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1.	Nowicka, Paulina, 1974-, et al. (author) Utility of Hemoglobin A1c for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents 2011 In: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 34:6, s. 1306-1311 Journal article (peer-reviewed)abstract OBJECTIVE—Hemoglobin A1c (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.RESEARCH DESIGN AND METHODS—We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of ;2 years in 218 subjects.RESULTS—At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (A1C,5.7%), 21% at risk for diabetes (A1C 5.7–6.4%), and 1% with diabetes (A1C .6.5%). In the at risk for diabetes category, 47% were classified with prediabetes or diabetes, and in the diabetes category, 62% were classified with type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1C was 0.81 (95%CI 0.70–0.92). The threshold for identifying type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1C and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.CONCLUSIONS—The American Diabetes Association suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1C by itself represents a poor diagnostic tool for prediabetes and type 2 diabetes in obese children and adolescents.
2.	Bergman, Karolin, 1979-, et al. (author) ‘A holistic approach’ : incorporating sustainability into biopedagogies of healthy eating in Sweden’s dietary guidelines 2020 In: Sociology of Health and Illness. - : Wiley. - 0141-9889 .- 1467-9566. ; 42:8, s. 1785-1800 Journal article (peer-reviewed)abstract Dietary guidelines can be considered a pedagogical tool, designed to promotehealthy eating at the population level. In this study, we critically examine thebiopedagogies implicated in Sweden’s official dietary guidelines. Published in2015, these guidelines take a potentially innovative ‘holistic approach’ to food andeating, addressing the challenge of formulating dietary advice that considers bothhuman health and environmental concerns. Applying Bacchi´s ‘What’s theproblem represented to be?’ approach, we interrogate how the guidelines frame theinterplay of public health concerns and environmental concerns in making foodchoices. We find that the biopedagogies of sustainable eating, as presented in theseguidelines, implicate the subject position of the ideal eater. The ideal eater valuessustainability, has high cultural capital, and draws on both taste and nutritionalknowledge to make good food choices. However, while the ideal eater is expectedto be aware of environmental issues, these are incorporated into the ideal eater’schoices only in addition to the primary concern of health. Thus, although theguidelines frame a ‘holistic approach’ as the solution to both health andenvironmental concerns, in cases where health and environmental prioritiesconflict, the guidelines’ biopedagogies of sustainable eating align with earlierbiopedagogies of healthy eating.
3.	Bergman, Karolin, 1979-, et al. (author) Healthy eating as conceptualized in referral responses to Sweden’s updated dietary guidelines: excluding the complexity of everyday life 2017 Conference paper (other academic/artistic)abstract National Dietary Guidelines have been published in many countries to support healthier food habits among the public. In Sweden, the guidelines are produced in a process involving experts and stakeholders under the responsibility of the National Food Agency. Stakeholder perspectives on the concept of state dietary advice was explored in this study, by analyzing 40 referral responses on updated guidelines in Sweden 2015. The study focused on ideas about how state dietary advice should be framed and what it should be based on. Thematic analysis was used and resulted in two main themes. 'Securing scientifically proven advice' represented a perspective of the guidelines as to be scientifically correct and verified, and built upon an underlying assumption to present an objective and optimal composition of foods and nutrients that will fit all. Arguments based on nutritional reductionism could be seen, which gave a delimited idea of what healthy food is. 'Getting the message across' represented a perspective of the guidelines to be easily understood by and inclusive to the end user. Clarity in advice was seen to be reached by explaining difficult words, defining amounts and exact mechanisms of why something is a good choice. Also this perspective added to excluding other values of food, especially qualitative ones. The construction of a healthy diet in these remittance responses builds upon a notion of an ideal diet composed on the basis of the best scientific proof and clearly presented so as to be easily understood and practiced. It was clearly based on an individualistic behavioral view making the individual responsible to make informed and good choices for a healthy diet. This approach may be questioned, as it is too simplified to include the complex reality of everyday life.
4.	Bergman, Karolin, 1979- (author) Negotiating healthy eating : Lay, stakeholder and government constructions of official dietary guidance in Sweden 2019 Doctoral thesis (other academic/artistic)abstract This thesis approaches dietary guidance as socio-culturally produced and comprised in a specific historical context. The work is premised on the position that ideas and understandings of healthy eating are discursively constructed, and that we form our understandings of the world, ourselves and others through discourse. The theoretical approach builds on the Foucauldian notion of governing, which includes how the state governs people through strategic techniques and individuals’ self-governing in relation to discursive norms related to official institutions. The four studies included in the thesis therefore explore how healthy eating and official dietary guidance are negotiated and constructed from stakeholder, lay and policy perspectives. Paper I takes a stakeholder perspective on “appropriate” national dietary advice by exploring 40 written responses to updated official dietary guidelines. Paper II and III focus on lay people’s discourses on dietary guidance and healthy eating by examining their written correspondences (727 and 60 digital messages, respectively) with the Swedish Food Agency. Paper IV examines how the Swedish Food Agency’s official dietary guidelines frame the interplay of public health concerns and environmental concerns in making food choices.The findings demonstrate the dominance of a nutrient-centered and scientific discourse in communication (arguments, statements, instructions and questions) related to official dietary guidance in the Swedish context, even among non-professionals (in stakeholder responses, lay messages and the official dietary guidelines). In lay people´s communication with the Swedish Food Agency, both resistance to and internalization of official dietary advice are expressed within this dominating discourse. Resistance is additionally expressed through emotional language and by referring to alternative authorities, including personal experiences. The nutrient-centered and scientific discourse builds on the basic assumption of individual responsibility for health and the taken-for-granted nature of the primacy of physical health. Environmental perspectives come secondary to nutrition, which is demonstrated by their subordinate status in the official dietary guidelines and limited presence in lay people´s correspondences. Most socio-cultural, emotional and structural aspects on eating are made invisible by these discourses, in which food figures as scientifically quantifiable or functional in relation to physical health. However, in the official dietary guidelines from 2015, an additional discourse of cultivating certain tastes as a key to a sustainable diet constructs an ‘ideal eater’ with ‘middle-class’ aspirations.
5.	Bergman, Karolin, 1979-, et al. (author) Public expressions of trust and distrust in governmental dietary advice in Sweden 2019 In: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 29:8, s. 1161-1173 Journal article (peer-reviewed)abstract We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice, or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice, or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and 'alternative' evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency’s advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.
6.	Bergman, Karolin, 1979-, et al. (author) Stakeholder responses to governmental dietary guidelines : Challenging the status quo, or reinforcing it? 2018 In: British Food Journal. - : Emerald Group Publishing Limited. - 0007-070X .- 1758-4108. ; 120:3, s. 613-624 Journal article (peer-reviewed)abstract PurposeThe purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.Design/methodology/approachIn total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.FindingsTwo main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.Practical implicationsPolicymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.Originality/valueThis research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.
