Health programs for childhood obesity

Unfortunately, stigma is widespread and tolerated in society, furthering the reach of negative harm. Children with obesity face explicit weight bias and stigma from multiple environments including from parents, obesity researchers, clinical settings, and school.

Parents not only demonstrate implicit bias against childhood obesity, but also implicit and explicit biases against children with obesity Lydecker et al Even among obesity researchers and health professionals, significant implicit and explicit anti-fat bias, and explicit anti-fat attitudes increased between — Tomiyama et al Exposure to stigma and weight bias can have damaging psychosocial effects on children, such that stigma can mediate the relationship between BMI, depression, and body dissatisfaction Stevens et al Weight stigma can also initiate bullying and weight related teasing, which can have serious psychological consequences such as depression among children, further weight gain and lessen motivation to change.

The relationship between obesity and bullying needs to be addressed through bullying engagement, and coping skills for victimization to prevent and manage associated behavioral and depressive symptoms. Children exposed to less supportive environments consisting of family stress, father absence, maternal depression, confinement, and unclean home environments at 1 year of age has been associated with high BMI at age 21 Bates et al The current climate is being shaped by the position of the American Medical Association.

In , the Board voted to classify obesity as a disease that requires medical attention. This classification aimed to emphasize health risks of obesity, remove individual blame, and create new implications and opportunities for intervention.

This classification can help to further: 1 a broader public understanding of the obesity condition and associated stigma; 2 prevention efforts; 3 research for treatment and management; 4 insurance reimbursement for intervention; and 5 medical education Kyle et al Reimbursement has been a significant barrier to uptake of effective interventions and the impact of the USPSTF in removing this impediment is not yet fully known.

A number of high-quality systematic reviews and meta-analyses have been published in recent years, which provide the most contemporary perspective of the effectiveness of interventions for prevention and management, as well as revealing wide variability and inconsistent findings.

For example, Peirson et al a saw that prevention interventions were associated with slightly improved weight outcomes compared to control groups in mixed-weight children and adolescents. However, intervention effects were not consistent among each intervention strategy tested, suggesting that specific characteristics of the interventions, such as setting, participants, dose, and tailoring, should be examined to determine what is and is not effective in achieving desired outcomes.

Relatedly, for prevention in particular, there is some correspondence between the sample being targeted and the context, such that community and school-based interventions are far more likely to be universal sample does not consider weight status or selective target sample is overweight or specifically targeted due to being at-risk for obesity; e.

Unsurprisingly, the specific intervention targets and behavior change strategies align with the context and approach St. George et al in press. Community interventions can involve the use of media, businesses e. Interventions delivered in community settings can be effective, but the impact could be diminished through the lower likelihood of intervention completion due to living in lower socioeconomic circumstances and other obstacles Fagg et al In comparison to other settings, such as the school and family level, there were fewer studies conducted at the community level in a recent review Bleich et al This may be due to the numerous challenges and complications involved in building community capacity and engaging community leaders, stakeholders, community agencies, and city organizations.

Alternatively, it could reflect a greater focus to date on other contexts and intervention targets, which we discuss in the following sections.

To address effectiveness and sustainability, a combined clinical and community intervention could hold promise, especially for racially diverse children living in a low-income community, who are most at-risk. A study by Hoffman et al showed that an integrated clinic-community model is feasible and improves physical activity and quality of life when compared to multidisciplinary treatment only in clinical care settings.

To summarize, there is promise in community-based interventions that involve either the health clinic and community partnerships or community and school partnerships.

Considering that the majority of children spend a significant amount of their day in school, many preventive interventions have leveraged schools as an entry point to improve the obesogenic environment by promoting more physical activity in physical education classes and recess, improving school playgrounds and nutritional options in school cafeterias, and providing healthy lifestyle education in classes or other school policies Ickes et al Previous reviews recommend using multi-component interventions targeting two or more health behaviors i.

