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This study aims to (1) assess the associations between sugar-sweetened beverages (SSB) consumption and C-reactive protein (CRP) levels, and (2) evaluate the modifying effect of body mass index (BMI) on the association between SSB consumption and CRP levels. A total of 6856 eligible adults were selected from the 2007–2010 National Health and Nutrition Examination Survey (NHANES). Average quantity of SSB consumption was calculated from 2-day 24-h dietary recalls. All data analyses were performed with appropriate sampling weights. Compared with non-SSB drinkers, a 0.26 mg/l higher CRP was observed in heavy SSB drinkers after adjusting for demographic characteristics, lifestyle patterns, and BMI. An effect modification of BMI on SSB intake and CRP levels was detected (P

Summary Introduction Significant health disparities exist in asthma and obesity for African American youths. Successful interventions present an opportunity to address these disparities but require detailed study in order to ensure generalizability. This study investigated the intersection of obesity, neighbourhood disadvantage, and asthma. Methods Data were extracted from 129 African American females ages 13 to 19 years (mean = 15.6 years [SD = 1.9]). Obesity was measured via body mass index (BMI). Asthma status was based on clinical diagnosis and/or results of the International Study of Asthma and Allergies during Childhood (ISAAC) questionnaire. The concentrated disadvantage index (CDI) assessed neighbourhood disadvantage. Results Findings showed that 21.5% (n = 28) of participants were clinically defined as having asthma, 76.2% (n = 99) had obesity, and 24.9% (n = 31) were classified without obesity. The mean BMI was 35.1 (SD = 9.1) and the mean CDI was 1.0 (SD = 0.9). CDI and obesity were significantly associated in participants without asthma, but not in those with asthma. Multivariable linear regression results showed a significant interaction between CDI and asthma (t value = 2.2, P = .03). Conclusion In sum, results from this study found that asthma moderated the relationship between neighbourhood disadvantage and obesity.

Objective This study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes.

Introduction Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual applications can reliably capture social determinants of health at the smallest geographic resolution (parcel level) remains uncertain. This paper presents a novel, parcel-level SSO methodology and assesses whether this new method can be collected reliably using Google Street View and is feasible. Methods Multiple raters (N=5) observed 42 neighborhoods. In 2016, inter-rater reliability (observed agreement and kappa coefficient) was compared for four SSO methods: (1) street-level in person; (2) street-level virtual; (3) parcel-level in person; and (4) parcel-level virtual. Intra-rater reliability (observed agreement and kappa coefficient) was calculated to determine whether parcel-level methods produce results comparable to traditional street-level observation. Results Substantial levels of inter-rater agreement were documented across all four methods; all methods had >70% of items with at least substantial agreement. Only physical decay showed higher levels of agreement (83% of items with >75% agreement) for direct versus virtual rating source. Intra-rater agreement comparing street- versus parcel-level methods resulted in observed agreement >75% for all but one item (90%). Conclusions Results support the use of Google Street View as a reliable, feasible tool for performing SSO at the smallest geographic resolution. Validation of a new parcel-level method collected virtually may improve the assessment of social determinants contributing to disparities in health behaviors and outcomes.

BackgroundHuman breastmilk contains pro- and anti-inflammatory compounds and hormones that can influence infant growth. However, little is known about the specific interrelationships between these compounds and whether their effects on infant growth may be influenced by pre-pregnancy weight status.ObjectiveThe purpose of this novel, prospective cohort study was to assess the interrelationships between pro-inflammatory cytokines (TNF-α, IL-6), hormones (insulin, leptin) and PUFAs (n-6, n-3) in blood and breastmilk in early postpartum between women with normal BMI (Group 1, n = 18; 18.5MethodsParticipants were robustly phenotyped along with their infants at 4-8 weeks postpartum. TNF-α, IL-6, insulin, leptin, and n-3 and n-6 PUFAs measured in blood and breastmilk and compared between pre-pregnancy BMI groups and with infant weight, length, head circumference and % fat mass.ResultsGroup 1 women had higher serum leptin (pConclusionsPro-inflammatory qualities of breastmilk were associated with infant growth measures regardless of maternal pre-pregnancy BMI. However, infants born to women with overweight or obesity demonstrated less responsive growth to breastmilk contents. More studies are needed to assess longitudinal effects of this impact.

Background: It has been estimated that there are approximately 14.5 million cancer survivors in the United States. One out of every six people over 65 is a cancer survivor. Recently growing evidence suggests a link between sugar-sweetened beverage (SSB) consumption and risk of pancreatic and endometrial cancer, and risk of colon cancer recurrence and mortality among cancer survivors. The objective of this study is to closely evaluate the impact of cancer status and other risk factors on sugar intake from SSBs. Methods: A total of 22,182 adults aged ≥20 years old were analyzed using the National Health and Nutrition Examination Survey (NHANES) 2003–2012 data. The primary outcome is high sugar intake (≥80 g) from SSBs per day. The association between sugar intake from SSB consumption and cancer status was evaluated using weighted logistic regression. Results: Approximately 17% of non-cancer participants and 8% of cancer survivors had high sugar intake from SSBs. However, this cancer group difference was not significant after adjusting for other factors, especially age and gender. Individuals who had high sugar intake from SSB were younger, male (21.7%), Black (23.3%), had education level at high school (20.9%), low income (poverty income ratio ≤1, 23.4%), obese (17.1%), current smokers (26.9%) and non-cancer individuals (16.7%) or cervix cancer survivors (17.1%). After adjusting for demographic factors, a significant association between sugar intake from SSBs and cancer status was not observed except that prostate cancer survivors were less likely to intake sugar from SSBs compared to non-cancer individuals (OR =0.41, 95% CI: 0.22–0.77). Conclusions: In general, cancer survivors consumed less sugars from SSBs compared to non-cancer individuals. However, this difference was primarily due to the differences in age distribution of the cancer and non-cancer groups (mean age, 62 and 45 years old, respectively). Individuals who were younger, male, Black, with lower education, with lower income, obese, and current smokers tended to have high sugar intake from SSBs. Custom intervention of decreasing sugar consumption from SSBs should be conducted for both non-cancer individuals and cancer survivors.