7.	Bergman, Karolin, 1979-, et al. (author) 'Writing nutritionistically' : A critical discourse analysis of lay people´s digital correspondence with the Swedish Food Agency 2022 In: Health. - : Sage Publications. - 1363-4593 .- 1461-7196. ; 26:5, s. 554-570 Journal article (peer-reviewed)abstract This article analyzes lay people’s use of nutritionistic discourse in written correspondence with the Swedish Food Agency, an authority responsible for dietary advice. Examining 60 food related written digital messages, we apply a critical discourse analysis to parse the terms and grammar people use when constructing “food” in scientific terms. Findings show that message writers place nutrients at the discursive center and frequently use terms that indicate preciseness, such as numbers and amounts, reinforced by modality (auxiliary verbs) and transitivity (nominalizations). Messages therefore emphasize the what, but not the how, of eating, implying a focus on food as subject to regulation and control. As such, eating is discursively reduced to an act of ingesting nutrients that can be decontextualized and managed in isolation – as entities to increase or avoid separately. These discursive features preclude the conceptualization of food choice and eating as subjective experiences of feelings, taste, and tradition.
8.	Braet, Caroline, et al. (author) The Assessment of Eating Behaviour in Children Who Are Obese: A Psychological Approach. A Position Paper from the European Childhood Obesity Group 2014 In: Obesity Facts. - : S. Karger AG. - 1662-4025 .- 1662-4033. ; 7, s. 153-164 Journal article (peer-reviewed)abstract Objective: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. Methods: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors’ combined clinical experience, a three-staged approach to assessment was agreed by consensus. Results: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three staged approach to assessing eating behaviours in the absence of hunger is described. Conclusions: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.
9.	Duncanson, K., et al. (author) Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity : a systematic review with meta-analysis 2021 In: Journal of human nutrition and dietetics. - : Wiley. - 0952-3871 .- 1365-277X. ; 34:1, s. 147-177 Journal article (peer-reviewed)abstract BACKGROUND: The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity.METHODS: Eligible randomised controlled trials (RCTs) published between 1975 and 2020 were identified by a systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses of eligible study outcomes were performed using statistical software. A multilevel random effects model was used with three significant random effects fitted using restricted maximum likelihood estimation.RESULTS: This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change and 14 reporting no significant dietary change. Results from the meta-analyses (n = 29 studies) indicated that, compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194 kcal day-1 , 95% confidence interval = -275.80 to -112.90 kcal day-1 , P < 0.001) and up to 12 months (-112 kcal day-1 95% confidence interval = -218.92 to -5.83 kcal day-1 ) P = 0.038), increases in fruit and/or vegetable intakes over 2-12 months (n = 34, range +0.6 to +1.5 servings day-1 ) and reductions in consumption of sugar-sweetened beverages (n = 28, range -0.25 to -1.5 servings day-1 ) at 4-24 months follow-up.CONCLUSIONS: Obesity interventions with a dietary component have a modest but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.
10.	Eiffener, Elodie, et al. (author) The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes : Secondary findings from a randomized controlled trial 2019 In: Pediatric Obesity. - : John Wiley & Sons. - 2047-6302 .- 2047-6310. ; 14:11 Journal article (peer-reviewed)abstract Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.Method: The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z‐scores.Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.
11.	Ek, Anna, et al. (author) A long-term follow-up of treatment for young children with obesity : a randomized controlled trial 2023 In: International Journal of Obesity. - : Springer Nature. - 0307-0565 .- 1476-5497. ; 47:11, s. 1152-1160 Journal article (peer-reviewed)abstract BACKGROUND: Early childhood obesity interventions supporting parents have the largest effects on child weight status. However, long-term follow-ups are lacking.OBJECTIVE: To examine weight status 48 months after obesity treatment initiation for 4- to 6-year-olds.METHODS: 177 families were recruited to the More and Less study, a 12-month randomized controlled trial (RCT) conducted in Sweden (2012-2017); 6 children were excluded due to medical diagnoses. Thus, 171 families (non-Swedish origin 59%, university degree 40%) were eligible for this 48-month follow-up with modified intention-to-treat (n = 114 had 48-month data, n = 34 dropped out, n = 23 lost to follow-up). The RCT compared 3 treatment approaches: a 10-week parent support program (1.5 h/w) with follow-up booster sessions (PGB) or without (PGNB), and standard outpatient treatment (ST). Treatment effects on primary outcome (BMI-SDS) and secondary outcomes (BMI, %IOTF25 i.e., the distance, in percent, above the cut-off for overweight) were assessed. Clinically significant reduction of BMI-SDS (≥0.5) was assessed with risk ratio. Sociodemographic factors and attendance were examined by three-way interactions.RESULTS: After 48 months (mean 50 months, range 38-67 months) mean (95% CI) BMI-SDS was reduced in all groups: PGB -0.45 (-0.18 to -0.73, p < 0.001), PGNB -0.34 (-0.13 to -0.55, p < 0.001), ST -0.25 (-0.10 to -0.40, p < 0.001), no significant difference between groups. A clinically significant reduction of BMI-SDS ≥ 0.5 was obtained in 53.7% of PGB which was twice as likely compared to ST, 33.0%, RR 2.03 (1.27 to 3.27, p = 0.003), with no difference to PGNB, 46.6% (p = 0.113). %IOTF25 was unchanged from baseline for PGB 4.50 (-1.64 to 10.63), and significantly lower compared to ST 11.92 (8.40 to 15.44) (p = 0.043). Sociodemographics or attendance had no effect.CONCLUSION: The intensive parent-support early childhood obesity intervention led to better weight status outcomes over time, though BMI-SDS alone did not reflect this. Further research should investigate how to assess weight changes in growing children.CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT01792531 .
12.	Ek, Anna, et al. (author) A Parent Treatment Program for Preschoolers With Obesity : A Randomized Controlled Trial 2019 In: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 144:2 Journal article (peer-reviewed)abstract Background And Objectives: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST).Methods: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (−0.5) was assessed with risk ratios.Results: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: −0.45 to −0.15) compared with ST (0.07; 95% CI: −0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (−0.54; 95% CI: −0.77 to −0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST.Conclusion: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.
13.	Ek, Anna, et al. (author) A randomized controlled trial for overweight and obesity in preschoolers : the More and Less Europe study – an intervention within the STOP project 2019 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19 Journal article (peer-reviewed)abstract BACKGROUND: Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.METHODS/DESIGN: A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.DISCUSSION: This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.
14.	Ek, Anna, 1975-, et al. (author) Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices : Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist 2016 In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:1 Journal article (peer-reviewed)abstract INTRODUCTION: Insight into parents' perceptions of their children's eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children's eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers' eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).MATERIALS AND METHODS: Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.RESULTS: 478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).DISCUSSION: The CEBQ is a valid instrument for assessing parental perceptions of preschoolers' eating behaviors. Parental pressure to eat was strongly associated with children's food avoidance. Parental restriction, however, was more strongly associated with parents' concerns about their children's weights than with children's food approach. This suggests that childhood obesity interventions should address parents' perceptions of healthy weight alongside perceptions of healthy eating.
