height percentile for children), dietary intake (3‐day food records), physical activity (measured by accelerometers), parental feeding style (Child Feeding Questionnaire), and maternal outcome expectations, self‐efficacy, and intention to change diet and exercise behaviors. Results : Changes in WHZ scores showed a trend toward significance, with WHZ scores decreasing in the PS condition and increasing among the OPPS group (?0.27 ± 1.1 vs. 0.31 ± 1.1, p = 0.06). Children in the OPPS condition also significantly decreased energy intake (?316 ± 835 kcal/d vs. 197 ± 608 kcal/d, p < 0.05). Scores on the restriction subscale of the Child Feeding Questionnaire decreased significantly in the OPPS condition (?0.22± 0.42 vs. 0.08± 0.63, p < 0.05), indicating that mothers in the OPPS group were engaging in less restrictive child feeding practices over time. Discussion : A home‐visiting program focused on changing lifestyle behaviors and improving parenting skills showed promise for obesity prevention in high‐risk Native‐American children.     

Childhood Obesity Prevention: An Intervention Targeting Primary Caregivers of School Children

Community‐based participatory research (CBPR) was used to design and evaluate the effectiveness of a culturally relevant, science‐based intervention for the prevention of childhood obesity in the Commonwealth of the Northern Mariana Islands (CNMI), a US Commonwealth in the western Pacific. This cognitive behavioral lifestyle intervention, Project Familia Giya Marianas (PFGM), was offered during the 2005–2007 school years in all CNMI public elementary schools over eight sessions to primary caregivers of 3rd grade children (N = 407). A crossover design was utilized with half of the schools offering the intervention in the Fall term, while the other half delivered the sessions in the Spring term. The primary outcome measure was change in BMI z‐score. There was an intervention‐dependent effect on BMI z‐score, with program impact being a function of baseline BMI and the number of lessons attended. This effect was most apparent in students whose baseline BMI z‐score was in healthy range (≥5 to <85 percentile). In both Asian and Pacific Island groups, children whose caregivers completed 5–8 lessons experienced a significant change in BMI z‐score as compared to those with 0 lessons (P < 0.05). Research that integrates multidisciplinary and multimethod approaches is effective in identifying and/or devising solutions to address a complex condition such as childhood obesity. PFGM demonstrated that community participation can be successfully utilized in the development and implementation of childhood obesity prevention programs.     

The association between changes in height and obesity in Chilean preschool children: 1996-2004

Objectives: To establish the association between changes in height and prevalence of obesity between 1996 and 2004 in Chilean preschool children. Research Methods and Procedures: Children registered in the Junta Nacional de Jardines Infantiles (JUNJI) preschool program were routinely measured three times a year and in consecutive years. Two indices [weight‐for‐height z‐scores (WHZ) and BMI centiles] were used to define obesity. Height‐for‐age z‐scores (HAZ) were used to define stature. Generalized estimating equations were used to describe the relationship between stature and obesity while controlling for repeated measurements in children. Results: The prevalence of obesity in Chilean preschool children has remained relatively constant over the past 9 years when either index is used. The prevalence of stunted (HAZ ≤2) children has decreased, while the proportion of children who are tall (HAZ >2) has increased. Using WHZ to define obesity, stunted children do not seem to be at increased risk of obesity when compared with children of normal height. Tall children were strongly protected from obesity when either criterion was used to define obesity. Discussion: The lack of association between stunting and obesity using WHZ ≥2 likely reflects the fact that Chile is in the post‐transitional phase of the nutrition transition, and stunting is no longer a risk factor for obesity; however, the associations observed between stunting and BMI suggest that either WHZ or BMI, or both, are inaccurate criteria to define overweight. Conclusions: There is a unique relationship between stature and obesity in preschool children that is different from that observed in older children in the same population.     

Life Course Impact of School-Based Promotion of Healthy Eating and Active Living to Prevent Childhood Obesity

Background

The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) is a comprehensive school health program that is proven feasible and effective in preventing obesity among school aged children. To support decision making on expanding this program, evidence on its long-term health and economic impacts is particularly critical. In the present study we estimate the life course impact of the APPLE Schools programs in terms of future body weights and avoided health care costs.

