Obesogenic Features of Food-Related Content Aimed at Children on YouTube

Obesity, and particularly childhood obesity, is considered an epidemic by the WHO because of the health problems it causes and its impact on the lives and environment of those who suffer from it. In this article, the term “obesogenic features” refers to the set of supposedly aggravating risk factors that could intensify the proven effect on minors of exposure to food-related media content. The article explores the characteristics of food-related content in YouTube videos aimed at children, with the objective of identifying videos that pose a high risk due to the presence of obesogenic arguments, as well as videos with innovative media trends. It presents an exploratory study of 293 videos (22 hr 41 min) aimed at children and containing food and/or food brands, posted from May 2020 to April 2021 on 28 YouTube channels of food brands and child YouTubers with the largest numbers of subscribers. Child YouTubers often appear to explicitly promote calorie intake as a diet alternative and to disseminate content in which the presence of low-nutrition foods undermines childhood obesity prevention policies. The sensitivity of this target audience and the highly emotional nature of the formats in which messages with obesogenic features appear, such as “challenges,” point to an urgent need to adopt ethical standards and legal measures to regulate such content.

Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study

Background The prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders. Methods A qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran. Results The identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents. Conclusion The existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders.

Validation and refinement of the Stakeholder-driven Community Diffusion Survey for childhood obesity prevention

Background Whole-of-community interventions hold promise in addressing childhood obesity. The COMPACT Stakeholder-driven Community Diffusion theory posits that stakeholders’ knowledge of childhood obesity prevention efforts and engagement with the issue contribute to successful intervention implementation. Building on completed formative research and pilot testing, we describe the validation and refinement of knowledge and engagement measures. Methods We assessed content validity using a modified Delphi process with science (n=18) and practice-based (n=16) experts. Next, we refined the survey based on input from science- and practice-based experts, cognitive response testing, and item analysis of extant survey data. Field testing of the refined survey involved community stakeholders in Greenville County, South Carolina (n=50), East Boston, Massachusetts (n=30), and Tucson, Arizona (n=84) between 2019 and 2020. Construct validity was assessed with confirmatory factor analysis (CFA). Two-week test-retest reliability was assessed among a subsample of 14 paired respondents in South Carolina. Results Experts rated existing knowledge domains (intervention factors, roles, sustainability, problem, resources) and engagement domains (dialogue/mutual learning, flexibility, influence/power, leadership/stewardship, trust) highly for their importance in addressing childhood obesity. Expert input resulted in 11 new knowledge items and 7 new engagement items that mapped onto existing domains. Correspondingly, two domain names were modified: implementation/sustainability and trust/trustworthiness. We also eliminated 8 extant items (4 knowledge and 4 engagement) and adapted item language for comprehension and consistency. Further modifications based on CFA results and item analyses resulted in 23 knowledge items across four domains (roles and resources merged) and 23 engagement items across five domains. Modified knowledge and engagement scales had adequate fit and strong item factor loadings (most >0.7 and all >0.5). Knowledge (α=0.86–0.87) and engagement (α=0.75–0.90) subscales had high internal scale consistency. Knowledge intraclass correlation coefficients (ICCs) for test-retest agreement of subscale scores ranged from 0.50 for intervention factors to 0.86 for roles/resources. For engagement subscale scores, ICCs ranged from 0.70 for trust/trustworthiness to 0.96 for leadership/stewardship. Conclusions Findings from this multi-method survey development process increase our confidence of the knowledge and engagement measures’ content validity, construct validity, and reliability.

Coalition-Committees as Network Interventions: Baseline Network Composition in Context of Childhood Obesity Prevention Interventions

Community coalitions can address local issues with deep, historic, and contextual understanding that enables customized implementation of evidence-based strategies. The individuals within the coalition, their partnerships, and the social context is likely an important component of unraveling the challenges of implementation so interventions reach people in need. We focus on the relevance of baseline coalition-committee network (CCN), the networks of purposely formed subcommittees within community coalitions, structure as one of the moderating, theoretical links between community coalition social networks and intervention success. We explore the baseline composition and characteristics of five CCNs at the beginning of childhood obesity prevention interventions. Using a combination of social network, multidimensional scaling, and correspondence analyses, we examine the structure and heterogeneity of five CCNs, each consisting of a core group of stakeholders in the coalition and sometimes the broader community itself. Cross-sectional analyses are used to examine the composition of coalition-committees related to network density, centralization, hierarchy, and coalition demographics and characteristics. Results indicate that CCNs are patterned in their structure and characteristics, and we discuss whether adjustments to childhood obesity prevention interventions according to baseline structure and characteristics could be advantageous for intervention implementation. Together, these findings can inform future longitudinal investigations into CCN network structure.

