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Introduction: Spain is the European leader in overweight (O-W), partly to the social and environmental changes of the last decades. The objective of the work was to study the modifiable risk factors that lead to O-W. Material and methods: A self-designed questionnaire with factors related to childhood obesity was produced, and was administered to the parents of adolescents who were attending first year of high school in four centres in Health Area V in Murcia. Weight, height, abdominal circumference and Waist-Height Index (WHI) of the students were measured, and classified as overweight-obesity. A reduction technique was applied, generating factors that grouped the items according to subject, as well as a multivalent technique to assess the dependency relationship between the variables, and the SB-OI. Results: Of the 421 students included, 28% and 35% had excess weight and abdominal obesity, respectively. The factor analysis grouped the items into 4 factors: diet, physical activity, technologies, and environment, with a subsection about body perception. The structural equation model presented an R2 of 0.440. The highest relationship was obtained with the environment factor (t 2.89), and perception (t 14.61), followed by the use of technologies. A direct relationship was also revealed regarding diet and physical activity, although not significant. Conclusions: Family perception and the social-school environment have an important influence on the development of the O-W. Health education interventions involving parents and teachers are probably the smartest and most cost-effective strategies. Resumen: Introducción: España se sitúa a la cabeza europea en exceso de peso (EP) debido en parte a los cambios sociales y ambientales de las últimas décadas. El objetivo del trabajo fue estudiar los factores de riesgo modificables que condicionan el EP. Material y métodos: Se autodiseñó una encuesta con los factores relacionados con la obesidad infantil y se administró a los padres de adolescentes que cursaban primero de secundaria en cuatro centros del Área V de Salud de Murcia. Se objetivó peso, talla, perímetro abdominal e Índice Cintura-Talla (ICT) de los alumnos y se clasificaron en sobrepeso-obesidad. Se aplicó técnica de reducción de dimensiones, generando factores que agruparon los ítems según materia y se realizó técnica multivalente para valorar la relación de dependencia entre las variables y el exceso de peso. Resultados: Fueron incluidos 421 alumnos, 28% y 35% con exceso de peso y obesidad abdominal, respectivamente El análisis factorial agrupó los ítems en 4 factores: alimentación, actividad física, tecnologías y entorno, existiendo un subapartado de percepción corporal. El modelo de ecuaciones estructurales presentó un R2 de 0.440. Se obtuvo la mayor relación con el factor entorno (t 2.89), y percepción (t 14.61), seguido del uso de tecnologías. Además reveló una relación directa respecto a la alimentación y la actividad física, aunque no significativa. Conclusiones: La percepción familiar y el ambiente social-escolar influyen de forma importante en el desarrollo del EP. Las intervenciones de educación para la salud con inclusión de padres y profesores probablemente sean las estrategias más inteligentes y rentables.

Resumen: Introducción: España se sitúa a la cabeza europea en exceso de peso (EP) debido en parte a los cambios sociales y ambientales de las últimas décadas. El objetivo del trabajo fue estudiar los factores de riesgo modificables que condicionan el EP. Material y métodos: Se autodiseñó una encuesta con los factores relacionados con la obesidad infantil, y se administró a los padres de adolescentes que cursaban primero de secundaria en 4 centros del Área V de Salud de Murcia. Se objetivó el peso, talla, perímetro abdominal e índice cintura-talla (ICT) de los alumnos, y se clasificaron en sobrepeso-obesidad. Se aplicó la técnica de reducción de dimensiones, generando factores que agruparon los ítems según materia, y se realizó una técnica multivalente para valorar la relación de dependencia entre las variables y el EP. Resultados: Fueron incluidos 421 alumnos, el 28 y el 35% con EP y obesidad abdominal, respectivamente. El análisis factorial agrupó los ítems en 4 factores: alimentación, actividad física, tecnologías y entorno, existiendo un subapartado de percepción corporal. El modelo de ecuaciones estructurales presentó un R2 de 0,440. Se obtuvo la mayor relación con el factor entorno (t 2,89) y percepción (t 14,61), seguido del uso de tecnologías. Además, reveló una relación directa respecto a la alimentación y la actividad física, aunque no significativa. Conclusiones: La percepción familiar y el ambiente social-escolar influyen de forma importante en el desarrollo del EP. Las intervenciones de educación para la salud con inclusión de padres y profesores probablemente sean las estrategias más inteligentes y rentables. Abstract: Introduction: Spain is the European leader in over weight (O-W), partly to the social and environmental changes of the last decades. The objective of the work was to study the modifiable risk factors that lead to O-W. Material and methods: A self-designed questionnaire with factors related to childhood obesity was produced, and was administered to the parents of adolescents who were attending first year of high school in four centres in Health Area V in Murcia. Weight, height, abdominal circumference and Waist-Height Index (WHI) of the students were measured, and classified as overweight-obesity. A reduction technique was applied, generating factors that grouped the items according to subject, as well as a multivalent technique to assess the dependency relationship between the variables, and the SB-OI. Results: Of the 421 students included, 28 and 35% had excess weight and abdominal obesity, respectively. The factor analysis grouped the items into 4 factors: diet, physical activity, technologies, and environment, with a subsection about body perception. The structural equation model presented an R2 of 0.440. The highest relationship was obtained with the environment factor (t 2.89), and perception (t 14.61), followed by the use of technologies. A direct relationship was also revealed regarding diet and physical activity, although not significant. Conclusions: Family perception and the social-school environment have an important influence on the development of the O-W. Health education interventions involving parents and teachers are probably the smartest and most cost-effective strategies.