Objective It is unclear whether physiologic and metabolic biomarkers are associated with chronic stressors evidenced during early childhood. Methods Cross-sectional data were obtained from a cohort of healthy, prepubertal (Tanner stage

Background: Low- and middle-income countries are affected disproportionately by the ongoing global obesity pandemic. Representing a middle income country, the high prevalence of obesity among Grenadian adults as compared to US adults is expected as part of global obesity trends. The objective of this study was to determine if Grenadian adolescents have a higher prevalence of overweight compared to their US counterparts, and if a disparity exists between urban and rural adolescents. Methods: Using a subcohort of participants in the Grenadian Nutrition Student Survey, diet quality and anthropometric measures were collected from 55% of the classrooms of first year secondary students in Grenada (n = 639). Rural or urban designations were given to each school. Body Mass Index (BMI) was calculated and categorized as overweight or obese for each student following CDC classification cutoffs. A standardized BMI (BMIz) was calculated for each school. Sex-specific BMI and overall BMIz were compared to a 1980s US cohort. Multilevel models, overall and stratified by sex, of students nested within schools were conducted to determine if BMIz differed by rural or urban locality, gender, and diet quality. Results: The mean age of this cohort was 12.7 (SD = 0.8) years with 83.8% of the cohort identifying as Afro-Caribbean. Females had nearly twice the prevalence of overweight when compared to males (22.7 vs. 12.2%) but a similar prevalence of obesity (8.2 vs. 6.8%). Grenadian adolescents had lower prevalence of overweight (females: 22.7 vs. 44.7%; males: 12.2 vs. 38.8%, respectively) as compared to US counterparts. Eating a traditional diet was negatively associated with BMIz score among females ( β^ = -0.395; SE = 0.123) in a stratified, multilevel analysis. BMIz scores did not differ significantly by rural or urban school designation. Conclusions: Among Grenadian adolescents, this study identified a lower overweight prevalence compared to US counterparts and no difference in overweight prevalence by urban or rural location. We hypothesize that the late introduction of processed foods to Grenada protected this cohort from obesogenic promoters due to a lack of fetal overnutrition. However, further research in subsequent birth cohorts is needed to determine if adolescent obesity will increase due to a generational effect.

Objective: Farmers’ markets are increas­ingly being promoted as a means to provide fresh produce to poor and underserved communities. However, farmers’ market (FM) use remains low among low-income patrons. The purpose of our study was to examine FM awareness and use, grocery shopping behaviors, and internet use among Supplemental Nutrition Assistance Program (SNAP) recipients.Design: A descriptive analysis of preliminary data was performed to evaluate quantita­tive baseline data among SNAP recipients between June and August 2016 in New Or­leans, Louisiana (N=51). Data were collected via a 42-item online survey that included demographics, internet use, FM awareness and use, health information seeking behaviors and fruit and vegetable purchasing behaviors.Results: Less than half of the survey respondents (n=24) had ever been to a FM. Local grocery stores and Wal-Mart were most used for purchasing fruits and vegetables (88% and 84%, respectively). The most common sources of healthy eat­ing information were Women, Infants and Children (WIC) and the internet, frequently accessed via smartphones. More than 80% of participants were not aware that local FMs accepted electronic benefit transfer payments as a form of payment.Conclusion: These results support the incorporation of promotional methodol­ogy that combines internet-based mobile technology and existing services (eg, WIC) as a viable strategy to improve farmers’ market use among low-income populations. As most participants were not aware that participating FMs accept electronic ben­efit transfer payments, this fact should be emphasized in promotional material.Ethn Dis. 2017;27(Suppl 1):295-302; doi:10.18865/ed.27.S1.295.

The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide. Significance for public health This brief report establishes the need for local farmers’ markets (FM) in New Orleans, Louisiana to distribute information to increase the awareness of the markets, especially among low-income individuals. A variety of the FMs in New Orleans offer discounts to increase access to fresh produce among underserved individuals. However, there is a lack of knowledge of these markets, the ability to utilize Supplemental Nutrition Assistance Program benefits to purchase food, and of the discounts offered. Furthermore, this assessment demonstrates that low-income individuals have adequate access to the internet and a variety of social media channels. Based on these results, our research establishes that cost-effective and efficient, web-based marketing could be used as means help increase FM participation among low-income individuals. Increasing awareness of FMs and discounts offered to low-income individuals is one step in creating better access to affordable produce, which could lead to increased fruit and vegetable consumption and better health outcomes among at-risk populations.

To examine for the first time the associations between pro-inflammatory cytokines and obesity-related metabolic biomarkers in, exclusively prepubertal, otherwise healthy obese and non-obese Black and White children, 7-9 years of age.Body mass index (BMI), homeostasis model assessment-estimated insulin resistance, visceral adipose tissue and subcutaneous adipose tissue (SAT (magnetic resonance imaging)); total body fat (dual-energy X-ray absorptiometry), ectopic, intrahepatic lipid (IHL) and intramyocellular lipid (IMCL) fat (proton magnetic resonance spectroscopy) and serum levels of interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor alpha (TNF-α) and monocyte chemoattractant protein-1 were measured in 40 obese and non-obese children. Relationships between inflammatory cytokines and obesity were assessed by analysis of variance and Spearman's rank correlation.Significant inverse correlations were found between BMI z-score, SAT, total BF, and IHL and levels of TNF-α (Spearman's ρ=-0.36, -0.39, -0.43 and -0.39, respectively; P0.05). Levels of IL-8 were significantly and inversely correlated with IMCL (-0.39; P=0.03) and remained significant after adjusting for race. IMCL was inversely associated with TNF-α only after adjusting for race (-0.37; P=0.04).Relationships between pro-inflammatory and metabolic markers commonly observed in adults are reversed in healthy, Black and White children before puberty. Prospective studies are warranted to determine how these inverse relationships modify chronic disease risk later in life.