15.	Ek, Anna, et al. (author) Child behaviors associated with childhood obesity and parents’ self-efficacy to handle them : Confirmatory factor analysis of the Lifestyle Behavior Checklist 2015 In: International Journal of Behavioral Nutrition and Physical Activity. - : Springer Science and Business Media LLC. - 1479-5868. ; 12 Journal article (peer-reviewed)abstract Background: The development of family-based programs for child weight management requires an understanding of parents’ difficulties in managing children’s eating and physical activity behaviors; however, knowledge about the specific behaviors that parents find most difficult to address is still limited. The Lifestyle Behavior Checklist (LBC) is an Australian instrument that assesses parents’ perceptions of children’s obesity-related behaviors (the Problem scale), and parents’ self-efficacy in dealing with these behaviors (the Confidence scale). Our aims were 1) to examine the psychometric properties (the factor structure, internal reliability, construct and discriminative validity) of the LBC in parents of preschoolers in Sweden, using the Child Feeding Questionnaire (CFQ) as a criterion measure, 2) to study associations between the LBC and socio-demographic factors.Methods: The LBC and the CFQ (measuring parental feeding practices) were distributed to parents from 25 schools/preschools and to parents starting a childhood obesity intervention. To test the fit of the original four-factor model (misbehavior in relation to food, overeating, emotional correlates of being overweight, physical activity (24 items)) to the data, confirmatory factor analysis (CFA) was performed. Structural equation modelling was used to examine associations between the LBC and the CFQ and socio-demographic factors.Results: In a sample of 478 parents, a five-factor structure proved best fit to data, after excluding 6 items and allowing two pairs of error terms to correlate (TLI = 0.899; CFI = 0.918; RMSEA = 0.042; SRMR = 0.055). The Confidence scale indicated unidimensionality, therefore a hierarchical CFA with 5 first order factors and one second order factor was tested showing good fit. The validity of the LBC was proven by relevant associations with the CFQ and child weight status; parental responses differed depending on child weight status. The Confidence scale was not associated with any child or parent variables.Conclusions: In a large sample of Swedish parents of preschoolers, the LBC showed good psychometric properties, with relevant correlations to similar constructs. A five-factor structure showed best fit to data with moderate to high internal reliability. The LBC was shown to discriminate effectively between parents of normal weight children and parents of overweight/obese children.
16.	Ek, Anna, 1975-, et al. (author) Parental concern about child weight is an important mediator of the effect of child eating behaviors on parental feeding practices : Results from a sample of 478 preschoolers and their parents 2015 In: Proceedings of the 25th European Childhood Obesity Congress 2015. - Stockholm. ; , s. 28-28 Conference paper (peer-reviewed)abstract Aim: To present a model for associations between preschoolers’ eating behaviors (measured with the Child Eating Behavior Questionnaire, CEBQ), and parental feeding practices (measured with the Child Feeding Questionnaire, CFQ).Methods: First, the original 8-factor structure of CEBQ was tested with Confirmatory factor analysis (CFA). Second, the associations between the two CEBQ dimensions of child eating (Food approach and Food avoidance) and the key CFQ parental feeding practices (Restriction and Pressure to eat) were examined with structural equation modelling (SEM). CFQ Concern for child weight and CFQ Perceived responsibility for child eating were used as mediators.Results: In a sample of 478 parents (81 % mothers, 87% of Nordic origin, 70 % with university degree) of children from Stockholm County (52 % girls, mean age 5.5 years, 20 % overweight/obese) the CFA demonstrated an acceptable fit (TLI=0.91, CFI=0.92, RMSEA=0.05) for a modified 8-factor structure. The SEM model, adjusted for child and parental characteristics, demonstrated that Food approach had a weak direct effect on Restriction, however, it had quite a strong (β: 0.30) indirect effect via concern, which resulted in a substantial total effect (β: 0.37). Further, there was a strong positive direct effect of Food avoidance on Pressure to eat (β: 0.71; p<0.001).Conclusion: The CEBQ proved to be a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental controling behaviour towards children with big appetites was especially pronounced when parents were concerned for child weight, implying that parental cognitions shouldn’t be forgotten when designing obesity interventions.
17.	Ek, Anna, et al. (author) Responding positively to "children who like to eat" : Parents' experiences of skills-based treatment for childhood obesity 2020 In: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 145 Journal article (peer-reviewed)abstract This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.
18.	Ek, Anna, et al. (author) The More and Less Study : a randomized controlled trial testing different approaches to treat obesity in preschoolers 2015 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15, s. 735- Journal article (peer-reviewed)abstract Background: While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.Methods/design: This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).Discussion: This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.
19.	Ek, Anna, et al. (author) The role of parental depression during early childhood obesity treatment : Secondary findings from a randomized controlled trial 2021 In: Pediatric Obesity. - : John Wiley & Sons. - 2047-6302 .- 2047-6310. ; 16:6 Journal article (peer-reviewed)abstract BACKGROUND: Parental depression is a risk factor for childhood obesity.OBJECTIVES: To examine the influence of parental depression on child weight status, eating behaviours, and parental feeding practices during childhood obesity treatment.METHODS: Hundred and twenty eight children with obesity aged 4 to 6 years and their parents were randomized to a parent support program or to standard treatment. At baseline and after 12 months, children's heights and weights were measured. Parents reported levels of depression (Beck's Depression Inventory-II), feeding practices (Child Feeding Questionnaire), and children's eating behaviors (Child Eating Behavior Questionnaire). Independent and dependent paired sample t-tests and linear regressions were used to analyze data.RESULTS: After obesity treatment, mothers reported lower levels of depression, whereas fathers did not. No associations were found between parental level of depression and child weight status, or between baseline level of parental depression and feeding practices. Associations were found between baseline parental depression and children's food responsiveness (β = .03; P = .01; 95% CI [0.01, 0.05]), emotional overeating (β = .02; P = .02; 95% CI [0.004, 0.04]), and desire to drink (β = .02; P = .03; 95% CI [0.002, 0.04]) (adjusted for background variables).CONCLUSIONS: Parental depression did not influence child weight status or parental feeding practices but was associated with obesity-related child eating behaviors.
20.	Eli, Karin, et al. (author) “A little on the heavy side”: a qualitative analysis of parents’ and grandparents’ perceptions of preschoolers' body weights 2014 In: BMJ Open. - : BMJ. - 2044-6055. ; 4 Journal article (peer-reviewed)abstract Objectives: Parents’ difficulties in perceiving children’s weight status accurately pose a barrier for family-based obesity interventions; however, the factors underlying weight misinterpretation still need to be identified. This study’s objective was to examine parents and grandparents’ perceptions of preschoolers’ body sizes. Interview questions also explored perceptions of parental responsibility for childhood obesity and appropriate contexts in which to discuss preschoolers’ weights.Design: Semistructured interviews, which were videotaped, transcribed and analysed qualitatively.Setting: Eugene and the Springfield metropolitan area, Oregon, USAParticipants: Families of children aged 3–5 years were recruited in February—May 2011 through advertisements about the study, published in the job seekers’ sections of a classified website (Craigslist) and in a local newspaper. 49 participants (22 parents and 27 grandparents, 70% women, 60% with overweight/obesity) from 16 low income families of children aged 3–5 years (50% girls, 56% with overweight/obesity) were interviewed.Results: There are important gaps between clinical definitions and lay perceptions of childhood obesity. While parents and grandparents were aware of their preschoolers’ growth chart percentiles, these measures did not translate into recognition of children’s overweight or obesity. The participants spoke of obesity as a problem that may affect the children in the future, but not at present. Participants identified childhood obesity as being transmitted from one generation to the next, and stigmatised it as resulting from ‘lazy’ parenting. Parents and grandparents avoided discussing the children’s weights with each other and with the children themselves.Conclusions: The results suggest that clinicians should clearly communicate with parents and grandparents about the meaning and appearance of obesity in early childhood, as well as counteract the social stigma attached to obesity, in order to improve the effectiveness of family-based interventions to manage obesity in early childhood.
