Katherine W. Bauer

“How Can We Stay Healthy when you’re Throwing All of this in Front of Us?” Findings from Focus Groups and Interviews in Middle Schools on Environmental Influences on Nutrition and Physical Activity

This study aimed to identify factors in school physical and social environments that may facilitate or compete with programs and policies to improve student physical activity and nutrition. Focus groups and interviews were conducted with students, faculty, and staff of two public middle schools. Participants identified numerous aspects of the school environments as significant. Competition, teasing and bullying, time, and safety were described as major barriers for students to be physically active during physical education class, on sports teams, and before and after school. The quality of the food served, easy access to nonnutritious snacks, limited time for lunch period, and weight concerns emerged as significant reasons why students do not eat nutritious meals in school. When developing programs and policies to improve the health of students, environmental influences that undermine efforts to improve student health behaviors must be addressed.

Do youth sports prevent pediatric obesity? A systematic review and commentary

Sport is a promising setting for obesity prevention among youth, but little is known about whether it prevents obesity. We reviewed research comparing sport participants with nonparticipants on weight status, physical activity, and diet. Among 19 studies, we found no clear pattern of association between body weight and sport participation. Among 17 studies, we found that sport participants are more physically active than those who do not participate. We found seven studies that compared the diet of sport participants with non-participants. These studies reported that youth involved in sport were more likely to consume fruits, vegetables, and milk, and also more likely to eat fast food and drink sugar-sweetened beverages and consume more calories overall. It is unclear from these results whether sports programs, as currently offered, protect youth from becoming overweight or obese. Additional research may foster understanding about how sport, and youth sport settings, can help promote energy balance and healthy body weight.

Energy Content of U.S. Fast-Food Restaurant Offerings 14-Year Trends

BACKGROUND Within the past decade, there has been increasing attention to the role of fast food in the American diet, including a rise in legislative and media-based efforts that address the healthfulness of fast food. However, no studies have been undertaken to evaluate changes in the energy content of fast-food chain restaurant menu items during this period. PURPOSE To examine changes in the energy content of lunch/dinner menu offerings at eight of the leading fast-food chain restaurants in the U.S. between 1997-1998 and 2009-2010. METHODS Menu offerings and nutrient composition information were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database. Nutrient composition information for items was updated biannually. Changes in median energy content of all lunch/dinner menu offerings and specific categories of menu items among all restaurants and for individual restaurants were examined. Data were collected between 1997 and 2010 and analysis was conducted in 2011. RESULTS Spanning 1997-1998 and 2009-2010, the number of lunch/dinner menu items offered by the restaurants in the study increased by 53%. Across all menu items, the median energy content remained relatively stable over the study period. Examining specific food categories, the median energy content of desserts and condiments increased, the energy content of side items decreased, and energy content of entrées and drinks remained level. CONCLUSIONS Although large increases in the number of menu items were observed, there have been few changes in the energy content of menu offerings at the leading fast-food chain restaurants examined in this study.

Body satisfaction during pregnancy

The current study examines how body satisfaction of pregnant women compares to that of nonpregnant women. The sample included 68 pregnant and 927 nonpregnant young women who participated in a population-based longitudinal study examining eating and weight concerns in young adults. Body satisfaction was assessed using a 10-item modified version of the Body Shape Satisfaction Scale. The longitudinal design allowed for the assessment of body satisfaction among women both prior to and during their pregnancy. Mean body satisfaction was higher in pregnant women (32.6, 95% CI: 30.7-34.5) than nonpregnant women (29.6, 95% CI: 29.1-30.1) with moderate effect size 0.32, after adjusting for body satisfaction and body mass index prior to pregnancy, indicating that pregnant women experienced a significant increase in body satisfaction from the time prior to their pregnancy (p=.003) despite weight gain. These findings have important implications for clinicians delivering weight-related messages to women during pregnancy.

Youth dietary intake and weight status: Healthful neighborhood food environments enhance the protective role of supportive family home environments

The aim of this study is to investigate individual and joint associations of the home environment and the neighborhood built environment with adolescent dietary patterns and body mass index (BMI) z-score. Racially/ethnically and socioeconomically diverse adolescents (n=2682; 53.2% girls; mean age14.4 years) participating in the EAT 2010 (Eating and Activity in Teens) study completed height and weight measurements and surveys in Minnesota middle and high schools. Neighborhood variables were measured using Geographic Information Systems data. Multiple regressions of BMI z-score, fruit and vegetable intake, and fast food consumption were fit including home and neighborhood environmental variables as predictors and also including their interactions to test for effect modification. Supportive family environments (i.e., higher family functioning, frequent family meals, and parent modeling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Associations between the built environment and adolescent outcomes were fewer. Interaction results, although not all consistent, indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighborhood was supportive of healthful behavior. Public health interventions that simultaneously improve both the home environment and the neighborhood environment of adolescents may have a greater impact on adolescent obesity prevention than interventions that address one of these environments alone.

Cardio-metabolic risk screening among adolescents: Understanding the utility of body mass index, waist circumference and waist to height ratio

Few studies have assessed how well body mass index (BMI), waist circumference (WC), or waist to height ratio (WtHR) perform in identifying cardio‐metabolic risk among youth.