Background:To determine if there are differences in time spent in physical activity and sedentary behavior between rural African American and Caucasian children.Methods:Children wore accelerometers for 3 weekdays. The students were randomly selected from a larger sample of children participating in a weight gain prevention intervention. Usable data were obtained from 272 of the 310 students who agreed to participate. The outcome data included counts per minute (CPM), time spent in moderate to vigorous (MVPA), light (LPA), and sedentary (SED) activity. The equation and cutoff used to analyze national accelerometry data were used for the current study.Results:The sample had an average age of 10.4 (1.1) years and 76% were African American. Lower SES African Americans had more CPM (P = .012) and spent more time in MVPA (P = .008) compared with middle SES African American and lower SES Caucasian children. Lower SES African American children also spent fewer minutes in SED activity (P = .044) compared with middle SES African American children.Conclusions:These findings support recent results that also used objective activity measures. Children appeared less active and more sedentary than a national sample, warranting interventions in minority and rural populations.

Intramyocellular and intrahepatic (IHL) lipids are significantly associated with insulin resistance in adults and adolescents and may represent an early marker for developing the metabolic syndrome or type 2 diabetes.During the pilot phase of a larger cross-sectional study, we used proton magnetic resonance spectroscopy ((1)H-MRS) to determine the feasibility of noninvasively evaluating IHL in 11 male (n = 4) and female (n = 7) prepubertal children using a standard clinical system and to determine whether IHL is correlated with adiposity, fasting insulin and glucose, and liver enzymes.Body mass index (BMI) (range, 13.4-32.4 kg/m(2)) and IHL stores (range, 0.07-3.2% relative to an oil phantom) were variable. IHL was correlated with body mass (r = 0.66, P = 0.037), BMI (r = 0.73, P = 0.016), percentage body fat (r = 0.73, P = 0.01, n = 10), waist circumference (r = 0.85, P = 0.016), and serum lactate dehydrogenase concentration (r = 0.77, P = 0.03) but was not significantly correlated with other markers of liver damage, including aspartate aminotransferase activity (r = 0.59, P = 0.09, n = 9) and alkaline phosphatase concentrations (r = 0.60, P = 0.087). IHL was also (P0.01) correlated with fasting insulin concentration (r = 0.85, P = 0.03, n = 6) and insulin resistance (r = 0.94, P = 0.006, n = 6), but these correlations were driven by the results for one child.These preliminary data suggest that (1)H-MRS obtained in a standard pediatric clinical environment may be used to determine IHL in healthy normal and overweight prepubertal youth. This noninvasive technique may prove useful in identifying early markers of the metabolic syndrome in at-risk youth.

Physical activity is a proven form of diabetes management and is considered a cornerstone in the prevention of diabetes. In children with diabetes, physical activity may improve insulin sensitivity and glucose uptake in skeletal muscle. Aerobic-based physical activity lasting 40-60 minutes daily for a minimum of four months is shown to enhance insulin sensitivity, and may reduce the risk for type 2 diabetes. An important adjunct to aerobic-based physical activity for diabetes prevention is resistance training. The American Academy of Pediatrics supports properly supervised strength/resistance training as a safe method for strength development in preadolescent children. Resistance training may increase skeletal muscle mass, therefore increasing whole-body glucose disposal capacity. In addition to immediate health benefits during childhood, increased physical activity in children and adolescents is likely to contribute to the establishment of healthy leisure habits over a lifetime and improved adult...

Rates of obesity among children have been rising in recent years. Information on the prevalence of obesity in children living in rural communities is needed. We report the prevalence of overweight and obesity in children enrolled in grades 4 to 6 who live in rural areas of Louisiana, USA.These data were collected as baseline assessment for the Louisiana (LA) Health project. Height, weight, and estimates of body fat (using body impedance analysis) were collected on 2 709 children. Average age was 10.5 years and the sample composition was 57.3% girls, 61.7% African-American, 36.0% Caucasian, and 2.3% other minority. A majority of children (77%) met the criterion for poverty status.The distribution of body mass index (BMI) percentile was highly skewed toward obesity. The most frequent BMI percentile scores were 98(th) and 99(th) percentile. Using Centers for Disease Control and Prevention (CDC) norms, the overall prevalence of obesity was 27.4%, and for overweight was 45.1%, of which 17.7% were between the 85(th) and 95(th) percentile. The prevalence of childhood overweight and obesity were much higher than the national norm and this increased prevalence was observed in both genders and in Caucasian and African-American children.The prevalence of childhood overweight and obesity was found to be much higher in rural and primarily poor (77%) children living in Louisiana when compared with national norms. This observation suggests that rural children from Louisiana may be experiencing an epidemic of obesity that exceeds national prevalence estimates.