21.	Eli, Karin, et al. (author) A question of balance : Explaining differences between parental and grandparental perspectives on preschoolers' feeding and physical activity 2016 In: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 154, s. 28-35 Journal article (peer-reviewed)abstract Rationale: Although one quarter of US and UK families rely on grandparents as the main providers of informal childcare, grandparental perspectives on the feeding and physical activity of young children remain understudied.Objective: The study's aim was to elucidate parents' and grandparents' perspectives on young children's feeding and physical activity, and identify how they negotiate potential differences between these perspectives.Methods: We interviewed 22 parents and 27 grandparents from 16 families of children aged 3-5 years in the Pacific Northwest, US. Using familial homeostasis as a novel theoretical framework, the interviews were analyzed to assess differences between parental and grandparental perspectives on feeding and physical activity.Results: The analysis yielded six thematic categories: (1) disagreements about feeding stem from parents' and grandparents' differing definitions of healthy feeding; (2) differences between parents' and grandparents' feeding practices reflect differences in perceived caretaking roles; (3) parents and grandparents negotiate differences in feeding practices through grandparental compliance and parental compromise; (4) differences in preschoolers' physical activity are influenced by parents' and grandparents' own access to and engagement in physical activity; (5) parents and grandparents express few disagreements about preschoolers' screen-time; (6) parents and grandparents rarely discuss preschoolers' physical activity. The findings suggest that parental and grandparental decision-making about feeding and exercise is informed by ideas of what constitutes familial balance and a balanced lifestyle for a preschool aged child, rather than by the child's weight status.Conclusions: Parents and grandparents appear to engage in practices designed to preserve familial homeostasis, which may provide a compelling explanation for the persistent difficulties in implementing family-based childhood obesity interventions.
22.	Eli, Karin, et al. (author) Associations between maternal sense of coherence and controlling feeding practices : The importance of resilience and support in families of preschoolers 2016 In: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 105, s. 134-143 Journal article (peer-reviewed)abstract Sense of Coherence (SOC) measures an individual's positive, or salutogenic, orientation toward her/his capacities, environment, future, and life. SOC comprises three factors: comprehensibility (the sense of one's own life as ordered and understandable); manageability (the perception of available resources and skills to manage stressors); and meaningfulness (the overall sense that life is filled with meaning and purpose). In numerous studies, SOC has been associated with resilience to stress. However, associations between parental SOC and controlling feeding practices have yet to be studied. This study examines the validity of the SOC 13-item, 3-factor questionnaire, associations between SOC and maternal and child characteristics, and associations between SOC and use of pressuring or restrictive feeding, among mothers of 4-year-olds. 565 mothers (23.5% of foreign origin, 30.3% with overweight/obesity) recruited via the Swedish population registry (response rate: 65%), completed the SOC-13, the Child Feeding Questionnaire (CFQ), and a background questionnaire. The validity of SOC-13 was examined using confirmatory factor analysis; associations with background characteristics and feeding practices were tested with structural equation modeling. SOC-13 validity testing showed acceptable fit (TLI = 0.93, CFI = 0.94, RMSEA = 0.06, SRMR = 0.04) after allowing one pair of error terms to correlate. The Cronbach's alpha for meaningfulness was 0.73, comprehensibility 0.76, and manageability 0.75. SOC increased with mothers' Swedish background and education, and decreased with higher BMI. Child gender, age, and BMI, were not associated with SOC. Lower SOC was associated with controlling practices and with concern about child weight and eating. The associations between SOC and feeding suggest that SOC-related parameters could inform childhood obesity research, and that prevention should address the socioeconomic barriers that parents face in building resilience to stress.
23.	Eli, Karin, et al. (author) ‘‘Those Comments Last Forever’’: Parents and Grandparents of Preschoolers Recount How They Became Aware of Their Own Body Weights as Children 2014 In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:11, s. e111974- Journal article (peer-reviewed)abstract Background: Parents’ and grandparents’ willingness to talk about children’s body weights may be influenced by their own childhood experiences of body weight awareness and ‘weight talk’ in the family; however, little is known about how adults describe their recollected weight-related childhood experiences.Aims: This paper examines how parents and grandparents of preschoolers describe the emergence of their own body weight awareness in childhood or adolescence. The analysis highlights the sources that participants identify as having instigated their body weight awareness, the feelings and experiences participants associate with the experience of becoming aware of their body weights, and their framings of potential links between childhood experiences and attitudes and practices in adulthood.Methods: 49 participants (22 parents, 27 grandparents, 70% women, 60% with overweight/obesity) from sixteen low income families of children aged 3–5 years (50% girls, 56% with overweight/obesity) in the Pacific Northwest were interviewed. The interviews were videotaped, transcribed, and analyzed qualitatively.Results: Twenty-five participants (51%) said they became aware of their body weights in childhood or adolescence. Fourteen participants said their body weight awareness emerged through comments made by others, with the majority citing parents or peers. No participant described the emergence of body weight awareness in positive terms. Four participants directly linked their own negative experiences to the decision not to discuss body weight with their preschoolers. All four cited critical comments from their parents as instigating their own body weight awareness in childhood.Conclusions: In most cases, participants associated their emergent awareness of body weight with overtly negative feelings or consequences; some participants said these negative experiences continued to affect them as adults. Since family-based childhood obesity interventions involve open discussion of children’s body sizes, the results suggest that clinicians should reframe the discussion to deconstruct obesity stigma and emphasize inclusive, affirmative, and health-focused messages.
