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This talks about how to prevent the suicide that could happen if a child is over weight.

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Abstract

The present study examined relative suicidal behavioral risks (ideation, attempts) for overweight, obese, and extremely obese adolescents (vs. healthy weight) and who did/did not accurately perceive themselves as overweight utilizing cross-sectional data from the publicly available Youth Risk Behavior Survey (YRBS). A new variable (weight status/accuracy) was computed that combined actual weight status (based on BMI) with weight perception accuracy. To evaluate the effect of weight status/accuracy on each suicidal risk behavior, logistic regression was performed to calculate odds-ratios and 95% confidence intervals (CI). Potential model covariates included gender, age, race, survey year, and whether they had felt sad/hopeless. Weight perception accuracy increased as the degree of excess weight increased. Relative to healthy weight, being obese or extremely obese (but not overweight) was associated with significantly greater risk for adolescent engagement in suicidal ideation, but was unrelated to suicide attempts. Adolescents in all excess weight categories who were accurate in their weight perception were at significantly greater odds of suicidal ideation, whereas those who were inaccurate of no greater odds of suicidal ideation than healthy weight youth who accurately perceived their weight. Findings regarding suicide attempts varied based on actual weight/weight perception accuracy and race/ethnicity. The present findings are both important and clinically relevant. While widely accepted that there are multiple pathways to suicide, our understanding of adolescent suicidal behavior risks and accordingly, prevention efforts, will be informed by comprehensive prospective studies that should also, from here forward, consider categorization of the entire weight spectrum (e.g., extreme obesity).

INTRODUCTION

As the third leading cause of death among adolescents in the United States, suicide is considered a critical public health problem for today's youth. Adolescence is a period of rapid change in physical, psychosocial, educational and vocational domains, also distinguished by an increase in behaviors considered to be risky, harmful, or even antisocial. Not surprisingly, adolescence is a developmental period known for increased risk for the first onset of nonfatal suicidal behaviors, with noteworthy lifetime prevalences of suicidal ideation (19.8-24%) and attempts (3.1-8.8%) for this age group. It is widely accepted that there are multiple pathways to adolescent suicide, with a myriad of known contributing factors (e.g., previous nonfatal attempts, depression, peer victimization, family history of suicide, peer suicidal behaviors, impulsivity, substance use, childhood trauma) to guide prevention initiatives. However, current evidence remains equivocal regarding whether being overweight or obese increases an adolescent's suicidal behavior risk.

The aim of the present study, to understand whether adolescent excess weight status is associated with suicidal behaviors, proves critical and timely for a number of reasons. First, adolescent overweight and obesity are also public health priorities, given their high prevalence, related health and psychosocial consequences, and likelihood of persistence into adulthood. Only recently have adolescents with extreme obesity (BMI ≥ 99 th percentile) emerged as their own unique excess weight sub-group in the pediatric literature, representing an alarming 3-6% of today's teenagers. Second, adolescents who are obese, and in particular, those with extreme obesity, while not necessarily depressed, report some of the greatest impairments in health-related quality of life (HRQOL) relative to other pediatric chronic health conditions and across domains (physical functioning/discomfort, social, emotional, body-esteem). Moreover, it is well established that overweight and obese youth also experience peer difficulties, including victimization which are known risk factors for higher rates of suicidal ideation and attempts. Third, a recent review of the extant adult obesity literature, which is largely based on retrospective reviews of "cause of death" records, suggests equivocal evidence supporting increased prevalence of completed suicides for obese adults, albeit leaning towards a positive association. Finally, the recent finding by Windover and colleagues demonstrating that adult bariatric surgery candidates (i.e., extreme obesity) report rates of previous suicide attempts 73 times greater than population norms is disturbing.

With these "facts" in mind, we hypothesized that suicide behavior risks (ideation, attempts) would be greater for adolescents across the excess weight status spectrum (e.g., overweight, obese, extremely obese) relative to youth of healthy weight. However, we could not ignore the interesting findings within the broader pediatric literature that suggest adolescent perception of weight (perceiving oneself as being underweight or overweight) as being more predictive of suicidal behaviors than an adolescent's actual weight status. This proves critical to the present aims given weight misperception is remarkably common in adolescents who are overweight/obese, with recent estimates suggesting 1 in 3 do not consider themselves to be "overweight". However, rates of weight misperception in adolescents whose obesity has progressed to extreme levels remains unknown.

Accordingly, the present study advances the literature by examining relative suicidal behavioral risks (ideation, attempts) for adolescents across the excess weight status spectrum (overweight, obese, extremely obese vs. healthy weight) and who do or do not accurately perceive themselves as overweight. We hypothesized that those youth who carried excess weight and perceived themselves to be overweight would report greater suicidal ideation and attempts than healthy weight youth who perceived their weight accurately. To achieve our aims, we used cross-sectional data from the publically accessible Youth Risk Behavior Survey (YRBS), which provides what is considered the "most comprehensive epidemiological data on suicide ideation and attempts" for youth in the United States. Given known links between depressive symptoms and suicide risk, analyses controlled for "feelings of sadness/hopelessness". Potential interactions with demographic variables were also considered.