736 Current Management Strategies, Perceptions, and Attitudes of the Paediatricians on Childhood Obesity: An Experience from the Middle East

Background Childhood obesity is a public health concern that in expanding globally. Of those aged between 5-19 years in Oman, 32% were found to be overweight in 2016. Method An electronic survey was distributed to in-training and post residency paediatricians in Oman. Results A total of 69 responses met the inclusion criteria and were analysed. 50% of participants were less than 30 years-old (53.6% female). 70% were in training residency (R1, R2 24.6%, R3, R4 36.2%,) and 30% were post residency. 72% had their training in Oman. About half of participants measure child’s weight and Height, however, only 24.4% document BMI and compare with previous records. 75% regularly obtain family history of obesity and related conditions along with dietary intake. More than half of participants were not confident on discussing weight and related complication with the child, but 62.3 % were confident in discussing it with the parents. 50% were confident in initiating treatment for childhood obesity and providing dietary advice. Attitudes towards exposure to childhood obesity and management varied and overall excellent exposure accounted for less than one third of responses (Medical school 21.7%, Residency 26.1%, 27.5%). In general, only 20.6% believe they are confident in managing childhood obesity and only 29% attended seminar or training on childhood obesity. 93% believe there is a need for a more focused training on childhood obesity prevention and management. Conclusions Great efforts need to be targeted towards strengthening Paediatricians’ confidence in childhood obesity prevention and management via in residency-training and continuous professional development.

1245Culturally-appropriate research supporting a co-designed childhood obesity prevention program tailored for Māori & Pacific Islanders

Background Children of Māori & Pacific Islander descent living in Australia experience higher rates of obesity, increasing their risk of developing life diminishing chronic diseases. However, community-based, childhood obesity prevention programs, tailored to the Māori & Pacific Islander population are lacking, further escalating the rates of health inequity. Methods Program co-design involved a three-phase, iterative, participatory and experienced-based process, guided by the Te Ara Tika: Guidelines for Māori Research Ethics, promoting respect and equity. Following traditional oratory customs of Māori & Pacific Islander cultures, “talanoa” facilitated the collaborative program design with consumers, cultural advisors and health professionals. Results Co-design developed an 8-week community-based childhood overweight/obesity prevention program, providing culturally-tailored education across nutrition, physical activity and parenting practices. Maximum engagement demonstrated life-changing improvements across the life course; 72% of children and 67% of parents reduced their sugar sweetened beverage consumption and 60% of children and 47% of adults increased their vegetable consumption. Resultingly, BMI z-score decreased among 59% of children and BMI decreased among 47% of parents. Conclusions Endorsing a bottom-up approach, via a co-design methodology, significantly improves culturally-tailored health care delivery. An evidence-based framework developed holds significant potential to be scaled to additional cultural groups. A consumer-led approach is pivotal to sustaining engagement and improving health outcomes, addressing health inequity among Australia’s priority populations. Key messages Co-design empowered consumers to formulate program objectives, session plans, resources and evaluation tools. Co-designed quality improvement practices ensure relevance of the program to sustainably address community needs, tackling the complexities of obesity over generations.

Cost-Effectiveness of a School-and Family-Based Childhood Obesity Prevention Programme in China: The “CHIRPY DRAGON” Cluster-Randomised Controlled Trial

Objectives: Rapid socioeconomic and nutrition transitions in Chinese populations have contributed to the growth in childhood obesity. This study presents a cost-effectiveness analysis of a school- and family-based childhood obesity prevention programme in China.Methods: A trial-based economic evaluation assessed cost-effectiveness at 12 months. Forty schools with 1,641 children were randomised to either receive the multi-component (diet and physical activity) intervention or to continue with usual activities. Both public sector and societal perspectives were adopted. Costs and benefits in the form of quality-adjusted life years (QALYs) were compared and uncertainty was assessed using established UK and US thresholds.Results: The intervention cost was 35.53 Yuan (£7.04/US$10.01) per child from a public sector perspective and 536.95 Yuan (£106/US$151) from a societal perspective. The incremental cost-effectiveness ratio (ICER) was 272.7 Yuan (£54/US$77)/BMI z-score change. The ICER was 8,888 Yuan (£1,760/US$2,502) and 73,831 Yuan (£14,620/US$20,796) per QALY from a public sector and societal perspective, respectively and was cost-effective using UK (£20,000) and US (US$50,000) per QALY thresholds.Conclusion: A multi-component school-based prevention programme is a cost-effective means of preventing childhood obesity in China.

Nutritional Strategies for Childhood Obesity Prevention

Background: Reducing the spread of obesity represents a challenge for clinicians in which obesity prevention plays a key role in achieving this purpose. The aim of this review is to analyze the nutritional interventions that can be implemented to prevent childhood obesity. Methods: Searching PubMed and Cochrane Library between 2019 and 2021. Further searching with no date range for articles selected for their specific relevance in the pediatric area or for their scientific relevance. A total of 871 articles were identified and 90 were included. Results: We organized the results of the selected articles into age groups, and according to the subjects targeted for interventions or to the site of interventions, reserving an in-depth analysis on specific nutritional aspects. Promotion of breastfeeding, reduction of protein content of formulated milks, and diet of the first 12–24 months, involving family and schools in interventions that promote physical activity and healthy diet, are promising strategies for reduction of the risk of obesity. To increase the efficacy of interventions, a multidimensional approach is crucial. Conclusions: A multidimensional approach, which takes into consideration different areas of intervention, is pivotal for childhood obesity prevention. Integrated programs involving several components (nutrition and physical activity at first) at different levels (individual, family, school, and institutional) are crucial.