Interestingly, well-designed school-based studies are effective in improving dietary behavior, but typically do not see statistically significant differences in child BMI between intervention and control schools, except for among children who are already in the obese range Bogart et al While increasing fruit, vegetable and water consumption are important, the health behavior modifications are not sufficient for significant long-term obesity management.

A way this has been addressed is partnerships between schools and community-based interventions which also engage parents. In a synthesis of systematic reviews and meta-analyses of school-based interventions, long-term interventions with a combination of diet and physical activity components and family or parental involvement significantly reduced weight among children Khambalia et al Aligned with previous research, Bleich et al found that school-based interventions that used a multi-component approach of both physical activity and nutrition with some intervention with families in the home had the largest effects.

A systematic review and meta-analysis by Wang et al observed that strength of evidence of obesity prevention programs for children ages 2—18 years was dependent on intervention type, and delivery setting s. Strength of evidence was high for physical activity-only interventions delivered in school settings with home involvement, or combined diet and physical activity interventions delivered in school settings with home and community involvement.

They also found moderately strong evidence when delivering combined interventions in school-based settings alone, in schools with home or community component, or in community with a school component. Bleich et al also reviewed a smaller number of pre-school interventions and found some promise in both single component interventions—focusing solely on physical activity—and multi-component interventions.

An exemplar study, Natale et al conducted an early childhood multi-level obesity intervention, which included menu modifications at the child care center, a nutrition and physical activity educational curriculum for preschoolers, and a healthy meal preparation and role modeling curriculum for parents.

At two-years follow-up, the researchers observed significantly less increase in BMI percentile among the intervention group versus controls.

Overall, strong obesity prevention interventions in early care and education settings were associated with healthy eating and anthropometric outcomes, which was further improved by parental engagement.

The home environment e. Playing an integral role in physical activity, diet, screen time, and sleep, parents can exhibit positive parenting practices e. Family-based interventions are defined as involving either passive or active parental involvement, often with parents viewed as the primary or sole agents of change Sung-Chan et al Active parental involvement entails repeated engagement, such as participation in workshops, counseling, or educational sessions; passive involvement does not integrally involve the parent or guardian e.

A fraction of studies occurred in multiple settings and over half targeted multiple components beyond diet and physical activity, such as screen time or sleep. Many preventive studies targeting young children pre-natal to five years old tend to use home or primary-care based settings with parental involvement, whereas interventions targeting older children tended to take place in community- and school-based settings.

These findings are commensurate with the review of St. George et al in press , which showed a decrease in parental involvement and family-based intervention strategies with child age.

This dovetails with the conclusions of Kothandan that family-based interventions demonstrated effectiveness for children younger than twelve, but for children twelve and up, school-based interventions were most effective in the short-term.

Regarding preventive interventions specifically, the majority of interventions have been tested among low SES families and predominantly white families Ash et al Latinx are particularly well-suited to participate in family-based interventions given their cultural emphasis on familial values; however, a recent meta-analysis noted diminishing intervention effects with a higher proportion of Hispanic children Ling et al , which was attributed to a lack of culturally competent interventions to address language barriers and dietary preferences.

In addition to incorporating other ethnic minorities and culturally appropriate interventions, Ash et al suggested that preventive family-based interventions should account for non-traditional families and their different needs and family dynamics. In regard to family dynamics and interactions, poor family functioning has been linked with an increased risk of obesity, obesogenic behaviors, and adverse health outcomes e. Interventions including both parents and children have shown more positive short and long-term effects on child weight when compared to parent-only interventions and controls in some studies Yackobovitch-Gavan et al , whereas others have found comparable effects for parent-only and child-involved family-based approaches Boutelle et al Further, parent-only interventions have been shown to be more cost-effective Janicke et al b.

In a meta-analysis evaluating comprehensive behavioral family lifestyle interventions treating pediatric obesity, Janicke et al found an overall standardized effect size of 0. The dose of treatment i. In addition, age was a significant moderator for weight outcomes indicating that older children had larger and more beneficial intervention effects than younger children.