24.	Eli, Karin, et al. (author) Water, juice, or soda? : Mothers and grandmothers of preschoolers discuss the acceptability and accessibility of beverages 2017 In: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 112, s. 133-142 Journal article (peer-reviewed)abstract Intake of sugary beverages is strongly associated with weight gain and obesity among children; however, differences between mothers' and grandmothers' attitudes and practices concerning young children's beverage consumption remain unclear. This is notable since about a quarter of families in the US and the UK rely on grandparents as the main providers of informal childcare. The aim of this study is to examine mothers' and maternal grandmothers' attitudes, knowledge, and practices regarding preschool aged children's beverage consumption. The analysis focuses on identifying intergenerational similarities and differences, given the potential impact that such differences might have on young children's beverage consumption habits. Twenty-two semi-structured interviews, representing eleven families, were analyzed using thematic analysis. The sample included all mother – maternal grandmother dyads from The Grandparents Study, which took place in Eugene, Oregon, USA. More than half of mothers and grandmothers met overweight/obesity criteria. Among the children (mean age 4.7 years; five girls and six boys), seven met overweight/obesity criteria. Most mothers and grandmothers were unemployed, and most reported an annual household income below 30,000 USD. The analysis identified three thematic categories: 1) mothers and grandmothers agree about the hierarchy of healthiness between and within beverages, though juice occupies an ambivalent position; 2) mothers and grandmothers cite role modeling and the home environment as important in regulating preschoolers' beverage intake; 3) mothers and grandmothers balance between restricting sugary beverages and using these beverages as treats. The results suggest that when mothers and grandmothers use soda, juice, and juice-drinks as treats, they do so within a wider dynamic of balancing practices, and within two intersecting domains: the hierarchy of beverages, including the still ambivalent status of juice as healthy or unhealthy, and the definition of 'special occasion'.
25.	Eli, Karin, et al. (author) "What happens at Grandma's stays at Grandma's" : Explaining differences between parental and grandparental perspectives on preschoolers' physical activity 2015 In: Proceedings of the 25th European Childhood Obesity Congress 2015. ; , s. 26-26 Conference paper (peer-reviewed)abstract Aim: While extensive evidence shows that family involvement is critically important in the prevention and treatment of childhood obesity, grandparental perspectives on physical activity of young children remain understudied. This is notable since nearly one quarter of US and UK families rely on grandparents as the main providers of informal childcare. Informal care has been linked to increased risk of overweight in preschoolers. The aim of this study was to assess differences between parental and grandparental perspectives on physical activity, and how such differences are negotiated in families.Methods: We interviewed 22 parents and 27 grandparents (70% women, 60% overweight/obese) from 16 families of children aged 3-5 years (50% girls, 56% overweight/obese) in the Pacific Northwest, US. The interviews were transcribed and analyzed qualitatively.Results: The analysis yielded three thematic categories: (1) differences in preschoolers’ physical activity are influenced by parents’ and grandparents’ own access to and engagement in physical activity; (2) parents and grandparents frame screen-time as an acceptable part of their preschoolers’ activities and rarely disagree about screen-time rules; (3) parents and grandparents perceive preschoolers as inclined toward physically active play and think of exercise as a non-issue for young children.Conclusions: The findings highlight that young children’s physical activity is rarely subject to familial discussion, suggesting that, parents’ and grandparents’ concepts of appropriate physical activity are less clearly defined. The findings also suggest that parental and grandparental decision-making about physical activity is informed by ideas of what constitutes a balanced lifestyle for a preschool aged child.
26.	Farpour-Lambert, Nathalie J., et al. (author) Childhood Obesity Is a Chronic Disease Demanding Specific Health Care - a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO) 2015 In: Obesity Facts. - : S. Karger AG. - 1662-4025 .- 1662-4033. ; 8, s. 342-349 Journal article (peer-reviewed)abstract Childhood obesity is one of the greatest health challenges of the 21st century. The EASO COTF is convinced that classifying obesity as a chronic disease in children and adolescents is a crucial step for increasing individual and societal awareness, and for improving early diagnosis and intervention. Such a classification will enhance the development of novel preventive and treatment approaches, health care policies and systems, and the education of healthcare workers. The management of obesity prior to the appearance of co-morbidities may prevent their escalation into significant medical and psychosocial problems, and reduce their economic and societal impact. Childhood is a unique window of opportunity to influence lifetime effects on health, quality of life, prevention of non-communicable chronic diseases and disabilities. The Convention on the Rights of the Child by UNICEF states that parties shall strive to ensure that no child is deprived of his or her right of access to health care services. The EASO COTF is aiming to address these issues via educational activities for health care workers, identification of research agendas, and the promotion of collaborations among clinicians, researchers, health institutions, organizations and states across Europe.
27.	Hemmingsson, Erik, et al. (author) The social origins of obesity within and across generations 2023 In: Obesity Reviews. - : John Wiley & Sons. - 1467-7881 .- 1467-789X. ; 24:1 Research review (peer-reviewed)abstract We propose a model for obesity development that traces a considerable part of its origins to the social domain (mainly different forms of prolonged social adversity), both within and across generations, working in tandem with a genetic predisposition. To facilitate overview of social pathways, we place particular focus on three areas that form a cascading sequence: (A) social adversity within the family (parents having a low education, a low social position, poverty and financial insecurity; offspring being exposed to gestational stress, unmet social and emotional needs, abuse, maltreatment and other negative life events, social deprivation and relationship discord); (B) increasing levels of insecurity, negative emotions, chronic stress, and a disruption of energy homeostasis; and (C) weight gain and obesity, eliciting further social stress and weight stigma in both generations. Social adversity, when combined with genetic predisposition, thereby substantially contributes to highly effective transmission of obesity from parents to offspring, as well as to obesity development within current generations. Prevention efforts may benefit from mitigating multiple types of social adversity in individuals, families, and communities, notably poverty and financial strain, and by improving education levels.
28.	Henriksson, Pontus, et al. (author) Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women : A registry linkage study of 0.5 million pregnancies 2020 In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:10 Journal article (peer-reviewed)abstract INTRODUCTION: Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden.METHODS: This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010-2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression.RESULTS: There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35-1.44) and 2.13 (95% CI 2.03-2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70-3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87-2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration.CONCLUSIONS: The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also indicate that additional support and interventions may be needed for first-generation migrant women from certain birth regions and countries in order to tackle the observed disparities in unhealthy BMI and GWG. Although further studies are needed, our results are useful for identifying groups of women at increased risk of unhealthy BMI and weight gain during pregnancy.
29.	Henriksson, Pontus, et al. (author) Self-Rated Health in Migrant and Non-Migrant Women before, during and after Pregnancy : A Population-Based Study of 0.5 Million Pregnancies from the Swedish Pregnancy Register 2020 In: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:6 Journal article (peer-reviewed)abstract Self-rated health is a strong health marker. Migrants have been suggested to have poorer self-rated health than non-migrants (i.e., native-born). However, little is known about whether there are disparities in self-reported health in relation to pregnancy. Therefore, the aim of the current study was to examine the odds of poor self-rated health before, during and after pregnancy in migrant women as compared to women born in Sweden. We utilized population-based data from the Swedish Pregnancy Register containing 0.5 million women born in Sweden (i.e., non-migrant women) and migrant women between 2010 and 2018. Self-rated health was reported on a 5-point scale (from very poor to very good). Very poor and poor health were categorized as poor self-rated health. Logistic regression was utilized to calculate odds ratios (ORs) that were unadjusted and adjusted for covariates (age, parity, educational attainment and body mass index). The results demonstrate disparities in self-rated health across birth regions. In comparison to women born in Sweden, women born in Latin America and the Caribbean, South Asia as well as North Africa and the Middle East had consistently higher odds of poor self-rated health before, during and after pregnancy (ORs ranging from 1.14 to 1.96 in both unadjusted and adjusted models). Although women born in Sub-Saharan Africa did have comparable self-rated health as to women born in Sweden before pregnancy, after accounting for covariates, they had lower odds of poor self-rated health during and after pregnancy (ORs: 0.71 and 0.80 respectively). Therefore, additional measures and support may be needed to tackle disparities in health between migrant and non-migrant women before, during and after pregnancy.
