Associations among obesity, physical activity, nutrition, and family environment in adolescents.

摘要

The ability to screen for risk factors (e.g., physical activity, dietary behavior, and sedentaryscreen time behavior) that relate to obesity risk in youth and the development of multi-disciplinary pediatric obesity treatment programs are vital in addressing the global pediatric obesity problem. The Family Nutrition and Physical Activity (FNPA) Screening Tool is a screening instrument that can be used to assess the family and home environment, which influences the health behaviors and obesity risk of children. FitKids360 is an obesity treatment program for 5-16 year olds that utilizes the FNPA as part of its assessment of pediatric obesity risk. However, the FNPA has not been examined in adolescents and has never been examined directly for its relationship with measures that represent constructs comprising the FNPA (e.g., child physical activity, diet quality). Similarly, FitKids360 has never been evaluated solely with an adolescent population. This dissertation was divided into two studies, and its overall purpose was two-fold: 1) To examine the association of the FNPA screening tool with physical activity, dietary quality, and sedentary behaviorscreen time behaviors in ninth grade students, as well as its relationship to obesity risk; 2) To evaluate the FitKids360 intervention, implementeddone as part of the Commit to Healthy Hearts Program, in participating ninth grade students.;In Study One, a total of 175 ninth grade students were measured for physical activity, dietary quality, and screen time behavior using the Physical Activity Questionnaire for Adolescents (PAQ-A), Healthy Eating Index-2010 (HEI-2010), and self-reported total screen time, respectively. Students were also assessed for height and weight to calculate body mass index (BMI) and for percent body fat using a portable stadiometer and electronic scale, respectively. Parents of the students completed the FNPA survey. Associations among the FNPA score, PAQ-A score, HEI-2010 and total screen time were determined along with differences in FNPA score by weight status using correlation, regression, and logistic regression analyses. In Study Two, 16 overweight/obese students completed the 7/8-week long FitKids360 program. Process evaluation of the FitKids360 program was conducted to determine reach, dose, and fidelity of the program. Assessments of weight status, physical activity, dietary behaviors, FNPA, and physical activity and dietary self-efficacy were taken at baseline, post-7/8-weeks and 3-months post-intervention were conducted and analyzed using repeated measures ANOVA.;Overall, no significant associations were found among the total FNPA score, PAQ-A score, HEI-2010 score, and total screen time in adolescents; however, the FNPA-Diet construct score was associated with HEI-2010 score. No significant differences in the FNPA were found by weight status. Process evaluation results showed that the FitKids360 program was positively received by staff and family participants and that the program was delivered with high fidelity. Pre-post assessments from baseline to 7/8-week follow-up showed a significant improvement in FNPA score (53.1 to 58.3), but no other significant differences in any other health outcome.;This study highlights that the FNPA Screening Tool may not be associated with health behaviors or obesity risk in an adolescent population. The FitKids360 program was shown to decrease BMI z-score, and notably improved FNPA scores, despite the fact that the FNPA was not related to health outcomes. Further research is needed to explore the utility of the FNPA and to evaluate the FitKids360 program with a larger sample size.