METHODS AND PROCEDURES

Study Design and Study Population

The YRBS is a biennial school-based survey administered by the Centers for Disease Control and Prevention (CDC) to a nationally representative sample of students who attend public and private schools and are enrolled in grades 9-12. YRBS methods and sampling procedures are described in greater detail elsewhere. Briefly, students providing assent who had parental and school consent for participation independently completed a battery of YRBS self-report forms in a classroom setting, with the guidance of a trained research staff person. The present study utilized a subsample (see Weight Status section below) from the pooled 2007 and 2009 surveys (Total N=28,240). The overall response rate (school response rate × participant response rate) was 68% in 2007 and 71% in 2009.

Outcome Variables

Independent Variables

Statistical Analyses

SAS v9.3 was used to complete analyses using weighted data to adjust for non-response and oversampling of Black and Hispanic students, accounting for the complex survey design. A new variable (weight status/accuracy) was computed that combined actual weight status (based on BMI) with weight perception accuracy. To evaluate the effect of weight status/accuracy on each suicidal risk behavior, logistic regression was performed to calculate odds-ratios and 95% confidence intervals (CI) (SAS Proc SurveyLogistic). Potential model covariates included gender, age, race, survey year, and sadness/hopelessness. All significant (p < 0.05) covariates were retained in the final models. Interactions of weight status/accuracy with demographic variables (e.g., gender, race, age) and feelings of sadness/hopelessness were examined. The Institutional Review Board at Cincinnati Children's Hospital Medical Center approved these secondary analyses.

RESULTS

Weight Status and Weight Perception Accuracy

Actual weight status prevalence of overweight (16.5%), obese (10.7%), and extreme obesity (2.8%) was consistent with widely cited national base rates. The frequencies for weight perception accuracy, gender, and race by weight status group are presented in . The percentage of adolescents whose perception of overweight status was accurate/inaccurate varied by degree of excess weight, race, and gender. Eighty-six percent of adolescents with extreme obesity accurately perceived themselves to be overweight whereas only 77.1% of obese and 54.2% of overweight youth did so. This trend was apparent when taking into account gender and race, although it is notable that a higher percentage of Black adolescents who were overweight were inaccurate in their weight perception as opposed to accurate.

Weight Status Group and Suicidal Ideation and Attempts

The associations between weight status group with suicidal behaviors were examined after adjusting for demographic covariates and feelings of sadness/hopelessness. The odds of suicidal ideation were significantly greater for adolescents who were obese (odds ratio [OR] adj.= 1.31, 95% confidence interval [CI]: 1.11 - 1.55) or extremely obese (OR adj.= 1.81, 95% CI: 1.24 - 2.66) relative to those who were of healthy weight. Adolescents who were overweight (OR adj.= 1.11, 95% CI: 0.98 - 1.26) were similar to healthy weight youth in suicidal ideation risk. The odds of suicide attempts were not significantly greater for any excess weight status group as compared to adolescents of healthy weight (p = 0.18).

Suicidal Ideation and Weight Status/Accuracy

Prevalence rates and odds ratios of suicidal ideation when examining weight status/accuracy are presented in . Adolescents in all excess weight categories who were accurate in their weight perception were at significantly greater odds of suicidal ideation than healthy weight youth who accurately perceived their weight status. Adolescents in all excess weight status groups who were inaccurate in their weight perception were similar to healthy weight youth who accurately perceived their weight status. These findings did not vary based on race, gender, age, data cohort or whether the adolescent had feelings of sadness/hopelessness.

Suicide Attempts and Weight Status/Accuracy

lists prevalence rates and odds ratios for suicide attempts when examining weight status/accuracy. Weight status/accuracy was found to significantly vary by race, therefore results were stratified by race. In general, odds of attempts were not significantly elevated among youth with excess weight and accurate weight perception. Black youth who were overweight/accurate and Hispanic youth who were extremely obese/accurate were the exceptions. When weight perception was inaccurate, Black obese youth, and Hispanic overweight and extremely obese youth had significantly higher odds of reporting suicide attempts. Of note, Hispanic, extremely obese/inaccurate youth had a 9-fold greater odds of suicide attempts compared to healthy weight/accurate adolescents.

DISCUSSION

Adolescent obesity as well as teen suicide are leading public health challenges. While adolescent suicide has many known risk factors, should adolescent excess weight status and further, recognition of that excess weight by the adolescent, be added to this list? The present study advances the adolescent health literature in several unique ways. First, these results are based on a large nationally representative sample of high school students both in terms of demographics as well as prevalence of excess weight status. Second, for the first time in the adolescent obesity/suicide literature, adolescents who were extremely obese (BMI≥ 99 th percentile) were deliberately differentiated from those who were relatively less obese (BMI 95 th-98 th percentile), or overweight (BMI 85 th-94 th percentile). Previous studies in this area, the majority of which also utilized YRBS data, did not identify the extreme sub-group, did not differentiate those who were obese (BMI ≥ 95 th percentile) from those who were overweight (BMI 85 th - 94 th percentile), or did not consider the entire excess weight spectrum. Finally, recognizing that the previous adolescent suicide literature suggests an adolescent's perception of weight (e.g., overweight, underweight) may play an important role in understanding suicidal risks, we examined accuracy of weight perception in a manner recently presented by Edwards and colleagues utilizing YRBS 2007 data (e.g., whether an adolescent who carries excess weight reports they are "overweight"), given its relative simplicity and potential utility for use in clinical settings.