Long-term prevention trials using family-based intervention to target positive behavior support found that children randomized to the intervention had lower BMI in the years following participation Smith et al Given the various ways individual, interpersonal, and family health behaviors contribute to child obesity, a tailored family-based intervention could be effective in identifying specific family needs and providing appropriate resources.

In a family-based tailored intervention, Taylor et al saw that the children of families randomized to the tailored treatment had significantly lower BMI compared to families in the usual care group.

Additionally, children in the tailored treatment had better dietary behaviors and were more physically active than children in the treatment as usual group. Smith, Berkel et al. Primary care interventions are defined as health promotion or weight management programs conducted within or in close coordination with the primary healthcare system.

Primary care is viewed as an ideal, real world environment for weight management interventions because of accessibility and frequency of visits i. In a meta-analysis evaluating weight management interventions delivered in primary-care settings, Mitchell et al found an overall effect size of 0. The dose-response relationship was significant, where the number of treatment contacts, length of treatment in months, and the number of visits with the pediatrician was associated with larger treatment effects.

A systematic review examining randomized control trials targeting obesity management in children ages 2—5 years saw five of six interventions, all in ambulatory healthcare settings, had significant decreases in child weight, with sustained intervention effects through follow-up Ling et al The effective interventions actively involved parents in health education, group meetings, physical activity sessions, or behavioral therapy.

George et al in press identified 74 distinct interventions reported across the included articles. Developmental stage of the child has also been found to align with the strategy, such that interventions in the prenatal and infancy periods are nearly all universal, whereas during childhood and adolescence, as compared to early childhood, the burden of disease is larger and intervention strategies more often target selected and indicated samples with greater intensity St.

The — Dietary Guidelines for Americans recommend consuming a variety of fruits and vegetables, whole grains, proteins, low-fat dairy products, and limiting intake of sodium, solid fats and added sugars beginning at age 2 years DeSalvo et al Unfortunately, only The American Academy of Pediatrics AAP recommends that children under 18 months should have no screen time aside from video-chatting, and children ages 2—5 years engage in one hour of screen time per day of high-quality programs with parents.

The most recent AAP guidelines recommend that children ages 1—2 years sleep 11—14 hours per 24 hours, children 3—5 sleep 10—13 hours, children 6—12 sleep 9—12 hours, and teenagers ages 13—18 should regularly sleep 8—10 hours Paruthi et al Certain behaviors such as a regular routine, avoiding large meals close to bedtime, being physically active during the day time, and eliminating electronic devices in the bedroom are associated with better sleep Irish et al The majority of existing interventions target multiple behaviors, but some have been designed for discrete behaviors.

Orlistat is the only FDA-approved medication for treating obesity for pediatric patients ages 12 years and older. Side effects in the gastrointestinal area are common in children, and further clinical trials are needed to evaluate medication risk and benefits among pediatric patients Chao et al And results are not unequivocal.

Additional research is needed on both effectiveness and tolerability in youth. Data show that bariatric surgery in morbidly obese adolescents can greatly impact weight loss, and attenuate or resolve associated chronic disease. However, adolescents undergoing bariatric surgery should be assessed for capability to adhere to follow-up care regimens to ensure proper nutrition intake and care.

The committee also recommends a multidisciplinary team for adolescents undergoing bariatric surgery, which could include an experienced bariatric surgeon, pediatric specialist, registered dietitian, mental health specialist, care coordinator, and exercise physiologist. The pro-inflammatory disease nature of obesity and contributing health behaviors affects normal physiology and metabolism, and can cause many associated diseases Gonzalez-Muniesa et al Obesity prevention and management interventions in childhood are imperative for averting the burden of associated comorbidities.

Children with obesity are four times as likely to develop type-2 diabetes compared to children with a normal BMI Abbasi et al Metformin is the main treatment of type-2 diabetes in youth and adults, though emerging evidence implicates a role in treating children with obesity and a family history of type-2 diabetes e.

