Wendelin Slusser

A retrospective medical chart review was conducted of patients enrolled in the Fit for Healthy Weight Clinic (Fit Clinic). At initial evaluation, comorbidities were identified by the patient and pediatrician. The number of comorbidities increased with age among patients. In reviewing the differences among the number of identified comorbidities among grade school age and adolescent patients, increases of 30% were observed in gastrointestinal-associated, 23% in psychiatric, 18% in endocrine, 16% in cardiovascular, and 14% in respiratory comorbidities. Fit Clinic patients already manifest many known obesity-related comorbidities as evidenced in identified conditions and abnormal laboratory values. The elevated blood pressures, blood glucose, and cholesterol levels raise concern for the future development of coronary artery disease and type 2 diabetes mellitus. With an average of five obesity-related comorbidities, Fit Clinic patients already have more comorbidities than what is evidenced in large US population-based studies, demonstrating that solely addressing body mass index is not sufficient.

Parents are in an ideal position to promote long-term healthy dietary behaviours for their children. This study aimed to determine parent and child characteristics and to test their associations in a cross-sectional sample of urban low-income, low-education Latino immigrants with preschool-age children. Also determined were family demographic characteristics, child feeding practices, parent nutrition knowledge, parent fruit and vegetable consumption, and child Body Mass Index (BMI). Our analysis shows several significant associations: (1) lower parent nutrition knowledge and less healthy child feeding practices (increased pressure, p = 0.017 and increased restrictions, p = 037); (2) higher parent vegetable consumption and healthier child feeding practices (more responsibility for the types and amount of food eaten, p = 0.022, and less restrictions on child eating, p = 0.030); and (3) a significant difference by child gender, such that parents of girls with higher BMIs for their age group being more concerned about their daughter's weight (p = 0.004) and practising healthier feeding practices, that is, less pressure (p = 0.008). Our findings support promoting healthy eating within the context of the family, and contribute to a growing literature on preschool parent–child feeding practices. Understanding the practices of immigrant Latino parents can help researchers and practitioners develop culturally appropriate interventions to address childhood obesity.

OBJECTIVE: The Reimbursement and Payment Subcommittee of the National Association of Children's Hospitals and Related Institutions FOCUS on a Fitter Future group sought to guide medical providers, patients, and payers to better serve obese children and adolescents to enable optimum health. Recommendations are provided for the essential components of a stage 3 comprehensive multidisciplinary intervention program as defined by the 2007 Expert Committee recommendations. In addition, suggestions are offered for a stepwise approach to implement these recommendations. METHODS: In 2009, key informant interviews were conducted with 15 children's hospitals participating in FOCUS on a Fitter Future and 1 nonparticipating hospital. Interview transcripts identified 5 financially sustainable stage 3 programs, each funded differently. RESULTS: The stage 3 programs interviewed ranged from being nascent to 21 years old (27%, 6 years). All of them had multidisciplinary teams that delivered services through 1 of 3 institutional structures: 60% freestanding; 7% specialty; and 33% hospital within a hospital. One-third of them had 1 to 2 funding sources, and 67% had ≥3 sources. CONCLUSIONS: The stage 3 programs in this review shared some common strategies for achieving financial stability. All of them followed key strategies of the chronic care model, the details of which led to the following recommendation: stage 3 programs should include a health care team with a medical provider, registered dietitian, physical activity specialist, mental health specialist, and coordinator who, as a team, provide service to overweight and obese children at no less than moderate intensity (26–75 hours).

Obesity among US children has increased in recent years. Although increased fruit and vegetable consumption has not been directly linked to obesity prevalence, it has been posited that more fruits and vegetables (FV) could reduce the consumption of high-fat, energy-dense foods and may protect against childhood illnesses including asthma and other respiratory diseases. The purpose of this current research was to assess the impact of a large public school district's hybrid approach to nutrition education programming on attitudes, beliefs, and behaviors related to fruit and vegetable consumption. A total of 12 elementary schools from the Los Angeles Unified School District (9 intervention schools, 3 control schools) were randomly selected to participate in a "hybrid" school-based nutrition education program. Data were collected at baseline (beginning of school year) and postintervention data (end of school year 9 months later). Linear mixed models were developed to assess the impact of the intervention. The intervention resulted in a significant change in teacher influence on students' attitudes toward FV (p < .05) and students' attitudes toward vegetables (p < .01), even after adjusting for gender, grade, and race/ethnicity. Although not statistically significant, there was a slight increase in fruit and vegetable consumption from pretest to posttest for both the intervention and control schools. The hybrid model reflects a more accurate representation of school-based interventions. More research is needed to identify the specific components of this model that are most successful in impacting fruit and vegetable consumption among US children.

ObjectiveThe present study was undertaken to learn more about parents’ (i) knowledge regarding healthy foods, factors associated with food purchasing and preparation, and current nutrition education resources, (ii) barriers to and promoters for establishing healthy eating habits for children and families, and (iii) interest in participating in nutrition interventions.DesignFocus group interviews were conducted with parents of low-income children from the Los Angeles Unified School District (LAUSD).SettingLAUSD Title 1 elementary schools where 50 % or more of students are eligible for free/reduced-price meals.SubjectsSixty-four parents (93 % female; 84 % Hispanic/Latino) of elementary-school students.ResultsThe most common barriers to eating healthy foods were cost, difficulty in getting children to eat healthier foods and easy access to fast food. Parents had a basic knowledge about what foods are healthy and received most of their nutrition education through the media. Parents expressed a desire for nutrition classes and almost all of them said they would attend a nutrition programme at their child's school. Topic areas of interest included what to purchase, how to cook healthier foods, how to encourage their children to eat healthier and how to read food labels. Parents also requested classes that engage the whole family, especially fathers.ConclusionsParents in our study were interested in participating in nutrition education programmes. The information from these focus groups was used to design a parent nutrition education programme especially designed to respond to the needs of the LAUSD parents, the majority of whom are low-income and Hispanic/Latino.

Rates of overweight children and adolescents have nearly tripled over the past 30 years. Many barriers exist to healthy eating and physical activity for children and adolescents, including factors in the school and community environment. It is these modifiable school environmental factors that led to the development of the Nutrition Friendly Schools and Communities (NFSC) model to prevent the development of overweight in children and adolescents. Development of the NFSC model built upon the Coordinated School Health Program, the Baby Friendly Hospital Initiative, Participatory Research, and Empowerment Evaluation. The purpose of the NFSC environmental intervention is to actively engage the school community to prevent overweight in students through a multi-level participative intervention that facilitates coordinated changes in the school environment in the following areas: health education, physical education, health services, food services, school policy, staff wellness, psychosocial services, and family/community involvement. The NFSC model is the basis by which school communities develop a plan and evaluation that lead to a healthy school environment and prevent the development of overweight in children. A pilot study of the NFSC model is currently being conducted in eight low—income, minority, urban schools. This paper describes the development of the NFSC model and criteria.