30.	Holm, Jens-Christian, et al. (author) The Ethics of Childhood Obesity Treatment – from the Childhood Obesity Task Force (COTF) of European Association for the Study of Obesity (EASO) 2014 In: Obesity Facts. - : S. Karger AG. - 1662-4025 .- 1662-4033. ; 7, s. 274-281 Journal article (peer-reviewed)
31.	Högström Berntson, Jenny, 1974, et al. (author) Kom och ät! Med skärmen som måltidssällskap 2023 In: Podcastserie Kom och ät!. - : Yle. Other publication (other academic/artistic)abstract Avsnitt i podcastserien Kom och ät! I sex avsnitt tar Annika Sylvin-Reuter reda på vad som styrt oss bort från måltidsgemenskapen och vad som kunde få oss dit tillbaka. I serien samtalar hon med måltidsforskare, historiker och kostrådgivare som alla ger sin syn på måltiden och vad den hade för syfte förr och vad den gemensamma måltiden har för funktion idag. Avsnitt 6: Med skärmen som måltidssällskap. Ända sedan TV-apparaterna hittade in i våra vardagsrum och kök, har de stått påslagna mer eller mindre hela tiden. Nu har de dessutom fått konkurrens av mobilskärmar, dataskärmar, applikationer och diverse streamingtjänster. Ett hur bra måltidssällskap är skärmen? Vad gör den med vår uppmärksamhet och vårt ätande? I detta avsnitt intervjuas Paulina Nowicka, professor i kostvetenskap, Uppsala universitet, och Jenny Högström Berntson, kulturarvsforskare, Göteborgs universitet.
32.	Jacobsson, Amanda, et al. (author) Dietisters erfarenhet av motiverande samtal inom öppenvård 2017 In: Dietistaktuellt. ; 26:3, s. 48-53 Journal article (other academic/artistic)abstract Som dietist möter man människor i behov av en livsstilsförändring. Ett sätt att bidra till detta är genom motiverande samtal, på engelska motivational interviewing (MI). MI är en samtalsmetod som blivit uppmärksammad under de senaste åren av forskare och kliniker. Evidensen är blandad. En del studier visar att MI är en effektiv metod för att hjälpa människor att genomföra livsstilsförändringar, medan andra visar att MI inte är bättre i jämförelse med annan behandling. Majoriteten av forskningen har fokuserat på andra personalgrupper inom hälso- och sjukvården än dietister. I denna studie har vi därför tillfrågat 139 dietister i Sverige om deras erfarenheter av MI. Resultaten visar en genomgående positiv inställning till MI men indikerar också på ett antal brister och hinder till användningen.
33.	Lindberg, Louise, et al. (author) Low grandparental social support combined with low parental socioeconomic status is closely associated with obesity in preschool-aged children: a pilot study 2015 In: Pediatric Obesity. - : Wiley. - 2047-6302 .- 2047-6310. Journal article (peer-reviewed)abstract While the influence of parental socioeconomic status (SES) on children’s weight status is well known, the impact of other family-related aspects such as parental and grandparental social support is less understood. This study investigates the importance of parents’ SES and social support (functional and structural) for weight status in a clinical sample of preschoolers 4–6 years old with obesity (n = 39, 56% girls; 73% of parents were overweight/obese, 50% were of non-Swedish origin). Linear regression analyses, simple and multiple, were performed on SES and social support with child BMI SDS (body mass index standard deviation score) as the dependent variable. The results show that parents’ income and low emotional support from paternal grandparents were significantly associated with more severe obesity. The association between parental income and the child’s BMI SDS was stronger among parents who had low emotional support from their own parents. In conclusion, grandparental social support may be protective against childhood obesity.
34.	Lobstein, Tim, et al. (author) Social disparities in obesity treatment for children age 3-10 years : A systematic review 2021 In: Obesity Reviews. - : John Wiley & Sons. - 1467-7881 .- 1467-789X. ; 22:2 Journal article (peer-reviewed)abstract Socio-economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio-economic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family-level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family-level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.
35.	Lövestam, Elin, 1983-, et al. (author) Kritisk dietetik : Att se mat och ätande bortom kalorier 2017 In: Dietistaktuellt. - Bjuv. ; 26:3, s. 32-34 Journal article (pop. science, debate, etc.)abstract Epidemiologiska studier visar att aspekter som låg utbildning, utländsk härkomst, hög arbetslöshet och boende i områden med lägre status är kopplade till större förekomst av ohälsa, exempelvis hjärtsjukdom, diabeteskomplikationer och fetma. Även vid sjukdomsrelaterad undernäring kan patientens sociala och ekonomiska situation vara avgörande för huruvida nutritionsbehandlingen ska lyckas. Men vilken verklighet och vilken vardag döljer sig bakom dessa samband? Hur ska dietister förhålla sig till det faktum att andra faktorer förutom omtanke om egen hälsa kan ha avgörande betydelse för patientens förmåga att göra hälsobefrämjande val? Bör vi ta ställning till och diskutera dessa frågor även utanför det rent nutritionsmässiga perspektivet?
36.	Lövestam, Elin, 1983-, et al. (author) Kritisk dietetik : självreflektion, ödmjukhet och dialog 2018 In: DietistAktuellt. - Bjuv. ; XXVII:2, s. 46-48 Journal article (pop. science, debate, etc.)abstract Tack vare medel från Vetenskapsrådet och Letterstedtska föreningen anordnade vi den 25 augusti konferensen ”The 1st Scandinavian Critical Dietetics Conference”, som syftade till att introducera ämnet kritisk dietetik i Sverige. I Dietistaktuellt nr 6 2017 skriver redaktören Magnus Forslin en personlig reflektion på åtta sidor där han angriper konferensen och de diskussioner som fördes där. Tonen i texten – kombinerat med associationer till bl a förintelseförnekelse och stalinism samt hånfulla illustrationer – inbjuder tyvärr inte till dialog. Istället för att ge oss in i en debatt på de premisserna tar vi tillfället i akt att kort och koncist lyfta några punkter om kritisk dietetik som vi gärna förtydligar. Då många av de antaganden och insinuationer som görs i artikeln saknar grund vill vi också bjuda in Dietistaktuellts läsare att själva ta del av konferensens presentationer, vilka ligger öppet på Institutionen för kostvetenskap, Uppsala Universitets webbplats.