1) Report the feasibility of completing the 180-minute Frequently Sampled Intravenous Glucose Tolerance Test (FSIVGTT) in healthy weight, overweight and obese pre-pubertal children and, 2) describe the finalized FSIVGTT protocol after addendums were implemented to decrease the frequency of mild adverse events and improve test completion rates.Insulin sensitivity was determined by FSIVGTT.FSIVGTT was attempted in a total of 22 study participants. Insulin sensitivity was successfully assessed in 15 study participants (8 males, 7 females, 10 Caucasian, 4 African American, 1 Pacific Islander, age range 7-9 years). Mean insulin sensitivity was 15.1+/-9.8 (mmicro/l)(-1) min(-1) range 4.4-43.2 (mmicro/l)(-1) min(-1). However, seven study participants experienced mild adverse events of hypoglycemia. Several addendums were made to the FSIVGTT protocol to ensure study participants' comfort and safety, and to decrease the frequency of mild adverse events and increase test completion rates.Addendums made to FSIVGTT protocol allowed successful completion of FSIVGTT in 15 (68%) of the 22 children. These results demonstrate that FSIVGTT is challenging, yet feasible in healthy lean and obese pre-pubertal children.

Incarcerated black women in the southern USA are understudied despite the high prevalence of sexually transmitted infections (STI) and human immunodeficiency virus (HIV). These incarceration and health disparities are rooted in centuries of historically inequitable treatment. Amidst the current dialogue on mass incarceration in the south and its relationship to the health of the black community, individual and environmental risk factors for STI/HIV transmission are seldom paired with discussions of evidence-based solutions. A narrative review of the literature from January 1995 to May 2015 was conducted. This sample of the literature (n = 18) revealed that partner concurrency, inconsistent condom use, sex work, previous STI, and drug abuse augmented individual STI/HIV risk. Recommended interventions include those which promote healthier relationships, cultural competence, and gender specificity, as well as those that enhance prevention skills. Policy recommendations include improving cultural sensitivity, cultural competence, and cultural humility training for clinicians, as well as substantially increasing funding for prevention, treatment, and rehabilitative services. These recommendations are timely given the recent national attention to incarceration, STI, and HIV disparities, particularly in the southern USA.

The purpose of this study was to compare heart rate peak in obese (n=43) and normal weight (n=45) female youth. Heart rate (HR) peak was significantly lower (p2 (L min-) peak similar between groups (1.77±20.53, 1.97±0.60). Bivariate correlations for heart rate peak with body weight, percent fat, and body mass index yielded the following: -0.53, -0.54, and -0.57. These findings agree with the adult data indicating low HR peak in obese individuals. Further research is needed to explore physiologic factors that may lead to reduced HR peak in obese female youth.

The integrated, 4-level approach of Committed to Kids is successful because of several factors: The sessions are designed to entertain the adolescents and promote initial success; The program features parent-training methods in short, interactive, educational sessions; In severely obese adolescents, the diet intervention results in noticeable weight loss that motivates the patient to continue; also, the improved exercise tolerance resulting from the weight loss promotes increased physical activity; and The program team provides consistent feedback-patients and their families receive results and updates every 3 months. Most importantly, the program is conducted in groups of families. The adolescent group dynamics and peer modeling are primary components of the successful management of obesity in youth.

Obesity has reached epidemic proportions worldwide with disproportionate prevalence in different communities and ethnic groups. Recently, the American Medical Association recognized obesity as a disease, which is a significant milestone that opens the possibilities of treating obesity under standardized health plans. Obesity is an inflammatory disease characterized by elevated levels of biomarkers associated with abnormal lipid profiles, glucose levels, and blood pressure that lead to the onset of metabolic syndrome. Interestingly, inflammatory biomarkers, in particular, have been implicated in the risk of developing several types of cancer. Likewise, obesity has been linked to esophageal, breast, gallbladder, kidney, pancreatic, and colorectal cancers. Thus, there exists a link between obesity status and tumor appearance, which may be associated to the differential levels and the circulating profiles of several inflammatory molecules. For example, mediators of the inflammatory responses in both obesity and gastric cancer risk are the same: pro-inflammatory molecules produced by the activated cells infiltrating the inflamed tissues. These molecules trigger pathways of activation shared by obesity and cancer. Therefore, understanding how these different pathways are modulated would help reduce the impact that both diseases, and their concomitant existence, have on society.

The aim of the study was to objectively determine whether the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program improved physical activity levels during the school day.The study compared the physical activity levels of subjects from 26 daycare centers, randomized into treatment (N=13) and control (N=13) groups. The subjects were 3 to 5 year olds (N=209, 104 males and 105 females; age [years]=3.85±0.8 [mean±standard deviation]), and accelerometry was used to determine the subjects' physical activity levels. Accelerometers were attached to each subject for 2 days before and immediately after a 6-month intervention. Height, mass, and waist were also measured.Regression analyses indicated that the treatment group demonstrated significant increases in moderate and vigorous physical activity, as compared to the control group (F(1, 207)=6.3, p0.05, Cohen's d=0.30; F(1, 207)=4.7, p0.05, Cohen's d=0.25, respectively). The treatment group also showed significant increases in total physical activity (F(1, 218)=12.4; p0.05) from pre- to post-test with significant increases in moderate and vigorous intensity physical activity (F(1, 218)=18.6, p0.05; F(1, 218)=23.3, p0.05, respectively). Regression analyses revealed significant increases in height for both groups from pre- to post-tests, but no differences were noted between groups.Implementation of the NAP SACC program in treatment daycare facilities resulted in significant increases in objectively measured physical activity levels, compared to the control group, demonstrating physical activity improvement in the treatment daycare centers.