Our initial analyses examined the most basic questions: are actual excess weight status and suicidal behaviors linked in adolescence? And, what is the prevalence of weight perception accuracy in adolescents with varying levels of excess weight? This first step revealed that, relative to youth of healthy weight, being obese or extremely obese (but not overweight) was associated with significantly greater risk for adolescent engagement in suicidal ideation, though excess weight did not increase the odds of suicide attempts during the same time period. Thus, being obese or when it has progressed to an extreme level is associated with heightened risk of one suicidal behavior but not the other, with risk of attempting suicide no greater than "normative" adolescent risk. This was arguably unexpected, although existing literature demonstrates a suicide risk factor can influence one adolescent suicidal behavior (e.g., attempt) and not the other (e.g., ideation).

As expected, these multi-year (2007, 2009) YRBS data document that weight misperception was remarkably common in adolescents with excess weight. Interestingly there was evidence of increasing weight perception accuracy as the degree of excess weight increased. In fact, 4 out of 5 adolescents with extreme obesity acknowledged their "overweight" status.

When actual weight status was placed in the context of whether or not an adolescent with excess weight perceived him/herself to be overweight, findings became less straightforward. With regard to suicidal ideation, an overweight, obese, or extremely obese adolescent (regardless of race, gender, age, or whether they acknowledged feelings of sadness/hopelessness) who understood they were overweight, was at significantly greater risk of reporting suicidal ideation than adolescents of healthy weight (who also accurately perceived their weight). Thus, our findings suggest that for all excess weight status groups represented in the present analyses (e.g., overweight, obese, extremely obese), it is not actual BMI that is key, but rather, weight perception accuracy that increases risk of adolescent suicidal ideation. In contrast, non-recognition of overweight status for an adolescent with of any level of excess weight indicated more "normative" (e.g., similar to healthy weight/accurate youth) suicidal ideation risk. Perhaps then, it is the subgroup of adolescents who both carry excess weight and acknowledge their overweight status who perceive their weight as particularly burdensome. Indeed, a recent study from a clinically referred sample of younger school-age obese children (BMI ≥ 95 th percentile; ages 5-11 years) found obese youth who did not perceive themselves as overweight self-reported less impairment in HRQOL as compared to those who understood they were overweight.

Like suicidal ideation, findings regarding suicide attempts varied based on actual weight/weight perception accuracy, but also race/ethnicity. Two clear patterns emerged relative to the respective healthy weight/accurate comparators of similar race/ethnicity. For White youth, excess weight status/accuracy had no impact on the odds of reporting a suicide attempt. However, extreme obesity was associated with greater risk of suicide attempts for Hispanic youth only and irrespective of weight perception accuracy. While in general, a disproportionately higher prevalence of suicidal behaviors have been reported for Hispanic youth relative to White and Black youth, no associations with obese weight status (BMI ≥ 95 th percentile) have yet to be identified. To our knowledge, these are the first analyses in the literature that isolate adolescents with extreme obesity within race/ethnic groups, revealing a specific weight group engaging in a less prevalent but more lethal suicidal behavior (actual attempt). Given there were no additional discernible patterns to the suicide attempt data, a clear area for future research is the examination of the role of excess weight status and weight perception accuracy within race/ethnicity that considers additional factors beyond those in the present analyses. Echoing the assertion of previous researchers, suicidal behavior risk factors, and risk of attempts in particular, may be culture-specific, with prevention efforts needing to be tailored accordingly.

The present findings are both important and clinically relevant. Adolescents who are overweight or obese comprise a considerable proportion of today's youth, with those who are extremely obese growing in numbers. Furthermore, adolescents who are obese will likely remain obese, carrying disease burden and risk into young adulthood. In addition to more universal prevention efforts to decrease adolescent suicidality (e.g., public education, screening programs, education of physicians, restriction of access to lethal means), adolescents with excess weight may benefit from routine screening for suicidal ideation. Furthermore, in this context, assessing an adolescent's perception of whether they are overweight (e.g., "how would you describe your weight?") may provide critical additional information. This may prove especially relevant to the clinical population of adolescents who consider and/or progress to undergoing bariatric surgery, given findings from the adult bariatric literature. However, it is important to recognize that while a history of suicide ideation in adolescents is known to predict subsequent ideation, a history of not acting on suicidal ideation (e.g., no attempt) is predictive of continuing not to do so. Only a history of progression to an attempt is associated with subsequent risk of a nonfatal or fatal suicide attempt in adolescents. With the adolescent bariatric surgery outcome literature in its infancy, controlled prospective long-term outcome studies with close monitoring of suicidal behaviors as well as other known risk factors for completed suicides (e.g., previous nonfatal attempts, depression, substance use, family history of suicide, childhood trauma, impulsivity, history of self-harm) are critical.