37.	Malek, Mahnoush, et al. (author) Familial practices, attitudes and knowledge related to the child’s beverage consumption : A qualitative study with mothers and grandmothers of preschool children 2015 In: Proceedings of the 25th European Childhood Obesity Congress 2015. - Stockholm. ; , s. 27-27 Conference paper (peer-reviewed)abstract Aim: To study maternal and grandparental attitudes, knowledge and practices regarding beverage consumption of preschool children.Methods: Twenty-two semi-structured interviews, representing 11 families, were analyzed using content analysis. The families consisted of a subsample (all mother-grandmother dyads) from “The Grandparents’ Study” performed in Eugene, Oregon, USA. Two thirds of the mothers and more than half of the grandmothers were overweight/obese. Among children (mean age 4.7 years; 45 % girls) 60% were overweight/obese.Results: The strategies used to influence children’s beverage consumption included parental involvement (e.g. offering healthy options, teaching about nutrition), restriction (of unhealthy beverages), moderation (of beverages perceived as healthy/partly healthy) and modeling (acting as a good role model). Both mothers and grandmothers used more than one of these strategies. While there was no clear difference in the choice of the strategies between mothers and grandmothers, the perceptions about what the children preferred to drink differed between the two generations. There was also a difference in views about beverages’ healthiness: more than half of the grandmothers perceived juice as healthy while none of the mothers did.Conclusions: The most distinct intergenerational difference was related to juice, with grandmothers being more positive. Increased knowledge regarding beverages may influence attitudes and behaviors of family members and ultimately impact upon children’s drinking habits. Further studies on how to implement familial practices in dietary treatment and how to effectively involve and educate members of the extended family are needed.
38.	Mazur, Artur, et al. (author) Reviewing and addressing the link between mass media and the increase in obesity among European children : The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement. 2018 In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 107, s. 568-576 Journal article (peer-reviewed)abstract This study reviewed the link between social media and the growing epidemic of childhood obesity in Europe. A task force from the European Academy of Paediatrics and the European Childhood Obesity Group searched published literature and developed a consensus statement. It found that there was evidence of a strong link between obesity levels across European countries and childhood media exposure and that parents and society needed a better understanding of the influence of social media on dietary habits.CONCLUSION: Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity.
39.	Miregård, Jessica, et al. (author) National data showed an increased prevalence of overweight and obesity among four-year-old Swedish children during the first year of COVID-19. 2023 In: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 112:6, s. 1269-1274 Journal article (peer-reviewed)abstract AIM: This paper summarised national data on the prevalence of overweight and obesity among 4-year-old children in Sweden in 2020, the first year of the COVID-19 pandemic. It compares this with data from 2018. Differences between regions and sex were identified.METHODS: Comparative data from Swedish Child Health Services were available for 18/21 regions. Chi-square tests were used to compare data from 2018 and 2020 and to examine differences between the sexes. Sex and year were examined through interaction tests.RESULTS: In 2020, 13.3% of the 100 001 children had overweight or obesity: 15.1% of the girls and 11.6% of the boys (p < 0.001). In 2018, 11.4% of the 105 445 children had overweight or obesity: 13.2% of the girls and 9.4% of the boys. This was an overall increase of 16.6% (p = 0.000) in the national Swedish data from 2018 to 2020. The increase between the years was greater for obesity (31.8%, p = 0.000) than for overweight (13.3%, p = 0.000).CONCLUSION: The prevalence of overweight and obesity among 4-year-olds in Sweden increased during the COVID-19 pandemic and needs to be addressed. The prevalence needs to be followed as part of prevention programmes and to evaluate health interventions.
40.	Neuman, Nicklas, 1987-, et al. (author) Childhood memories of food and eating in lower-income families in the United States : A qualitative study 2021 In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 21:1 Journal article (peer-reviewed)abstract Background Childhood obesity prevention initiatives emphasize healthy eating within the family. However, family-focused initiatives may not benefit children whose families lack economic and/or social resources for home cooking and shared meals. The aim of this paper is to examine how adults talk about and make sense of childhood memories of food and eating, with particular attention to understandings of family life and socioeconomic conditions.Methods Semi-structured interviews with 49 adults in 16 families (22 parents and 27 grandparents of young children) were conducted in Oregon, United States. Most participants had experienced socioeconomically disadvantaged childhoods. The interviews were analyzed using thematic analysis, with a focus on the participants’ memories of food provision, preparation, and consumption in their childhood homes.Results Two main themes were developed: (1) “Food and cohesion”, with the subthemes “Care and nurturance” and “Virtue transmission through shared meals”, and (2) “Food and adversity”, with the subthemes “Lack and neglect” and “Restriction and dominance”. The first theme captures idealized notions of food in the family, with participants recounting memories of care, nurturance, and culinary pleasure. The second theme captures how participants’ recollections of neglectful or rigidly restrictive feeding, as well as food discipline tipping over into dominance, upend such idealized images. Notably, the participants alternately identified poverty as a source of lack and as an instigator of creative and caring, if not always nutritionally-ideal, feeding. Thus, they remembered food they deemed unhealthy as a symbol of both neglect and care, depending on the context in which it was provided.Conclusions Childhood memories of food and eating may express both family cohesion and family adversity, and are deeply affected by experiences of socioeconomic disadvantage. The connection between memories of food the participants deemed unhealthy and memories of care suggests that, in the context of socioeconomic disadvantage, unhealthy feeding and eating may become a form of caregiving, with nutrition considered only one aspect of well-being. This has implications for public health initiatives directed at lower-income families.
41.	Neuman, Nicklas, 1987-, et al. (author) Children's experiences of meals after obesity treatment : a qualitative follow-up four years after a randomized controlled trial 2022 In: BMC Pediatrics. - : BioMed Central (BMC). - 1471-2431. ; 22:1 Journal article (peer-reviewed)abstract Background: The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.Method: The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.Results: We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized.Conclusions: While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.
42.	Neuman, Nicklas, 1987-, et al. (author) Feeding the extended family : Gender, generation, and socioeconomic disadvantage in food provision to children 2019 In: Food, Culture, and Society. - : Routledge. - 1552-8014 .- 1751-7443. ; 22:1, s. 45-62 Journal article (peer-reviewed)abstract This paper examines how US parents and grandparents describe their provision of food to preschool-age children. Drawing on 49 interviews with 16 families, most of which were socio-economically disadvantaged, we argue that gender and generation intersect in everyday efforts to care for children’s eating. The analysis explores gendered divisions of foodwork, highlights the struggles of single mothers, and examines fathers’ redefinitions of the paternal role to include feeding and caring for children. At the core of the analysis, however, is the participants’ emphasis on grandmothers as sources of knowledge and support, with both fathers and mothers citing grandmothers and other women of earlier generations as culinary influences and as role models for good parenting. We thus discuss “feeding the extended family,” and conclude with a discussion about moving beyond the couple-focused paradigm of parenting in research on food and the gendered division of foodwork.