Several variations in the nicotinic receptor genes have been identified to be associated with both lung cancer risk and smoking in the genome-wide association (GWA) studies. However, the relationships among these three factors (genetic variants, nicotine dependence, and lung cancer) remain unclear. In an attempt to elucidate these relationships, we applied mediation analysis to quantify the impact of nicotine dependence on the association between the nicotinic receptor genetic variants and lung adenocarcinoma risk. We evaluated 23 single nucleotide polymorphisms (SNPs) in the five nicotinic receptor related genes (CHRNB3, CHRNA6, and CHRNA5/A3/B4) previously reported to be associated with lung cancer risk and smoking behavior and 14 SNPs in the four 'control' genes (TERT, CLPTM1L, CYP1A1, and TP53), which were not reported in the smoking GWA studies. A total of 661 lung adenocarcinoma cases and 1,347 controls with a smoking history, obtained from the Environment and Genetics in Lung Cancer Etiology case-control study, were included in the study. Results show that nicotine dependence is a mediator of the association between lung adenocarcinoma and gene variations in the regions of CHRNA5/A3/B4 and accounts for approximately 15% of this relationship. The top two CHRNA3 SNPs associated with the risk for lung adenocarcinoma were rs1051730 and rs12914385 (p-value = 1.9×10(-10) and 1.1×10(-10), respectively). Also, these two SNPs had significant indirect effects on lung adenocarcinoma risk through nicotine dependence (p = 0.003 and 0.007). Gene variations rs2736100 and rs2853676 in TERT and rs401681 and rs31489 in CLPTM1L had significant direct associations on lung adenocarcinoma without indirect effects through nicotine dependence. Our findings suggest that nicotine dependence plays an important role between genetic variants in the CHRNA5/A3/B4 region, especially CHRNA3, and lung adenocarcinoma. This may provide valuable information for understanding the pathogenesis of lung adenocarcinoma and for conducting personalized smoking cessation interventions.

The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial–ethnic, age, and sex groups. 32,38,54 Evidence continues to support reduced physical activity and sedentary behaviors, such as television viewing, as primary causes of the current worldwide obesity epidemic. 15,28,30 Several researchers have published results of programs that target decreases in sedentary behaviors as methods to increase physical activity and reduce obesity in children. 12,30,36,55 It is possible that, for many children, increasing physical activity may be adequate to prevent the onset of childhood obesity. 28,35,47,55 Because young animals, including humans, are inherently active, young children will be active if given encouragement and opportunity. 21,62 Childhood activity is often intermittent and sporadic 4 ; thus, children likely will not participate in prolonged exercise without rest periods; however, if given the opportunity, young children will perform relatively large volumes of intermittent, nonstructured physical activity. 4,21,62 Generous periods of free play are recommended highly, together with frequent periods of adult-initiated moderate to vigorous activities, including the participation of parents and teachers. 35,42,62 Encouraging active play as a means for increasing overall energy expenditure has been shown to be effective in reducing obesity in 5- to 8-year-old girls. 21 Providing safe environments for young children to play actively outdoors is essential to increasing the physical activity patterns of overweight children and those at risk for obesity. 35 This provision may be accomplished only through policy changes, environmental planning, and school and community educational efforts. Motivating young, nonobese, physically active children to maintain activity patterns may be less challenging than increasing patterns in already obese older children. Javernick 42 suggests that just monitoring children during free play does not encourage the participation of heavier children. Heavier children often are ignored and ridiculed 1 and often choose indoor, sedentary activities to escape negative activity situations. 42 Therefore, encouraging sedentary, obese children to participate in physical activity is difficult. In addition, even mildly overweight children have a decreased exercise tolerance; movement may be uncomfortable and, in some cases, painful. 64,66,69 Structured and vigorous, aerobic-type activities when prescribed to overweight children, regardless of the individual's cognitive, physical, and emotional stage of development, may result in noncompliance or physical injury. Prior failure to motivate and maintain increased physical activity in overweight or obese children may be attributed to inappropriate exercise recommendations 64,65,71 and a lack of physical opportunities for overweight children in the traditional school environment. 42 In addition, emotional problems further may inhibit successful motivation of sedentary children. 1,38,64

Background: Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. Resistance or strength training has been prescribed for adult obese persons. Research is limited concerning the use of resistance training in programs that treat obese preadolescents. Methods: Nineteen treatment subjects (7-12 years of age) were enrolled in a 1 O-week weight management program which included diet, behavior modification, and aerobic and flexibi lity exercises. Forty-eight control subjects (7-12 years of age) participated in the diet, behavior modification program, and a thrice-a-week walking program. The efficacy of the overall weight management program was examined by anthropometry at 10 weeks and 1 year. Results: Fifteen treatment subjects completed the 10-week program (retention rate, 78.9%). Thereafter compliance decreased by approximately 33% for the long-term study. Seventeen control subjects completed the program (retention rate, 35%). Weight, percent of ideal body weight, and body mass index were reduced significantly at 10 weeks (P and did not increase significantly at 1-year follow-up in both treatment and control groups. Height increased significantly at 1 year in both treatment and control subjects. In the treatment subjects, percent fat decreased significantly (p P > 0.05). Conclusions: A resistance-training program may be included safely in a multidisciplinary weight management program for obese preadolescent male and female children. The addition of specific exercise regimes such as resistance training may improve program retention especially in severely obese youth.

Peak cardiorespiratory responses, physical activity patterns, and the association of VO2peak and physical activity were examined in 16 elementary (ES) and 16 high school (HS) females. Peak responses were assessed during treadmill running, and physical activity patterns were examined over two 12-hour weekdays. Results indicated similar relative VO2peak responses between groups (ES: M = 46.8 ml · kg−1 · min−1;HS:M = 46.6 ml · kg−1 · min−1). No statistical differences (p ≤ .05) were noted when moderate to vigorous physical activity (MVPA) and vigorous physical activity (VPA) were compared. Also, a three-way (Group × HR level × Sustained minutes) ANOVA revealed no statistical differences. A median correlation (r = .27) was found from 8 independent correlations of habitual physical activity and VO2peak. ES and HS appeared similar in regard to VO2peak, accumulative and sustained MVPA and VPA. Low levels of sustained MVPA and VPA (≥ 10 min) were evident in both groups.