The present findings must be interpreted within the context of several limitations, with consequent directions for future research. First, YRBS adolescent weight and height (i.e., BMI) were self-reported. Previous work has shown YRBS self-report methodology to be highly correlated with measured weight and height values. However, given noted trends that adolescents may underestimate weight and overestimate height, the present data may reflect an underestimation of true BMI and the extent of excess weight in the YRBS sample. Arguably, the present study may also represent an underestimation in weight misperception as well, given weight perception accuracy increased as excess weight status increased. Interestingly however, extant research would suggest that a child or adolescent who carries excess weight does not base their self-perception of their weight status ("Am I overweight or not?") on just their knowledge (or lack thereof) of their actual height/weight or BMI. Rather, overweight perception accuracy in youth has been shown to be associated with a number of individual and contextual factors including the psychosocial impact of their weight (e.g., weight-related quality of life), race, gender as well as their social environment. For example, overweight and obese youth are more likely to misperceive their weight status if they have parents or school classmates who are also overweight.

Second, the YRBS survey was developed with the specific purpose of monitoring epidemiological trends of a broad array of adolescent health and health-risk behaviors, including the extent of suicidality as public health problem for the Centers for Disease Control and Prevention. We recognize single item criterion measures of suicidality, even with established validity, are not full clinical assessments of these behaviors. Furthermore, these data characterize only nonfatal suicidal behaviors and do not reflect the role of weight status in completed suicides in adolescents. Thus, comparison to the findings in the adult obesity literature proves challenging, as with few exceptions, those investigating adults have focused on completed suicide as an outcome, versus the suicidal risk behaviors that precede the fatal event. Third, the YRBS also lacks an indicator of socioeconomic status (SES), a potential confound given suggested links between SES or proxy variables (e.g., parental education) with obesity prevalence in youth and weight status misperception and suicide in adults. Finally, YRBS data is cross-sectional in design and, accordingly, causality cannot be inferred.

We recognize there are a number of additional avenues worthy of further exploration, including weight misperception as it relates to adolescent suicidal behaviors for youth who do not carry excess weight. For example, in the present data, adolescents who were of a healthy weight yet who misperceived their weight status (either underweight or overweight) were at greater risk of reporting suicidal ideation, and for White and Black adolescents, greater attempts than their healthy weight counterparts who perceived their weight accurately. Further, we did not include examination of the additional weight category of underweight adolescents (BMI < 5 th percentile). Certainly our reported findings and those of others highlight weight perception accuracy as critical in understanding adolescent suicide behavior risks. The goals of the present study were deliberately simple in their focus on adolescents with excess weight.

As is evident, not all adolescents of excess weight status or even those at an extreme level will consider or attempt suicide, nor should any adolescent, independent of demographic background or weight status/accuracy, be exempt from monitoring or concern. Adolescent risk pathways for suicidal behaviors will only be understood with the testing of comprehensive adolescent models (e.g., previous nonfatal attempts, depression, peer victimization, family history of suicide, peer suicidal behaviors, impulsivity, substance use, childhood trauma) and with assessments that are more clinically driven (vs. public health surveillance) and utilize prospective designs. Based on the present findings, these future studies would also benefit from use of the actual measurement of height and weight (e.g., weight status), the categorization of the entire excess weight spectrum (e.g., extreme obesity), and the adolescent's weight perception accuracy when they carry excess weight.

Acknowledgments

Research supported by a grant from the National Institutes of Health awarded to the MHZ (R01DK080020).

References

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Adolescent Suicidal Behavior Across the Excess Weight Status Spectrum

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The present study examined relative suicidal behavioral risks (ideation, attempts) for overweight, obese, and extremely obese adolescents (vs. healthy weight) and who did/did not accurately perceive themselves as overweight utilizing cross-sectional data from the publicly available Youth Risk Behavior Survey (YRBS).

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This photo shows a diagram of what happens to your body when you have obesity and it can cause many heart and lung problems and ect

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This video is talking about the possible problems that children can have and it also talks about how to prevent childhood obesity.

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This video talks about how children can be bullied and some tips on how to prevent childhood obesity and to keep children safe and it also talks about how many problems the children can have.

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This photo is showing some things that could happen to you when you are obese and this could kill you due to your heart not being able to pump blood threw the body fast enough.

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Childhood obesity has gone up in the last year or so and it can hurt the children and possibly kill them because of how big they are.

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This photo is showing what some kids look like when they have obesity and it can cause some very and it can cause bad problems to the child's life and that could mean that they can die earlier than others.

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There are no veggies nor something heathly bedsides the milk but the burger and fries have so much grease and other fatty ingredients

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This webpage is talking about if resrurants advertising should be banned because it is causing more problems to kids teeth and body weight and many more problems.

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Fast Food Advertising Should Be Banned - DebateWise

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Banning and partial banning of fast food advertising has been a cause for debate globally over the last few years. The call to ban has been in large part due to the influence these businesses have on childhood obesity rates. Another factor driving the debate is health issues in the general population from the consumption of fast foods.

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This talks about how if the children eat the food everyday they will become addicted and want the food more often. In the article it states, ".... determinants of away-from-home food consumption in two contexts and the influence of frequency of away-from-home food consumption on children’s dietary intake and parent and child weight status.