Method

We modeled growth rates of body mass index (BMI) using longitudinal data from the National Population Health Survey collected between 1996–2008. These growth rate characteristics were used to project BMI trajectories for students that attended APPLE Schools and for students who attended control schools (141 randomly selected schools) in the Canadian province of Alberta.

Results

Throughout the life course, the prevalence of overweight (including obesity) was 1.2% to 2.8% (1.7 on average) less among students attending APPLE Schools relative to their peers attending control schools. The life course prevalence of obesity was 0.4% to 1.4% (0.8% on average) less among APPLE Schools students. If the APPLE Schools program were to be scaled up, the potential cost savings would be $33 to 82 million per year for the province of Alberta, or $150 to 330 million per year for Canada.

Conclusions

These projected health and economic benefits seem to support broader implementation of school-based health promotion programs.     

Rapid Postnatal Weight Gain and Visceral Adiposity in Adulthood: The Fels Longitudinal Study

Rapid infant weight gain is associated with increased abdominal adiposity, but there is no published report of the relationship of early infant growth to differences in specific adipose tissue depots in the abdomen, including visceral adipose tissue (VAT). In this study, we tested the associations of birth weight, infant weight gain, and other early life traits with VAT, abdominal subcutaneous adipose tissue (ASAT), and other body composition measures using magnetic resonance imaging (MRI) and dual‐energy X‐ray absorptiometry in middle adulthood (mean age = 46.5 years). The sample included 233 appropriate for gestational age singleton white children (114 males) enrolled in the Fels Longitudinal Study. Multivariate‐adjusted general linear models were used to test the association of infant weight gain (from 0 to 2 years), maternal BMI, gestational age, parity, maternal age, and other covariates with adulthood body composition. Compared to infants with slow weight gain, rapid weight gain was associated with elevated risk of obesity (adjusted odds ratio = 4.1, 95% confidence interval = 1.4, 11.1), higher total body fat (+7 kg, P = 0.0002), percent body fat (+5%, P = 0.0006), logVAT mass (+0.43 kg, P = 0.02), logASAT mass (+0.47 kg, P = 0.001), and percent abdominal fat (+5%, P = 0.03). There was no evidence that the increased abdominal adipose tissue was due to a preferential deposition of VAT. In conclusion, rapid infant weight gain is associated with increases in both VAT and ASAT, as well as total adiposity and the risk of obesity in middle adulthood.     

Calcium and Dairy Intake and Measures of Obesity in Hyper‐ and Normocholesterolemic Children

Objective: Calcium intake has been inversely associated with body weight and body fatness in adults and, to a lesser extent, in children. Dairy intake has been inversely associated with metabolic syndrome in overweight but not normal‐weight adults. We assessed whether intakes of calcium and dairy foods were associated with measures of obesity in hypercholesterolemic (HC) and normocholesterolemic (non‐HC) children at baseline and over 1 year. Research Methods and Procedures: Non‐obese 4‐ to 10‐year‐old HC and non‐HC children (342) completed three 24‐hour dietary recalls and provided measures of relative weight (BMI and BMI z scores) and adiposity (sum of skinfolds, trunk skinfolds) at baseline, 3, 6, and 12 months. Cross‐sectional and longitudinal regression analyses, stratified by cholesterol risk status (HC vs. non‐HC) and age (4 to 6 years and 7 to 10 years) and adjusted for potential confounders, were conducted. Results: After adjusting for age, sex, energy intake, and percentage energy from fat, calcium intake was inversely associated with BMI, sum of skinfolds, and trunk skinfolds at baseline and over 1 year in the 7‐ to 10‐year‐old non‐HC children. Results from the regression models also indicated an inverse relation between intake of dairy foods and measures of obesity at baseline in these children. Calcium or dairy intake was not associated with measures of obesity in HC children or in the 4‐ to 6‐year‐old non‐HC children. Discussion: These results suggest a complex relation among intake of calcium and dairy foods, measures of obesity, age, and serum cholesterol in children. Older children without risk of metabolic syndrome may benefit most from increased calcium intake.     