Childhood overweight and obesity have increased over the past decades1 with children residing in rural areas and those of ethnic minority status being disproportionally impacted.2 Childhood overweight and obesity have been associated with negative physical health outcomes, decreased quality of life, and psychological distress.3,4 In response, childhood overweight and obesity have been identified as a pressing public health problem, leading to calls for increased efforts to treat and prevent childhood obesity.3,5 School-based settings may be an effective location to conduct prevention and intervention activities. However, many schools, under pressure to increase academic achievement, have decreased or eliminated recess and physical education6 and may hesitate to spend instructional time on nutrition education or interventions. Research is warranted to investigate potential associations among childhood overweight and obesity, physical activity, and academic achievement to address constraints in schools. Adiposity and Academic Achievement Different methods have been used to assess adiposity, including self-reported or directly-measured height and weight, used to calculate body mass index (BMI), or percentage body fat, and academic achievement, including self-reported grade point average (GPA), teacher-assigned GPA, or standardized test scores. Research findings have been equivocal concerning the association between adiposity and academic achievement and these differing methodologies may account for the divergent findings. An inverse association has been found in studies utilizing BMI calculated with self-reported data and academic achievement; however, this association has been weak or inconsistent across demographic groups. For example, Sabia7 found a negative body weight-achievement relation for white girls, but not for nonwhite girls or boys of any ethnic group. Results were statistically significant, but a 50–60 pound (22.7 to 27.3 kg) weight increase was associated with only a 0.2 GPA reduction. Reliance on self-reported data for BMI and academic achievement is a limitation. Children and adolescents can be inaccurate reporters of BMI8 and academic performance9 and method bias also may limit self-report. In support, Huang et al. found different results in the same sample, depending on measurement of achievement. Overweight status was inversely related to achievement in middle school children, but only for self-reported grades. There was no BMI-achievement relation for teacher-reported grades.10 Recognizing these limitations, researchers have used standardized measurements of weight and achievement and found negative and significant, yet weak, correlations. Obese status was related to lower test scores in kindergarten in a national sample, but the correlation weakened or disappeared when SES and other variables were controlled.11 Datar and Sturm12 examined change in weight from kindergarten to third grade with three groups: never overweight, became overweight, and always overweight. Girls who became overweight had significantly lower test scores than girls who had never been overweight, although parental income and education were more strongly related to achievement than weight status change. There were no differences between girls who had always been overweight and those who had never been overweight, or any significant results for boys.12 These results did not support a strong inverse association between weight and academic achievement. Any correlation between adiposity and academic achievement may be attributed to mediator variables, such as weight bias or teasing. One study examined weight and academic achievement in a middle school sample using teacher-assigned GPA and a standardized reading assessment. Lower achievement was found for teacher-assigned grades, but not for the reading test.13 Overweight students may have been assigned lower grades by teachers due to weight bias; in support of this possibility, researchers have documented weight bias in educators, e.g., negative beliefs about obese children.3 Concerning negative peer interactions, Krukowski et al. found a weak, yet significant relationship between BMI and parent-reported grades in girls, but not boys. When weight-based teasing was added to the model, the BMI-grade association disappeared, indicating that weight-bias teasing functioned as a mediator variable.14 Physical Activity Research on the relation between physical activity and academic achievement has also yielded inconsistent findings across studies. Also, similar to the adiposity-achievement research, studies on the relationship between physical activity and academic achievement have used different methods to assess both variables. Some studies with self-reported physical activity have reported a positive association. For instance, Stevens et al.15 investigated parent- and school-reported physical activity and test scores in a national sample and found a small, yet significant correlations (r = 0.11 to 0.16) between parent-reported physical activity and test performance, but not school-based physical education (r = 0.01 to 0.04). Conversely, other studies found weak negative associations (r = −0.03 to −0.07) between physical activity and achievement.16,17 These equivocal findings may be related to the questionable reliability and validity of self- and parent-report for children. Developmental differences between adults and children, including children’s different concepts of time; sensitivity to socially desirable responding; and difficulty separating behavioral intentions and actual behavior, may decrease the psychometric properties of self-report.18 In support, a review of assessment methods revealed that self- and parent-reports overestimated physical activity compared to accelerometry and heart rate monitoring.18 Randomized controlled trials (RCT) designed to increase physical activity during school have examined changes in academic achievement. Some studies have found that physical activity interventions in schools do not lead to improved academic achievement.19–21 Conversely, one RCT found greater achievement gains for intervention schools than control schools across three years.22 Overall, evidence suggests that time spent in physical activity does not result in academic decline and may be associated with gains. Several mechanisms for the physical activity-achievement link have been proposed. For example, the executive functioning hypothesis posits that physical activity improves executive functioning, as well as other neuropsychological processes, such as processing speed and visual-spatial processing. These improved functions enable children to develop behaviors necessary for academic achievement, such as planning, metacognition, attention, and behavioral self-control.23 Other psychological constructs, such as depression and self-esteem, may also serve as mediators of the physical activity-achievement association. However, Tomporowski et al. recently noted that there is no strong theory underlying any association between exercise and cognition.23 Current Study Recent studies have reported that the connection between childhood overweight and obesity and reduced achievement has been unequivocally supported in the literature (e.g., Cho et al.24). However, the evidence for this association is mixed and leans towards no meaningful association between adiposity and academic achievement. Studies that found a stronger inverse relation generally relied on self-report. Those with objective assessment have found either weak correlations or that significant correlations are diminished when other variables, such as SES, are statistically controlled. Nonetheless, the hypothesis that being overweight or obese is associated strongly with diminished academic achievement persists. Similarly, studies of physical activity and academic achievement are limited by methodological weaknesses, such as reliance on self-report and different operational definitions of physical activity, and results are mixed. A recent review of the literature concluded that research using accelerometry to measure physical activity is needed to test the hypothesis that higher levels of physical activity are associated with higher academic achievement.25 In conclusion, the associations among adiposity, physical activity and academic achievement in children are unclear due to conflicting findings and differences in methodological rigor. The primary aims of this cross-sectional study were to test the following two hypotheses in a relatively large sample of elementary school students using objective measurement of body weight, academic achievement, and physical activity: 1) there is a negative correlation between adiposity (defined by body mass index percentile and percent body fat) and academic achievement and 2) physical activity is positively correlated with academic achievement.

BackgroundChildhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown.Methods and resultsThe sample included 385 children 5-18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels >3 mg/L to those with levels ≤ 3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2-6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences.ConclusionsChildren living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty.

Insulin sensitivity is impaired and ectopic fat (accretion of lipids outside of typical adipose tissue depots) increased in obese adults and adolescents. It is unknown how early in life this occurs; thus, it is important to evaluate young children to identify potential factors leading to the development of metabolic syndrome. We examined an ethnically diverse cohort of healthy, exclusively prepubertal children (N = 123; F = 57, M = 66; age 8.04 ± 0.77 years) to examine differences in insulin sensitivity and ectopic and visceral fat deposition between obese and nonobese youth. Obesity was categorized by age- and sex-adjusted BMI z-scores (nonobese = z-score

The multidisciplinary, four-phase approach, which includes PSMF, BEM, and MPE is successful in treating mild, moderate, and severe degrees of childhood and adolescent obesity. The MPE program is appropriate for use with PSMF and BEM due to its progressive nature, variety of options, and moderate intensity level. In addition, the MPE program is of sufficient intensity, duration, and frequency to promote a significant increase in estimated aerobic capacity (VO2max) and to promote the maintenance of lean body mass and resting energy expenditure. The short-term intervention of PSMF, BEM, and MPE also results in an improvement in body composition, lipid profiles, and IGF-1 and T3 levels. The 1200-calorie balanced diet, MPE, and BEM also provide a successful method of weight maintenance in children and adolescents, as indicated by further improvement in body composition at the 26-week measure. Additional studies are needed to assess the contribution of exercise to the maintenance of lean body mass and resting energy expenditure in obese children and adolescents. In addition, it will be important to assess long-term weight maintenance in obese adolescents who effectively lose weight in this multidisciplinary program.

Purpose.To examine the influence of an environmental intervention to prevent excess weight gain in African-American children.Design.Single-group repeated measures.Setting.The intervention was delivered to a school composed of African-American children.Participants.Approximately 45% (N = 77) of enrolled second through sixth grade students.Intervention.The 18-month intervention was designed to alter the school environment to prevent excess weight gain by making healthier eating choices and physical activity opportunities more available.Measures.Body mass index percentile was the primary outcome variable. Body mass index z score was also calculated, and percent body fat, using bioelectrical impedance, was also measured. Total caloric intake (kilocalories) and percent kilocalories from fat, carbohydrate, and protein were measured by digital photography. Minutes of physical activity and sedentary behavior were self-reported.Analysis.Mixed-models analysis was used with covarying baseline values.Results.Boys maintained, whereas girls increased, percent body fat over 18 months (p = .027). All children decreased percent of kilocalories consumed from total and saturated fat and increased carbohydrate intake and self-reported physical activity during the intervention (p < .025). Body mass index z score, sedentary behavior, and total caloric intake were unchanged.Conclusion.The program may have resulted in maintenance of percent body fat in boys. The percent body fat in girls steadily increased, despite similar behavioral changes as boys. School-based interventions targeting African-American children should investigate strategies that can be effective across gender.

The prevalent surge in childhood and adolescent obesity within the past 3 decades poses a significant challenge for many pediatric clinicians who are charged with treating this condition. The need for comprehensive, research-based pediatric obesity treatment programs are essential in addressing this problem and preventing the transition of obesity and its many co-morbidities into adulthood. This paper will identify dietary, physical activity, and behavioral approaches to lifestyle change and describe how they are incorporated as part of multidisciplinary treatment interventions in youth. Specific tailoring of treatment programs to address age and varying degrees of overweight and obesity will also be presented along with recommendations for future research.

Background:Parks provide environments for physical activity, yet little is known about how natural disasters affect them or how these disasters alter physical activity. Our objectives were to (1) describe the development of an instrument to assess park conditions following a hurricane and (2) document the conditions of New Orleans’ parks 3 and 6 months after Hurricane Katrina.Methods:A Post-Hurricane Assessment (PHA) instrument was developed and implemented in 54 parks 3 and 6 months post-hurricane.Results:Summary scores of the Park Damage Index and the Neighborhood Damage Index showed improvement between 3 and 6 months of data collection. Parks and neighborhoods most affected by the hurricane were located in the most- and least-affluent areas of the city.Conclusion:The PHA proved to be a promising tool for assessing park conditions in a timely manner following a natural disaster and allowed for the creation of summary damage scores to correlate to community changes.