Exercise and lifestyle interventions have had significantly positive health effects in adults, however trials evaluating effects in youth with type-2 diabetes are limited. Given the data from adult trials, the American Diabetes Association recommends that youth with type-2 diabetes meet the 1-hour per day physical activity goal to manage symptoms and decrease health risks Colberg et al Obesity confers the most significant risk for OSA.

Obesity management such as increased physical activity and a healthy diet are recommended for OSA treatment, as well as surgical procedures, if appropriate. Asthma is one of the most common chronic diseases among children and adolescents: Although both obesity and asthma rates have been increasing, it does not appear that obesity has been contributing to the increased asthma prevalence rate Akinbami et al This does not discount the risks of obesity on asthma and its unique effects on asthma symptoms.

Hypertension, like obesity, has been increasing among youth and is associated with increased cardiovascular disease risk throughout the lifetime May et al The greatest risk factor for pediatric hypertension is elevated BMI Falkner et al In a meta-analysis examining cardiovascular risk factors, compared with normal weight children, systolic blood pressure was higher by 4.

A review shows that children with obesity-related hypertension are at increased risk of cardiovascular morbidity and mortality Wuhl About 3.

NAFLD is the leading cause of liver disease, leading to a shorter life expectancy due to associated comorbidities; one of which, non-alcoholic steatohepatitis, is projected to be the leading indication for pediatric liver transplant by Charlton et al The associated risk was removed if participants obtained a normal range BMI by adulthood, emphasizing the salient role of weight management.

The high prevalence of NAFLD among children with obesity, and effectiveness of weight change in treating this condition, emphasizes the need for prevention and management of obesity. Their study exposes the critical role of family functioning on child health, and the importance of using targeted intervention to prevent, and manage obesity and associated disease using a family-centered approach.

Weight being the most modifiable factor, the mainstay of NAFLD treatment is lifestyle behavior modifications aimed at weight loss Marchesini et al This relationship can be attributed to multi-level factors including health behaviors, parenting styles, and family functioning.

A review by Hoare et al suggests that obesogenic risk factors, such as infrequent physical activity, sedentary behavior, poor diet quality, and adiposity were associated with depressive symptoms in adolescents.

Conversely, healthier eating patterns were associated with decreased depressive symptoms. Further, negative psychological experiences more generally, such as trauma and stigma, trigger emotional eating, leading to an ongoing obesity-depression cycle Milaneschi et al The bidirectional relationship of obesity and eating disorders, including eating disorder psychopathology, should be properly evaluated during treatment planning.

One of the abundant challenges for the field is the translation and implementation of effective interventions to the real-world service delivery systems that can reach those most in need.

This so-called research-practice gap is pronounced in obesity prevention and management given the preponderance of untested, usual care approaches currently in use; the persistence of debunked myths about causes and effective intervention approaches e.

This says nothing about the consumer of evidence-based interventions, who historically have had only cursory involvement in the design and deployment of interventions. While many of the aforementioned conceptual models encapsulate the multiple levels contributing to childhood obesity, researchers are trying to elucidate which combination of levels and service contexts have greatest effectiveness, and which implementation strategies best address the complexity at levels of the community, school, family, and primary care.

Implementation strategies are defined as the methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice Proctor et al They are the actions taken on agents in the system of care itself, and rarely only on the patient or client that is the recipient of the clinical program or practice. The three projects around the US, identified the facilitators and barriers of implementing multi-setting interventions targeting levels of the socioecologial model in racially diverse, lower-income communities Dooyema et al CORD 1.

Interventions in rural communities and multiple settings benefited from engaging parents and obtaining support from organization members and leadership Chuang et al , Ganter et al Facilitators of school interventions included using the principal as a champion and using students to engage other students Blaine et al Such knowledge assists in the design of future studies to develop effective, accessible, and acceptable interventions for those needing it most.

Obesity Silver Spring ; 14 — Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children. Public Health Nutr. Hispanic J Behav Sci. Health and nutrition education in primary schools of Crete: follow-up changes in body mass index and overweight status.