Children at High Risk for Overweight: A Classification and Regression Trees Analysis Approach

Objective: Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry. Research Methods and Procedures: A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex‐ and age‐specific BMI cut‐points proposed by the International Obesity Task Force. Results: Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10, 000 grams was found in about one‐half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children. Discussion: A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high‐risk children.     

Nut consumption and weight gain in a Mediterranean cohort: The SUN study

Objective: To assess the association, in a Mediterranean population, between nut consumption and risk of weight gain (at least 5 kg) or the risk of becoming overweight/obese. Research Methods and Procedures: The Seguimiento Universidad de Navarra project is a prospective cohort of 8865 adult men and women who completed a follow‐up questionnaire after a median of 28 months. Dietary habits were assessed with a previously validated semiquantitative food‐frequency questionnaire. Results: Nine hundred thirty‐seven participants reported a weight gain of ≥5 kg at follow‐up. After adjusting for age, sex, smoking, leisure time physical activity, and other known risk factors for obesity, participants who ate nuts two or more times per week had a significantly lower risk of weight gain (odds ratio: 0.69; 95% confidence interval: 0.53 to 0.90, p for trend = 0.006) than those who never or almost never ate nuts. Participants with little nut consumption (never/almost never) gained an average of 424 grams (95% confidence interval: 102 to 746) more than frequent nut eaters. Nut consumption was not significantly associated with incident overweight/obesity in the cohort. Discussion: Frequent nut consumption was associated with a reduced risk of weight gain (5 kg or more). These results support the recommendation of nut consumption as an important component of a cardioprotective diet and also allay fears of possible weight gain.     

Economic Analysis of a School‐Based Obesity Prevention Program

Objective: To assess the cost‐effectiveness and cost‐benefit of Planet Health, a school‐based intervention designed to reduce obesity in youth of middle‐school age children. Research Methods and Procedures: Standard cost‐effectiveness analysis methods and a societal perspective were used in this study. Three categories of costs were measured: intervention costs, medical care costs associated with adulthood overweight, and costs of productivity loss associated with adulthood overweight. Health outcome was measured as cases of adulthood overweight prevented and quality‐adjusted life years (QALYs) saved. Cost‐effectiveness ratio was measured as the ratio of net intervention costs to the total number of QALYs saved, and net‐benefit was measured as costs averted by the intervention minus program costs. Results: Under base‐case assumptions, at an intervention cost of $33, 677 or $14 per student per year, the program would prevent an estimated 1.9% of the female students (5.8 of 310) from becoming overweight adults. As a result, an estimated 4.1 QALYs would be saved by the program, and society could expect to save an estimated $15, 887 in medical care costs and $25, 104 in loss of productivity costs. These findings translated to a cost of $4305 per QALY saved and a net saving of $7313 to society. Results remained cost‐effective under all scenarios considered and remained cost‐saving under most scenarios. Discussion: The Planet Health program is cost‐effective and cost‐saving as implemented. School‐based prevention programs of this type are likely to be cost‐effective uses of public funds and warrant careful consideration by policy makers and program planners.     

Adult obesity does not predict 6-year weight gain in men: the Aerobics Center Longitudinal Study

Objective: To determine the longitudinal relation between history of adult obesity and the 6‐year trajectory of weight change in men. Research Methods and Procedures: Subjects were healthy, affluent men (n = 761) between the ages of 20 and 78 years who completed at least four comprehensive medical exams at the Cooper Clinic between 1987 and 2003. Maximum adult weight was reported, and current height was measured at baseline. Body weight and cardiorespiratory fitness were measured at all examinations. Adult obesity status was determined from self‐reported maximum weight and measured height at baseline as BMI ≥ 30 kg/m². Weight at all examinations was regressed on a history of adult obesity using linear mixed effects modeling. Results: At baseline, men reporting a history of adult obesity were significantly heavier than men reporting no such history (BMI 29.8 vs. 25.0 kg/m²; p < 0.05). However, the rate of weight gain among men with a history of obesity was slower than among men without a history of adult obesity (0.04 vs. 0.18 kg/yr; p = 0.09), although this difference was only marginally significant. Fitness modulated the relationship between history of obesity and weight change over time, and both higher levels of fitness and greater frequency of dieting were associated with attenuated weight gain. In contrast, chronic disease and depression were associated with accelerated weight gain. Discussion: Although a history of obesity was associated with higher weight, it did not seem to result in accelerated weight gain over time. Additionally, dieting and fitness were important for minimizing weight gain.     