43.	Neuman, Nicklas, 1987-, et al. (author) Memories of meals in the Grandparents Study : A work in progress 2019 Conference paper (other academic/artistic)abstract The Grandparent Study, an interview-based qualitative study in Eugene, Oregon, was launched in 2011 with the aim of exploring parents’ and grandparents’ roles in the food habits and physical activity of children in socioeconomically disadvantaged families. The data are collected through semi-structured interviews from 16 families which all centred around one child in the family (3-5 years of age). The sample consists of 49 participants: 22 parents (14 women) and 27 grandparents (21 women). Since the study’s initiation, several works have been published related to subjects such as perceptions about the children’s body weight (Eli, Howell, Fisher, & Nowicka, 2014a), the gendered and generational division of domestic food responsibilities (Neuman, Eli, & Nowicka, 2019) and the participants’ own memories of becoming aware of their bodies (Eli, Howell, Fisher, & Nowicka, 2014b). The latter publication connects to the present study, which is a work in progress about the participants’ meal memories. Drawing on research on commensality – the activity of sharing a meal – we explore how eating in the family is recounted in a variety of ways, positively and negatively, thus problematizing a priori assumptions about the family meal as a social knit. As argued by other scholars before us (e.g. Andersen, Holm, & Baarts, 2015; Grignon, 2001; Julier, 2013), commensality may facilitate social communion and is both desired and idealized among some, but it may also bring with it social exclusion, stigma or other undesirable social consequences. ReferencesAndersen, S. S., Holm, L., & Baarts, C. (2015). School meal sociality or lunch pack individualism? Using an intervention study to compare the social impacts of school meals and packed lunches from home. Social Science Information, 54(3), 394–416Eli, K., Howell, K., Fisher, P. A., & Nowicka, P. (2014a). “A little on the heavy side”: a qualitative analysis of parents' and grandparents' perceptions of preschoolers' body weights. BMJ Open, 4(12). doi:10.1136/bmjopen-2014-006609Eli, K., Howell, K., Fisher, P. A., & Nowicka, P. (2014b). “Those comments last forever”: Parents and grandparents of preschoolers recount how they became aware of their own body weights as children. PloS one, 9(11), e111974. Grignon, C. (2001). Commensality and social morphology : an essay of typology. In P. Scholliers (Ed.), Food, drink and identity : cooking, eating and drinking in Europe since the Middle Ages (pp. 23-33). Oxford: Berg.Julier, A. P. (2013). Eating together : food, friendship, and inequality. Urbana: University of Illinois Press.Neuman, N., Eli, K., & Nowicka, P. (2019). Feeding the extended family: Gender, generation, and socioeconomic disadvantage in food provision to children. Food, Culture & Society, 22(1), 45-62.
44.	Nowicka, Paulina, 1974-, et al. (author) Assessment of parental overt and covert control of child's food intake: A population-based validation study with mothers of preschoolers 2014 In: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 15, s. 673-678 Journal article (peer-reviewed)abstract Introduction: Overt and covert control are novel constructs representing two different parental feeding practices with regard to the child's ability to detect them. Preliminary research indicates that covert control is linked to a healthier diet and lower child weight status. In this study,we report the first psychometric validation of the original measures of overt and covert control outside the UK in a large sample of parents of preschoolers.Methods: Based on records from the population register, all mothers of 4-year-olds (n = 3007) from the third largest city in Sweden,Malmö, were contacted by mail. Out of those, 876 returned the measures of overt and covert control together with a background questionnaire and the Child Feeding Questionnaire (CFQ). Test–retest data were obtained from 64% (n = 563) of these mothers. The mean age of the mothers was 35.6 years; their mean BMI was 24.1, 31.5% were overweight or obese. The children were on average 4.5 years old; 48% were girls, 12.8% were overweight or obese.Results: While the fit for the original 9-item 2-factor model was poor, shorter 8- and 6-item versions were supported by confirmatory factor analysis (CFI N 0.95, RMSEA b 0.05). Internal and test–retest reliability of the shorter version was good (ICC= 0.65–0.71). Results also suggest that the factor structure and loadings were invariant (i.e., did not significantly differ) over time and between child sexes. Both overt and covert control factors were moderately correlated with CFQ monitoring. Overt control was also moderately related to CFQ pressure and weakly correlated with CFQ restriction. Covert control, on the other hand, was moderately related to restriction and not related with pressure. Correlations of both factors with child and parent BMI were very small.Conclusion: We found good psychometric properties of the revised versions of the overt and control behaviors in a multiethnic sample of mothers from Sweden. Future studies need to establish causal associations between overt and covert control and the obesity related outcomes.
45.	Nowicka, Paulina, 1974-, et al. (author) Barnövervikt i praktiken. Evidensbaserad familjeviktskola 2006. - 1 Book (pop. science, debate, etc.)
46.	Nowicka, Paulina, 1974-, et al. (author) Beteendemodifikation – enda rimliga terapin vid fetma hos barn och vuxna 2011 In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 11:49, s. 2581-2585 Journal article (peer-reviewed)abstract Beteendemodifierande fetmabehandling bygger på det självklara – om man äter mindre och rör sig mer så går vikten ner. De framsteg som gjorts inom detta behandlingsområde summeras, med fokus på barn.
47.	Nowicka, Paulina, 1974-, et al. (author) Beteendemodifikation och barnfetma. Vart står vi idag? 2012 In: Dietistaktuellt. ; XXI:1 Journal article (pop. science, debate, etc.)
48.	Nowicka, Paulina, 1974-, et al. (author) Changing the Home Food Environment : Parents’ Perspectives Four Years after Starting Obesity Treatment for Their Preschool Aged Child 2021 In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:21 Journal article (peer-reviewed)abstract Changing the home food environment is key to childhood obesity treatment. However, new challenges arise as the child grows older. This study investigates parents’ views on the longer-term management of the home food environment, 4 years after starting obesity treatment for their preschool-aged child. Semi-structured interviews were conducted with 33 parents (85% mothers, 48% with a university degree) of 33 children (mean age 9.3 (SD 0.7), 46% girls) from Sweden. The interviews were analyzed using thematic analysis. Two main themes were developed. Making changes in the home food environment illustrates the types of changes families make over time in relation to child development. It consists of three subthemes: covert changes, overt changes and child-directed changes. The second theme, an ongoing negotiation, captures parents’ experiences of managing the home food environment as a continuous process of balancing and recalibrating in relation to present challenges and concerns about the future. It includes three subthemes: concern and care, two steps forward one back and maintaining everyday balance. Managing the home food environment is a constant process affected by everyday life, parents’ strategies and the child’s development. Our findings can strengthen childhood obesity treatment and help prepare parents for challenges that lie ahead.
49.	Nowicka, Paulina, 1974- (author) Dietitians and exercise professionals in a childhood obesity treatment team. 2005 In: Acta Paediatrica. Supplement. - : Wiley. - 0803-5326 .- 0803-5253. ; 94:448, s. 23-29 Journal article (peer-reviewed)abstract UNLABELLED: There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given.CONCLUSION: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.
50.	Nowicka, Paulina, 1974- (author) Early obesity treatment: Motivational work with the parents of the youngest. Current evidence of effectiveness and practical examples. 2016 In: 1st European Obesity Summit, 2016. Conference paper (other academic/artistic)

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