Eur J Clin Nutr. Healthy Buddies: a novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school. Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. An environmental intervention to prevent excess weight gain in African-American students: a pilot study.

Am J Health Promot. A school-based intervention to teach third grade children about the prevention of heart disease. Pediatr Nurs. Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention.

Am J Epidemiol. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Relationship between self-monitoring of diet and exercise change and subsequent risk factor changes in children and adults. Patient Educ Couns.

Bronikowski M, Bronikowska M. Will they stay fit and healthy? A three-year follow-up evaluation of a physical activity and health intervention in Polish youth.

Scand J Public Health. Obes Facts. The healthy options for nutrition environments in schools Healthy ONES group randomized trial: using implementation models to change nutrition policy and environments in low income schools. Student public commitment in a school-based diabetes prevention project: impact on physical health and health behavior. BMC Public Health. Multicomponent school-initiated obesity intervention in a high-risk, Hispanic elementary school.

J Pediatr Gastroenterol Nutr. Potential moderators and mediators of intervention effects in an obesity prevention program for adolescent boys from disadvantaged schools. J Sci Med Sport. A school-based obesity control programme: Project Energize.

Two-year outcomes. A school based community partnership for promoting healthy habits for life. J Community Health. Evaluation of a pilot school programme aimed at the prevention of obesity in children. Health Promot Int. Acta Paediatr Suppl. Appendix A3 Interventions implemented in schools and included a home component Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: a randomized controlled trial.

Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. Robinson TN. The effects of a health education intervention initiated at first grade over a 3 year period: physical activity and fitness indices.

J Pediatr. Effects of a physical education program on physical activity, fitness, and health in children: the JuvenTUM project. Bright Start: description and main outcomes from a group-randomized obesity prevention trial in American Indian children. Obesity Silver Spring ; 20 — School health education programs in Crete: evaluation of behavioural and health indices a decade after initiation.

Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study. J Epidemiol Community Health. A controlled, class-based multicomponent intervention to promote healthy lifestyle and to reduce the burden of childhood obesity. A participatory and capacity-building approach to healthy eating and physical activity- SCIP-school: a 2-year controlled trial.

Using routinely collected growth data to assess a school-based obesity prevention strategy. Int J Obes Lond ; 37 — A school-based program of physical activity may prevent obesity.

Prevention of obesity in elementary and nursery school children. Public Health. Effect of school based physical activity programme KISS on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. Effect of a two-year obesity prevention intervention on percentile changes in body mass index and academic performance in low-income elementary school children.

Am J Public Health. Child and Adolescent Trial for Cardiovascular Health. The effects of a health education intervention program among Cretan adolescents. A coordinated school health approach to obesity prevention among Appalachian youth: the Winning with Wellness Pilot Project. Fam Community Health. Int J Obes Lond ; 33 — Overweight prevention implemented by primary school teachers: a randomised controlled trial. Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme HeLP : a novel school-based obesity prevention programme.

BMJ Open. Effect of an environmental school-based obesity prevention program on changes in body fat and body weight: a randomized trial. Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention. A policy-based school intervention to prevent overweight and obesity.

Evaluating the effectiveness of the Kids Living Fit program: a comparative study. The effects of a family fitness program on the physical activity and nutrition behaviors of third-grade children.

Res Q Exerc Sport. Prevention of the epidemic increase in child risk of overweight in low-income schools: the El Paso coordinated approach to child health. Appendix A4 School-based interventions with home and community components Eur J Public Health. Efficacy of a school-based childhood obesity intervention program in a rural southern community: TEAM Mississippi Project. Obesity Silver Spring ; 19 — Effectiveness of a primary school-based intervention to reduce overweight.

Effects of a 2-year healthy eating and physical activity intervention for 3—6-year-olds in communities of high and low socio-economic status: the POP Prevention of Overweight among Pre-school and school children project.

Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: a parallel-group, randomized control trial. Int J Nurs Stud. Effectiveness of JUMP-in, a Dutch primary school-based community intervention aimed at the promotion of physical activity. Br J Sports Med. Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well.