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Abstract

Keywords: Children, eating behaviors, family behavior, Hispanics, weight

INTRODUCTION

Research from the United States Department of Agriculture estimates that between 1985 and 2000 daily per capita energy consumption increased by 12 percent or 300 calories per day. One eating behavior contributing to this increase in energy consumption is the increase in frequency of away-from-home food consumption. Away-from-home foods are generally defined as "full meals and single ready-to-eat items (including take-away foods) purchased at restaurants, prepared-food counters at grocery stores, and other outlets" (p. 5) Away-from-home foods are higher in fat and lower in fiber and frequent consumption of fast food, in particular, is associated with poorer diet quality and risk for obesity for both children and adults. In 1999-2000, 41 percent of U.S. adults reported eating away-from-home foods at least weekly, and 25 percent of adults and 30 percent of children 4-19 years old reported eating fast food at least daily. Purchasing away-from-home foods now accounts for approximately 46 percent of Americans' annual food budget compared with 26% in 1970 and, opportunities for consuming away-from-home foods are easier given that the number of foodservice establishments has nearly doubled in the last 30 years, from 491,000 in 1972 to 878,000 in 2004.

Notwithstanding the importance of traditional definitions of away-from-home foods on diet quality and risk for obesity, several other contexts also have been identified and examined, including day care centers, schools, and worksites for adults. This study adds to this body of research by examining a relatively unexplored context in which food consumption occurs, namely relatives, neighbors, and friends' [RNF] homes. This context may be particularly important for immigrant families given their reliance on informal sources of child care, and among Latinos who exhibit greater involvement with immediate and extended family members, often living in close proximity to relatives, and a stronger familial bond compared with a White population. Importantly, relatives, neighbors, and friends often gather to celebrate life events during which high fat foods are consumed. Finally, although home versus away-from-home environments are generally considered healthier dietary environments (e.g., toddlers' mean energy intake at lunch was 281 kcal at home versus 308 kcal away from home and 332 kcal at day care), the relative influence of RNF environments has not been examined.

Examining behavioral determinants of dietary intake and weight status is important given the prevalence of obesity among Latino children in the U.S. National prevalence rates using measured height and weight from the National Health and Nutrition Examination Survey [NHANES] indicate that 19.5% of Mexican-American children 3-5 years old were overweight compared with 13.9% of all children in this age group. Rates of being at risk for overweight in this age group were similarly different (32.6% among Mexican-American children versus 26.2% overall).

This study was informed by two frameworks, both of which have explained dietary behaviors and risk for obesity. The Socio-Ecological Framework recognizes that individual behavior is nested within contexts and systems that influence an individual's behaviors and health status. Social Cognitive Theory proposes that individual behavior is reciprocally determined by the environments in which the behaviors occur or are engaged in. This examination of dietary intake and risk for obesity by context reflects the direct influence that the environment has on behavior, as well as the individual's response to the environment.

The present study examined the relationship between away-from-home eating, children's dietary intake, and children's and adults' weight status using three conceptualizations of away-from-home foods: frequency of eating at relatives/friends/neighbors' homes [RNF], frequency of eating at restaurants, and the type of restaurant. Our sample consists of Latino families, predominantly Mexican/Mexican-American families, living along the U.S.-Mexico border in Southern California. Study hypotheses were:

1. Consumption of away-from-home foods at least once a week or more versus less than once a week is associated with children's dietary intake and children's and adults' weight status in two contexts: RNF and restaurants

2. Frequenting fast food versus sit-down or buffet restaurants is associated with children's dietary intake and a greater risk for obesity among children and adults.

Exploratory analyses examined whether families who frequented various away-from-home eating contexts at least once a week or more and those who choose fast-food versus other restaurant types differed significantly on a number of demographic and cultural characteristics. By identifying attributes of families who engage in these unhealthy behaviors, interventions can be targeted and tailored with greater efficiency and efficacy.

RESEARCH METHODS AND PROCEDURES

Study Design and Recruitment

This secondary data analysis used baseline data from Aventuras para Niños, an obesity prevention study. The study was funded by the National Institute of Heart, Lung, and Blood to the last author. All study protocols were approved by the Institutional Review Board at San Diego State University.

Study participants were recruited from 13 schools in southern San Diego County, California that met the following criteria: 1) Latino enrollment of at least 70%; 2) a defined attendance boundary (no charter or magnet schools); and 3) no other obesity-prevention programs or additional physical education training for teachers within the past 4 years. Parents were recruited directly on school grounds and during school presentations, and through telephone calls and fliers sent home with students. Eligible families had a child in kindergarten, first or second grade at one of the 13 schools and 1) had no major health problems; 2) lived within the school attendance boundaries; and 3) intended to stay in the area for at least one year. Parents received an incentive of $20 to enroll and complete the baseline survey. A total of 812 parent-child (aged four to seven) dyads were recruited in two waves, the first from August 2003 to January 2004, and the second from May 2004 to Dec 2004. The present study included only the Latino subsample (88%; n=708) given our interest in Latino health promotion.

Procedures

Administration of the baseline assessment protocol occurred on the school grounds. After consenting to participate in the study, parents completed a self-administered 22-page survey in the language of their choice (Spanish or English). The survey included questions on frequency of away-from-home food consumption, type of restaurant frequented, and a 49-item food frequency screener assessing children's dietary intake. Trained bilingual, bicultural evaluators measured the child's and parent's height and weight using standard procedures. Twenty percent of the anthropometric measurements were randomly selected for reliability testing. Inter-rater reliability on the anthropometric measures was 97-99%.