Mother-reported parental weight talk and adolescent girls’ emotional health, weight control attempts, and disordered eating behaviors

BackgroundThe aim of this paper is to explore the relationships between mothers’ report of parental weight talk about her daughter, herself, and others, and adolescent girls’ weight-related behaviors and cognitions among a socio-demographically diverse population of mothers and their adolescent daughters.MethodsData were drawn from the baseline assessment of 218 mother/adolescent daughter dyads. Mothers completed survey items regarding the frequency of weight talk by parents, and girls completed survey items assessing outcomes including body dissatisfaction, depressive symptomology, use of extreme weight control methods, and binge eating.ResultsMore frequent comments to daughters about their weight were associated with higher depressive symptomology (p = 0.041), greater prevalence of extreme weight control behaviors (p = 0.040), and greater prevalence of binge eating (p = 0.048) among girls after adjustment for socio-demographic characteristics and girls’ standardized body mass index (BMI). For example, among girls whose parents never commented on their weight, 4.2% reported use of any extreme weight control behaviors, while 23.2% of girls whose parents frequently commented on their weight reported use of any of these behaviors. Mothers’ more frequent talk about their own weight, shape, or size was associated with lower self-worth (p = 0.007) and higher depressive symptomology (p = 0.004) among girls.ConclusionsFrequent parental weight talk as perceived by mothers was associated with adolescent girls’ use of harmful weight control methods and poor psychological health, while no associations were found between weight talk and girls’ use of healthful weight control strategies. Interventions that help parents create a family environment that supports healthful activities while reducing weight-related talk may be particularly effective in decreasing the prevalence of harmful outcomes among adolescent girls.

Feeding and Mealtime Correlates of Maternal Concern About Children's Weight

Objective: To examine associations between maternal concern regarding their children becoming overweight and two domains of weight‐related parenting; child feeding practices and family meal characteristics. Design: Cross‐sectional study. Participants: Low‐income mothers (n = 264; 67% non‐Hispanic white) and their children (51.5% male, aged 4.02–8.06 years). Variables Measured: Maternal concern and feeding practices, using the Child Feeding Questionnaire. Meal characteristics were assessed using video‐recorded meals and meal information collected from mothers. Analysis: The authors used MANOVA and logistic regression to identify differences in maternal feeding practices and family meal characteristics across levels of maternal concern (none, some, and high). Results: Approximately half of mothers were not concerned about their child becoming overweight, 28.4% reported some concern, and 19.0% had high concern. Mothers reporting no concern described lower restrictive feeding compared with mothers who reported some or high concern (mean [SE], none = 3.1 [0.1]; some = 3.5 [0.1]; and high = 3.6 [0.1]; P = .004). No differences in other feeding practices or family meal characteristics were observed by level of concern. Conclusions and Implications: Concern regarding children becoming overweight was common. However, concern rarely translated into healthier feeding practices or family meal characteristics. Maternal concern alone may not be sufficient to motivate action to reduce childrens risk of obesity.

Ten‐Year Secular Trends in Youth Violence: Results From the Philadelphia Youth Risk Behavior Survey 2003‐2013

BACKGROUND Youth violence reduction is a public health priority, yet few studies have examined secular trends in violence among urban youth, who may be particularly vulnerable to numerous forms of violence. This study examines 10-year secular trends in the prevalence of violence-related behaviors among Philadelphia high school students. METHODS Repeated cross-sectional data were analyzed from 5 waves of the Philadelphia Youth Risk Behavior Survey (YRBS) from 2003 to 2013. Sex-specific multivariate regression models were used to examine secular trends in multiple types of violence, accounting for age, race/ethnicity, and sampling strategy. RESULTS In 2013, the most prevalent violent behavior was physical fighting among boys (38.4%) and girls (32.7%). Among girls, the prevalence of sexual assault and suicide attempts declined between 2003 and 2013 (β = -0.13, p = .04 and β = -0.14, p = .007, respectively). Among boys, significant declines in carrying a weapon (β = -0.31, p < .001), carrying a gun (β = -0.16, p = .01), and physical fighting (β = -0.35, p = .001) were observed. CONCLUSIONS Whereas the prevalence of some forms of violence stabilized or declined among Philadelphia youth during 2003-2013 time span, involvement in violence-related behaviors remains common among this population. Continued surveillance and evidence-based violence reduction strategies are needed to address violence among urban youth.

Childhood Maltreatment and BMI Trajectory: The Mediating Role of Depression

INTRODUCTION Childhood maltreatment is associated with later obesity, but the underlying mechanisms are unknown. The objective of this study was to estimate the extent to which depression mediates the associations between childhood maltreatment and BMI in adolescence through adulthood. METHODS Data on a cohort of 13,362 adolescents in the National Longitudinal Study of Adolescent to Adult Health (Wave I [1994-1995] to Wave IV [2008-2009]) were analyzed in 2015-2016. Classes of maltreatment experienced prior to age 12 years were statistically identified using latent class analysis. Gender-stratified latent growth curve analysis was used to estimate total effects of maltreatment classes on latent BMI trajectory (aged 13-31 years) and indirect effects of maltreatment classes that occurred through latent depression trajectory (aged 12-31 years). RESULTS Four latent maltreatment classes were identified: high abuse and neglect; physical abuse dominant; supervisory neglect dominant; and no/low maltreatment. In girls, compared with no/low maltreatment, supervisory neglect dominant (coefficient=0.3, 95% CI=0.0, 0.7) and physical abuse dominant (coefficient=0.6, 95% CI=0.1, 1.2) maltreatment were associated with faster gain in BMI. Change in depression over time fully mediated the association of BMI slope with physical abuse dominant maltreatment, but not with supervisory neglect dominant maltreatment. In boys, high abuse and neglect maltreatment was associated with marginally greater BMI at baseline (coefficient=0.7, 95% CI= -0.1, 1.5); this association was not mediated by depression. CONCLUSIONS Although maltreatment was associated with depression and BMI trajectories from adolescence to adulthood, depression only mediated associations with physical abuse dominant maltreatment in girls.