Fam Pract. The impact of Action Schools! BC on the health of Aboriginal children and youth living in rural and remote communities in British Columbia. Int J Circumpolar Health.

Appendix A5 School-based interventions with a community component A simple dietary intervention in the school setting decreased incidence of overweight in children. Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls. Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Ninos Study.

Ann Behav Med. The Kahnawake Schools Diabetes Prevention Project: intervention, evaluation, and baseline results of a diabetes primary prevention program with a native community in Canada.

After-school program to reduce obesity in minority children: a pilot study. J Child Health Care. Evaluation of the Living 4 Life project: a youth-led, school-based obesity prevention study.

Appendix A6 School-based interventions with a consumer health informatics component Spiegel SA, Foulk D. Reducing overweight through a multi-disciplinary school-based intervention.

Evaluation of the web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. Impact of a school-based physical activity intervention on fitness and bone in adolescent females. Effectiveness of YouRAction, an intervention to promote adolescent physical activity using personal and environmental feedback: a cluster RCT. PLoS One. An internet obesity prevention program for adolescents. Appendix A7 Home only-based interventions Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity.

Obes Res. Girls on a high-calcium diet gain weight at the same rate as girls on a normal diet: a pilot study. J Am Diet Assoc. Household obesity prevention: Take Action — a group-randomized trial. Family-based hip-hop to health: outcome results. Obesity Silver Spring ; 21 — Appendix A8 Community-based or environmental-level interventions High-intensity training increases spontaneous physical activity in children: a randomized controlled study.

Dutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behavior. Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools.

Healthy Living Cambridge Kids: a community-based participatory effort to promote healthy weight and fitness. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS. A statewide strategy to battle child obesity in Delaware. Health Aff Millwood ; 29 — Improving weight status in childhood: results from the eat well be active community programs.

Int J Public Health. Footnotes Conflict of interest statement No conflict of interest was declared. RFW is the project manager. Yang Wu is the project coordinator. All authors and some other research team members were responsible for acquisition of data. All authors participated in the analysis and interpretation of data. All authors were responsible for the critical revision of the manuscript for important intellectual content.

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Evaluation of a multiple ecological level child obesity prevention program: switch what you do, view, and chew. BMC Med. Impact of a primary care intervention on physician practice and patient and family behavior: keep ME Healthy — the Maine Youth Overweight Collaborative. Office-based randomized controlled trial to reduce screen time in preschool children.

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Percept Mot Skills. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. Effect of childhood obesity prevention programs on blood pressure: a systematic review and meta-analysis. To download this course for your eReader, please click on a link for your device type and follow the instructions below.

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Furthermore, these links do not constitute an endorsement of these organizations or their programs by NetCE, and none should be inferred. Obesity is occurring at an epidemic rate in the United States. The statistics paint a grim picture of the future of health care and management. Multiple factors contribute to the increase in prevalence of childhood obesity including, but not limited to, sedentary lifestyle, sugared drinks and soda, and the increase in convenience "fast" foods.

Children burdened with obesity are at an increased risk for early onset of cardiovascular disease, bone and joint complications, depression, and other mental illnesses, and diabetes. This course provides an overview of the development and complications associated with obesity in children and adolescents. Treatment and education points are emphasized. This course is designed for nurses in all practice settings with a desire to better understand the issues facing obese children and their families and the impact of childhood obesity on national and global health care.

NetCE designates this continuing education activity for 6 hours for Alabama nurses. The impact of childhood obesity on an already stressed healthcare system is high and is estimated to rise as the diagnoses of comorbid conditions continue to occur at a younger age. The purpose of this course is to provide nurses with the information necessary to improve the care of children and adolescents who are overweight or obese.

Outline the prevalence and cost of childhood obesity in the United States. Analyze the etiology of overweight and obesity in the pediatric population. Identify groups at high risk for childhood obesity. Utilize the criteria for the diagnosis of overweight and obesity in children. Review the findings of research regarding childhood obesity.