This study examined energy expenditure and physiologic determinants for marathon performance in recreational runners. Twenty recreational marathon runners participated (10 males aged 41 +/- 11.3 years, 10 females aged 42.7 +/- 11.7 years). Each subject completed a V(.-)O2max and a 1-hour treadmill run at recent marathon pace, and body composition was indirectly determined via dual energy X-ray absorptiometry. The male runners exhibited higher V(.-)O2max (ml x kg(-1) x min(-1)) values (52.6 +/- 5.5) than their female counterparts (41.9 +/- 6.6), although ventilatory threshold (T-vent) values were similar between groups (males: 76.2 +/- 6.1 % of V(.-)O2max, females: 75.1 +/- 5.1%). The male runners expended more energy (2,792 +/- 235 kcal) for their most recent marathon as calculated from the 1-hour treadmill run at marathon pace than the female runners (2,436 +/- 297 kcal). Body composition parameters correlated moderately to highly (r ranging from 0.50 to 0.87) with marathon run time. Also, V(.-)O2max (r = -0.73) and ventilatory threshold (r = -0.73) moderately correlated with marathon run time. As a group, the participants ran near their ventilatory threshold for their most recent marathon (r = 0.74). These results indicate the influence of body size on marathon run performance. In general, the larger male and female runners ran slower and expended more kilocalories than smaller runners. Regardless of marathon finishing time, the runners maintained a pace near their T-vent, and as T-vent or V(.-)O2max increased, marathon performance time decreased.

BACKGROUND. Adolescent obesity is a major public health problem. Treatment options in addition to behavioral therapy could include pharmacotherapy with sibutramine. OBJECTIVES. Concerns regarding increases in blood pressure and heart rate after sibutramine treatment in some adult patients precipitated the present analysis, which evaluated the cardiovascular safety of sibutramine plus a behavioral therapy program in obese adolescents. PATIENTS AND METHODS. With this 12-month, randomized, double-blind, placebo-controlled trial in 33 US clinics we studied 498 adolescents aged 12 to 16 years with multiethnic backgrounds and BMIs of 28.1 to 46.3 kg/m2. RESULTS. The subjects were randomly assigned to behavioral therapy plus 10 mg of sibutramine or behavioral therapy plus placebo daily. At the end point, there was a mean treatment group difference in BMI of 2.6 kg/m2 in favor of sibutramine. Small mean decreases in blood pressure and pulse rate were seen in both sibutramine and placebo groups at the end point (systolic blood pressure: −2.1 vs −2.1 mmHg; diastolic blood pressure: −0.1 vs −1.1 mmHg; pulse rate: −0.2 vs −1.8 bpm). In both treatment groups, these reductions in vital signs were greater at the end point when BMI reduction was ≥5% compared with CONCLUSIONS. Sibutramine may have some direct cardiovascular effects on obese adolescents. These cardiovascular effects may be balanced by a reduction in BMI, which, in adolescents, seems to be greater than that observed in adults.

Objective: The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol, tobacco, and drugs. Research Methods and Procedures: A total of 670 second to sixth grade students from four schools were enrolled in the study. The study spanned 2 academic years, and 586 students were available for evaluation at the end of the study. Two schools were randomly assigned to each treatment arm. The environmental approach for weight gain prevention focused on modification of eating habits and physical activity, and the active control group focused on modification of expectancies related to substance use. Results: Using an intention to treat design, the study found no differences in weight gain prevention between the two interventions. The weight gain prevention program was associated with reduction of total caloric intake, reduction of dietary fat intake, reduction of protein intake, and increased physical activity in comparison with the active control group and relative to baseline. These changes in food intake were attributed to changes in food selections that resulted from modification of school cafeteria menus and food preparation. Discussion: The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm. Recommendations for future research are provided.

Over 15% of children 6–11 yr old and adolescents 12–19 yr old in the United States are overweight (17). Among adolescent girls, the prevalence of overweight was reported as 15.5% in the 1999–2000 National Health and Nutrition Examination Survey (NHANES), compared with 9.7% in NHANES III (1988–1994) (17). Boys are generally more likely to be overweight and at risk than girls (11). However, African American girls have significantly higher rates of overweight than boys, and in Native American children no gender differences are apparent (6). In the simplest terms, overweight occurs when there is an imbalance between energy intake and energy expenditure. However, because physical activity is a highly variable component of energy expenditure, its relationship to weight status is not clearly understood, especially in female youth. Regardless, it is generally well accepted that lower than desirable energy expenditure, because of low physical activity, is a contributing factor to the recent increase in childhood overweight and obesity. Previous studies have examined the relationship between childhood weight or body composition and physical activity (9,10,15,16). Higher levels of physical activity were associated with lower levels of weight or body fat in several studies (9,16,24). Physical activity estimated by a questionnaire, but not activity energy expenditure (derived by doubly labeled water), was inversely related to body fat in children (10). The findings across studies likely differ because of differences in measurement techniques for body composition, physical activity and energy expenditure, and whether the focus is on an estimate of total physical activity or the energy cost of activity. Overweight/obesity can be determined by simple anthropometric measures (body mass and height) or by body composition techniques (e.g., skinfolds, bioelectric impedance, or dual-energy x-ray absorptiometry). Physical activity can be measured through self-reports (diaries and questionnaires) or more objectively, by accelerometry or doubly-labeled water. Accelerometers can quantify total activity over several days, and intensity can be characterized by utilizing previously established accelerometer thresholds for sedentary, light, moderate, and vigorous activity (26). Combining measures of body composition with accelerometry provides a unique way to explore relationships among body fatness, fat-free mass, and physical activity. Our purpose for the present analysis was to examine the nature of the relationship (linear, curvilinear) of body composition (size, fat mass, fat-free mass) to physical activity as assessed in sixth grade girls. Because physical activity is the primary outcome in the TAAG trial, we wanted to establish baseline relationships between physical activity (dependent variable) and body composition (independent variable). Specifically, we examined whether components of body composition were associated to moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA), and MET-weighted physical activity using a large sample of girls from across the United States. This paper presents the baseline body composition and physical activity (as measured by accelerometry) of girls enrolled in The Trial of Activity for Adolescent Girls (TAAG), a multisite school- and community-based intervention designed to prevent the decline in physical activity in adolescent girls.