Measures

Statistical Analysis

Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software, version 13.0 for Windows. Alpha levels of .05 indicated statistical significance. Descriptive statistics were used to characterize the sample on demographic variables, child dietary intake, adult and child BMI, and away-from-home food consumption behaviors.

RESULTS

Participants

Seven hundred and eight Latino parents completed the survey. The average age of the respondents was 35 years old (SD=7.5) and the average child's age was six years old (SD =.94). Most of the respondents were female (97.7%) and married (78.2%), while slightly over half of the children were female (51.9%). Approximately 37% of the households reported an income of $1,500 or less per month, with a median household size of 5 individuals. Nearly 40% of respondents did not graduate from high school, and 63.9% were employed either full or part-time outside the home.

In terms of health status, nearly one third of the children (31.1%) were classified as overweight according to CDC guidelines (> 95 th percentile for their age and gender). Another 16.6% had a BMI > 85 th percentile but < 95 th percentile and therefore were classified as at-risk for overweight. The adults were classified as either under-to-normal weight (24.5% with BMI <18 to 24.99), overweight (34.7% with BMI > 25 to 29.99), obese (33.9% BMI > 30 to 39.99) or excess obese (6.9% with BMI ≥ 40). The average adult BMI was 29.6 (SD = 6.33).

Fast food and sit-down restaurants were the most common contexts where families ate at least once a week or more, followed by relative's homes, restaurants across the U.S.-Mexico border, and finally in neighbors/friends' homes (). Significantly more families reported preferring to eat at fast food restaurants followed by sit-down restaurants and then buffet restaurants (p≤.05; see ). Overall, 45.9% of the sample reported consuming foods away-from-home foods at least weekly from any type of restaurant and 37.5% from RNF homes.

Hypothesis 1

illustrates differences in children's diet intake and child and adult BMI status by frequency of consuming away-from-home foods in RNF homes and restaurants. Children of parents who reported at least weekly RNF food consumption reported that their children drank more sugar sweetened beverages compared with families who ate at RNF homes less often. Parents of families who ate at restaurants at least weekly reported that their children consumed more sugar sweetened beverages, more sweet/savory snacks and less water compared by families who did not frequent restaurants this often.

In terms of BMI status, children whose families ate at RNF homes or restaurants at least once a week or more were more likely to be overweight (see ). The prevalence of childhood overweight was nearly 5% higher among families who ate at RNF homes at least once a week or more versus those who did not. No such relationship was observed among adults. A similar pattern to RNF food consumption was observed between the children's weight status and restaurant food consumption; however, unlike RNF, twice as many adults were classified as excess obese if their families visited restaurants at least once a week or more.

Hypothesis 2

As shown in , contrary to our hypothesis, few associations were observed between children's diet intake and type of restaurant frequented. Parents of families who preferred buffet restaurants reported more consumption of fruits and vegetables compared with those who preferred fast food and sit down restaurants. No associations were observed between child and adult BMI and type of restaurant frequented.

Exploratory analyses

To better tailor future interventions to parent and family/household characteristics, we examined several important demographic and sociocultural correlates of away-from-home food consumption in RNF homes and restaurants. All variables were entered simultaneously into the two multivariate logistic regression models. Households with fewer members were more likely to consume away-from-home foods at least once a week or more in RNF homes (see ). With respect to restaurants, parent age, homeownership, and acculturation level were significantly related to consuming foods in restaurants at least once a week or more. Families who visited restaurants at least once a week consisted of a younger parent (33 years old versus 35 years old), homeowners (54% versus 46%), and were more acculturated to the U.S. culture.

Similar analyses were not conducted to examine differences by type of restaurant given the relatively null findings to Hypothesis 2.

DISCUSSION

Away-from-home food consumption is an important determinant of dietary intake and risk for obesity. Research indicates that foods consumed outside the home are generally less nutritious, including larger in portion size. Away-from-home foods contain more calories per eating occasion, higher levels of total fat and saturated fat, lower levels of fiber, calcium, and iron; and more sodium than foods prepared at home. This study examined the diet and health effects of at least weekly consumption of restaurant food among Latino parents and their young children, as well as the effects of at least weekly consumption in a previously unexplored context, specifically the homes of relatives, friends, and neighbors. It was hypothesized that weekly consumption of away-from-home foods would be associated with children's dietary intake and child and adult BMI.

Similar to national data , 46% of participating families reported consuming restaurant food at least weekly. The most common restaurant types were fast food and sit-down restaurants. As hypothesized, weekly consumption of restaurant food was associated with children's intake and child and adult BMI. These results are consistent with those of other researchers who have found that consuming restaurant food was associated with daily energy and fat intake and body fatness among women, and with a high fat diet and BMI among adults. However, when examining the effects of restaurant type on children's dietary intake and child and adult BMI, our hypotheses were not support. This is inconsistent with previous research. For example, although 'fast food' was not explicitly defined, French and colleagues found that frequency of fast food restaurant use among women was associated with higher fat and calorie intake, and lower consumption of fruit and fiber. Similarly, a positive association was observed between fast food consumption and the total calorie intake and BMIs of women. Nevertheless, other researchers have found that type of restaurant was not as important as frequency of consuming restaurant food in predicting BMI among adult men.