The Relationship of Rapid Weight Gain in Infancy to Obesity and Skeletal Maturity in Childhood

Objective: Children with birth weight appropriate for gestational age (AGA) who also demonstrate rapid weight gain in infancy have a greater risk of being overweight or obese during childhood. A concurrent advancement in skeletal maturity would account for their greater size and would, therefore, not necessarily pose a threat of greater risk during adolescence and early adulthood. This study aims to determine whether children with rapid weight gain during infancy have advanced skeletal maturity during childhood. Research Methods and Procedures: One hundred and ninety‐three African children (boys = 108; girls = 85) of normal birth weight and gestational age were assessed from birth to 9 years. Body composition was assessed at 9 years of age by whole‐body DXA, and skeletal maturity was assessed using the Tanner‐Whitehouse II technique. Rapid weight gain in infancy was defined as a +0.67 change in weight‐for‐age Z‐score between birth and 2 years. Results: Rapid weight gain was experienced by over 20% of the sample. Children with rapid weight gain were significantly lighter at birth and significantly taller, heavier, and fatter throughout childhood. Chronological age and Tanner‐Whitehouse II technique skeletal ages at 9 years were not significantly different between groups or between sexes within groups. Discussion: Because AGA children with rapid weight gain have a greater risk of overweight and obesity but are not advanced in skeletal maturity, later adolescent adjustments toward average weight and fatness values are unlikely. The identification and monitoring of such children is of importance in reducing their risk of morbidity.     

A family-based approach to preventing excessive weight gain

Objective: Preventing weight gain in adults and excessive weight gain in children is a high priority. We evaluated the ability of a family‐based program aimed at increasing steps and cereal consumption (for breakfast and snacks) to reduce weight gain in children and adults. Research Methods and Procedures: Families (n = 105) with at least one 8‐ to 12‐year‐old child who was at‐risk‐for‐overweight or overweight (designated as the target child) were recruited for the study. Eighty‐two families were randomly assigned to receive the family‐based intervention and 23 families to the control condition. The 13‐week intervention consisted of specific increases in daily steps (an additional 2000 steps/d) and consumption of 2 servings/d of ready‐to‐eat cereal. Results: The intervention was successful in increasing walking (steps) and cereal consumption. The intervention had positive, significant effects on percentage BMI‐for‐age and percentage body fat for target children and weight, BMI, and percentage body fat for parents. On further analysis, the positive effects of the intervention were seen largely in target girls and moms, rather than in target boys and dads. Discussion: This family‐based weight gain prevention program based on small changes holds promise for reducing excessive weight gain in families and especially in growing overweight children.     

Stigmatized Students: Age,Sex, and Ethnicity Effects in the Stigmatization of Obesity

Objective: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. Research Methods and Procedures: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m²; range, 14.4 to 45.0 kg/m²) who ranked six drawings of same‐sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth‐ and sixth‐grade children. Results: Obesity was highly stigmatized relative to physical disabilities. African‐American women liked obese peers more than did African‐American men, white men, or white women [F (1, 216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t (761) = 9.16, p < 0.001]. Discussion: Although the stigmatization of obesity was high among participants overall, African‐American women seemed to have more positive attitudes toward obesity than did white women, white men, or African‐American men. Participants’ weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non‐overweight adults. Such internalized stigmatization could help to explain the low self‐esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African‐American women could help efforts to reduce stigma.     