In Spain, childhood obesity is worrying, and its development might be influenced by the family setting. The objectives were to determine the prevalence of excess weight among adolescents, evaluate family variables that could affect it, and determine parents' body perception.Cross-sectional study; students from five secondary schools in health area V of the Region of Murcia were included. Students' anthropometric measurements were recorded and a survey was administered to parents, including variables such as weight, height, exercise, level of education, family structure, and body perception. The analysis was done using contingency tables and the association with Somers' D measures.Four hundred and twenty one students participated (age: 12.8 ± 0.6 years old); 21.1 % were overweight and 19.5 %, obese. There was an association between parent and child excess weight (Somers' D with a p value0.05). If both parents had a sedentary lifestyle, their children would exercise less. The higher the level of parental education, the lower the rate of childhood overweight (p0.05). Overweightobesity among children was higher in separated or single-parent families. In total, 32 % of parents misperceived their children's excess weight and 53 %, their own.In this sample, the prevalence of excess weight was 40.6 %. Parents' nutritional status, level of education, and family structure were associated with childhood obesity. Mothers had a greater influence on the development of their children's overweight. Parents underestimated obesity.es preocupante y el entorno familiar puede influir en su desarrollo. Los objetivos fueron determinar la prevalencia de exceso de peso en adolescentes, evaluar variables familiares que pudieran condicionarla y determinar la percepción corporal de los padres. Población y métodos. Estudio transversal; se incluyeron alumnos de cinco centros de secundaria del Área V de Murcia. Se registró antropometría de los alumnos y se administró una encuesta a los padres con variables de peso, talla, ejercicio, estudios, tipo de familia y percepción corporal. Se realizó el análisis mediante tablas de contingencia y asociación con d de Somers. Resultados. Participaron 421 alumnos (edad: 12,8 ± 0,6 años); el 21,1 % tenían sobrepeso, y el 19,5 %, obesidad. Existió asociación entre padres e hijos con sobrecarga ponderal (d de Somers con p0,05). Si ambos padres eran sedentarios, sus hijos realizaban menos ejercicio. A mayor nivel de estudios parental, menor tasa de sobrepeso infantil (p0,05). El sobrepeso-obesidad en los hijos fue mayor en familias separadas o monoparentales. El 32 % de los padres no percibía el exceso de peso de sus hijos ni el 53 % en sí mismos. Conclusiones. La prevalencia de exceso de peso en esta muestra fue del 40,6 %. El estado nutricional de los padres, el nivel de estudios y el tipo de familia se asociaron con la obesidad infantil. Influyó en mayor medida la figura materna. Existió una infraconsideración de la obesidad por parte de los padres.

Aim: To describe the implementation process and effect of a quality-improvement intervention aimed at achieving compliance with the Baby-friendly Hospital Initiative (BFHI). Methods: We conducted a prospective study of the development and evaluation of a quality-improvement intervention at the Yecla Hospital, Spain. A random sample of 1273 infants born in the hospital was followed up in primary care centres between 1997 and 2005. The study interventions were process-oriented training, audit and feedback, quality-improvement cycles and provision of breastfeeding support resources. The main outcome measures were changes in compliance with the Global Criteria for the BFHI and breastfeeding rates before, during and after the intervention. Results: Compliance with the Global Criteria increased progressively, and in 2004 all criteria were met. The median duration of breastfeeding went up gradually from the start of the intervention. The likelihood of being breastfed at different ages among infants born in 2005 was between 45% [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38–0.79] and 86% (OR 0.14; 95% CI 0.09–0.20) higher than among infants born in 1997. Conclusion: Quality-improvement interventions based on participation, training, audit and feedback of information, and provision of resources are useful for the implementation of the BFHI, which is associated with a significant increase in breastfeeding rates.

To describe the implementation process and effect of a quality-improvement intervention aimed at achieving compliance with the Baby-friendly Hospital Initiative (BFHI).We conducted a prospective study of the development and evaluation of a quality-improvement intervention at the Yecla Hospital, Spain. A random sample of 1273 infants born in the hospital was followed up in primary care centres between 1997 and 2005. The study interventions were process-oriented training, audit and feedback, quality-improvement cycles and provision of breastfeeding support resources. The main outcome measures were changes in compliance with the Global Criteria for the BFHI and breastfeeding rates before, during and after the intervention.Compliance with the Global Criteria increased progressively, and in 2004 all criteria were met. The median duration of breastfeeding went up gradually from the start of the intervention. The likelihood of being breastfed at different ages among infants born in 2005 was between 45% [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38-0.79] and 86% (OR 0.14; 95% CI 0.09-0.20) higher than among infants born in 1997.Quality-improvement interventions based on participation, training, audit and feedback of information, and provision of resources are useful for the implementation of the BFHI, which is associated with a significant increase in breastfeeding rates.