This study examined a previously unexplored context in which food consumption occurs, namely the homes of relatives, neighbors, and friends. Evidence from other studies led the research team to hypothesize that these contexts may be associated with dietary intake and BMI given that visiting other people's homes is often associated with celebration and consumption of rich foods. In this study close to 40% of participating families reported consuming foods in these contexts at least weekly. Children who consumed foods in these contexts at least weekly were more likely to be overweight than those who did not. However, the same was not true for adults. Latino children may be particularly affected by what is available in these environments if future data support previous findings that childcare is more likely to occur in this context than in formal day care settings. A literature search in PubMed, PsycInfo, and Sociofile revealed no other studies examining this context and its affects on risk for obesity. Thus the extent to which these findings may generalize to the larger U.S. Latino population or to other ethnic groups in the U.S. is not yet known.

The problem of obesity is clear and present in this study. Nearly 50% of the children in this study were classified as at risk for overweight or overweight. These estimates are consistent with national data which indicate that the prevalence of at risk for overweight and overweight among Mexican-American children 3-5 years old is 51.8% based on 2003-2004 data and similar to rates seen in past studies with Mexican-American children. The rate of overweight to excess obesity among the adults in the sample was slightly higher than the rates estimated by the CDC for Mexican-American women.

Limitations of this study include the lack of portion size information on the food frequency screener and reliance on self-reported data. In addition, although differences in the frequency of various foods consumed were statistically significant, additional research is needed to determine if these differences are clinically meaningful. The response options to questions on frequency of eating out limits our ability to draw conclusions about the actual nutrient contributions of away-from-home foods. More rigorous methodologies, such as 24-hour dietary recalls, should be considered for future studies to collect nutrient information by location. A higher reporting bias has been noted in the Latino population compared with a non-Latino population. Reporting bias may be particularly relevant for questions regarding frequency of fast food consumption, particularly because these families were recruited to participate in a childhood obesity prevention intervention. However, given that these behaviors are likely to have been underreported due to social desirability and recall bias, the observed effects may be underestimations versus over-estimations of the true effects. Notwithstanding these limitations, a strength of this study is that it was conducted in a geographic area heavily impacted by continued and long-standing Latino immigration. As a result, it offers insight into several important dietary behaviors of the largest ethnic minority population in the U.S.

Conclusions

Foods consumed in other people's homes are unlikely to have the same diet quality as food prepared commercially and thus may not represent the same level of risk for obesity as foods prepared in restaurants. Nevertheless, these results clearly indicate that foods consumed in RNF contribute to a child's overall dietary intake and risk for obesity. Given evidence that one of the most important parenting behaviors related to childhood risk for obesity is monitoring, clearly more research is needed on how to teach parents to monitor and regulate the foods that their children consume in the homes of other people. Effective intervention strategies applied in formal childcare settings could be adapted to this environment, including the use of train-the-trainer interventions that are similar to lay health advisor models in which community leaders are trained to intervene with other community members. Several studies have examined correlates of fast-food dining. Few have considered other contexts, such as buffet and sit-down restaurants, and the homes of relatives, friends, and neighbors. Through revealing the influences behind frequency of consuming away-from-home foods and restaurant selection, this study may further contribute to the development of effective interventions for the Latino community.

Acknowledgments

This research was funded by the National Heart Lung and Blood Institute (5R01HL073776).

References

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Away-from-home food intake and risk for obesity: Examining the influence of context

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Keywords: Children, eating behaviors, family behavior, Hispanics, weight Research from the United States Department of Agriculture estimates that between 1985 and 2000 daily per capita energy consumption increased by 12 percent or 300 calories per day. One eating behavior contributing to this increase in energy consumption is the increase in frequency of away-from-home food consumption.

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This article talks about how restaurants should stop putting fatty foods in kids menus and how it can change the parents lives because they don't have to make food for their child.

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Kids' Meals: What's the Problem?

Growing bodies need healthy food to thrive. Busy parents with limited time to prepare food at home often rely on restaurant meals to feed their children. Restaurant food and drinks account for about 25 percent of children's calorie intake, ¹ often in the form of so-called "kids' meals" which are combinations packaged and marketed by chains especially for 2-11 year olds. These meals should be packed with healthy options, but typically have been full of fat, sodium, and too many empty calories from sugary drinks. Over the past decade, advocates have been working with restaurant chains to revise their kids' meal menus to include fruit, vegetables, and healthy beverages, to give growing children the real nutrition they need. Some progress has been made, but there's still plenty of work to do to align kids' meals with good nutrition standards.