Weight gain prevention among women

Objective: Women 25 to 45 years old are at risk for weight gain and future obesity. This trial was designed to evaluate the efficacy of two interventions relative to a control group in preventing weight gain among normal or overweight women and to identify demographic, behavioral, and psychosocial factors related to weight gain prevention. Research Methods and Procedures: Healthy women (N = 284), ages 25 to 44, with BMI < 30 were randomized to one of three intervention conditions: a clinic‐based group, a correspondence course, or an information‐only control. Intervention was provided over 2 years, with a follow‐up at Year 3. BMI and factors related to eating and weight were assessed yearly. Results: Over the 3‐year study period, 40% (n = 114) of the women remained at or below baseline body weight (±2 lbs), and 60% gained weight (>2 lbs). Intervention had no effect on weight over time. Independently of intervention, women who were older, not actively dieting to lose weight, and who reported less perceived hunger at baseline were more likely to be successful at weight maintenance. Weight maintenance also was associated with increasing dietary restraint (conscious thoughts and purposeful behaviors to control calorie intake) and decreasing dietary disinhibition (the tendency to lose control over eating) over time. Discussion: This study raises concern about the feasibility and efficacy of weight gain prevention interventions because most women were interested in weight loss, rather than weight gain prevention, and the interventions had no effect on weight stability. Novel approaches to the prevention of weight gain are needed.     

Psychological workload and weight gain among women with and without familial obesity

Objective : High job demands and low job influence may be associated with subsequent weight gain. Predisposition to obesity may further modify such associations. The purpose of the study was to determine whether familial predisposition to obesity modified associations between psychological workload and 6‐year weight changes among nurses. Research Methods and Procedures : A total of 6404 Danish nurses 45 to 65 years old, who belonged to the workforce in both 1993 and 1999, answered a questionnaire on psychological workload, body weight, and familial obesity. Women were considered to be predisposed to obesity if they were overweight and had at least one obese parent. Parents’ body shape was reported using pictograms. Results : An increased psychological workload, reflected by high job demands and low influence in job, was associated with an increased body weight. This was particularly the case for nurses being predisposed to obesity, suggesting a synergy between familial obesity predisposition and the psychological workload environment. An interaction test among job demands, familial predisposition to obesity, and weight gain on adjusted data was made. The test showed p = 0.05. The adjusted interaction test among influence in job, familial predisposition to obesity, and weight gain showed p = 0.02. Predisposed nurses who were busy in their job gained 4.4 kg, whereas other nurses gained only 3.2 kg during the 6 years. Similarly, nurses predisposed to obesity with low influence in job had a higher body weight gain (5.4 vs. 3.2 kg) compared with other nurses. Discussion : High psychological workload due to high job demands and low influence in job seems to predict weight gain in general and, in particular, among those nurses with a familial predisposition to obesity.     

Two‐Year Changes in Child Weight Status,Diet, and Activity by Neighborhood Nutrition and Physical Activity Environment

Objective

The aim of this study was to examine 2‐year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments.

Methods

A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Children 6 to 12 years old and a parent or caregiver completed Time 1 (n = 681) and Time 2 (n = 618) assessments. Children lived in neighborhoods characterized as “high/favorable” or “low/unfavorable” in nutrition and activity environments, respectively (four neighborhood types). Child BMI z score and overweight or obesity status were primary outcomes, with diet and activity behaviors as behavioral outcomes.

Results

After adjusting for sociodemographics and Time 1 values, children living in two of the three less environmentally supportive neighborhoods had significantly less favorable BMI z score changes (+0.11, 95% CI: 0.01‐0.21; + 0.12, 95% CI: 0.03‐0.21), and all three less supportive neighborhoods had higher overweight or obesity (relative risks, 1.41‐1.49; 95% CI: 1.13‐1.80) compared with children in the most environmentally supportive neighborhoods. Changes in daily energy intake and sedentary behavior by neighborhood type were consistent with observed weight status changes, with unexpected findings for physical activity.

Conclusions

More walkable and recreation‐supportive environments with better nutrition access were associated with better child weight outcomes and related behavior changes.