Eating out can mean eating poorly. Children take in almost twice as many calories when they eat a meal at a restaurant as when they eat at home, ² and kids' meals can be particularly unhealthy. A 2013 study of the top 50 U.S. chain restaurants determined that 86 percent of kids' meal combinations are too high in calories, 55 percent are too high in saturated fat, and 66 percent are too high in sodium. ³ The food is not the only problem: kids' meals have traditionally come with a soda, sugared fruit drink, or sweetened, flavored milk, all which are full of calories from sugar, and typically have little to no nutrition. A 2017 study of those top 50 chains showed that 38 of them had beverages on their kids' meal menus, and 74 percent of those included sugary drinks. ⁴ This is an improvement, compared to 2008 when sugary drinks were available on 93 percent of the kids' menus. ⁵ But it still means that too many sugary drinks are making their way into kids' meals.

With national childhood obesity rates at an all-time high of 18.5 percent, ⁶ these drinks are especially problematic because there is a substantial risk of weight gain and diabetes resulting from added sugars in beverages. ⁷ The obesity rates for children in the target age range for kids' meals is also alarming: 13.9% of 2-5 year olds and 18.4% of 6-11 year olds have obesity, as do more Black and Hispanic children than white children. ⁸ Children with obesity are at an increased risk for type 2 diabetes, heart disease, stroke, certain cancers, asthma, low self-esteem, and depression. ⁹ Studies have shown that reducing the intake of sugary drinks can lower the prevalence of obesity and obesity-related diseases. ¹⁰

Over the last 10 years, some of the major fast food chains have pledged to do better by kids. They've promised to remove soda as the default beverage in kids' meals and replace some of the fat and calories in the side dishes (e.g. fries) with healthier options (e.g. apple slices). Despite the commitments of eight major restaurant chains to implement some kind of improvement to their kids' meals (see box ¹¹), the percentage of those meals that meet evidence-based nutrition standards has barely budged-rising from 1% to just 3%. ¹² Some progress is being made: In February, 2018, McDonald's announced that by the summer its Happy Meals will contain 600 calories or fewer, with reduced sugar, saturated fat, and sodium. But otherwise, few changes have been made in the nutrient content of the main and side dishes, and the benefit of removing soda from kids' meals is sometimes offset by offerings of sugary, flavored milks instead. ¹² A 2017 study found that while the chains' listed healthier options on their online menus, there was considerable inconsistency in what was actually offered at individual restaurants. ¹³

Why is it so difficult for these chains to follow through on their pledges?

Chains Market Heavily to Kids

Major chain restaurants spend hundreds of millions of dollars per year to market fast food not only to parents, but also directly to young children, so clearly the kids' meals are profitable for the chains. Preschool and elementary school-aged children see about three fast-food television ads per day, but are also exposed to ads on websites with "advergames" (branded games), and on mobile applications among others. ¹⁴ As an added enticement, more than $300 million worth of toys per year are distributed as premiums with kids' meals. ¹⁵ They are often miniatures of beloved movie characters, making the meals, with toys, even more attractive to young children. Research conducted by the food industry confirms that this marketing generates purchases driven by children's "pester power"-the ability of children to nag their parents enough that they influence them to purchase fast food for them.

Improving Kids Meals: What Can We Do?

Over the years advocates have endorsed a variety of policy approaches to improve the nutrition in kids' meals. The original policy, enacted in Santa Clara County and San Francisco, CA in 2010, set nutritional standards for meals which came with a toy or prize. The restaurant could not include a toy if the meal didn't conform to the standards. One chain's response was to sell the toys separately, for a very low price. ¹⁶ Subsequent advocacy focused on pushing industry to voluntarily pledge to make improvements, as noted above. And there have been legislative efforts to introduce default beverage ordinances in a few cities and counties in Maryland, California, and Colorado, and at the state level in Maryland and Vermont. These ordinances require restaurants to make the default beverage that comes with a kids' meal a healthy one, rather than a soda. Since 2015, eight jurisdictions in California, one in Colorado, and one in Maryland have passed healthy beverage ordinances (see box). The new beverage defaults include milk, milk alternatives, water, and 100% juice in lieu of sodas and sugary juice drinks. While most ordinances do allow a customer to swap out the healthy default drink for a soda as part of the meal, the Santa Clara ordinance specifies that those who want to buy a sugary drink for the child will have to pay for it separately.

There is still room for improvement. ¹⁷ Advocates can push the industry to further improve the nutrition in their kids' meals by following the precedent set by cities and counties in Colorado and California in passing legislation to make healthy beverages the default in kids' meals. They can encourage restaurants to make healthy choices the automatic default, rather than offering a choice of healthy and less-healthy options. At their local chain restaurants, advocates (including parents) can insist on adherence to the pledges made at the national level, and that chains can advertise to children only if all the offerings in kids' meals are healthy. For more ideas, see the Rudd Center for Food Policy and Obesity's report on advertising of kids' meals in fast-food restaurants, and the Center for Science in the Public Interest's report on soda in kids' meals.

While additional scientific research studies are needed to describe the real-world impact of the kids' meal default beverage policies, adoption of this policy is recommended by public health organizations such as the American Heart Association, the American Cancer Society, and the American Diabetes Association. ¹⁸
Online resources
ENDNOTES

¹ Lin B, Morrison RM. "Food and Nutrient Intake Data: Taking a Look at the Nutritional Quality of Foods Eaten at Home and Away From Home." Amber Waves 2012, vol 10(2), pp. 1-2. https://www.ers.usda.gov/amber-waves/2012/june/data-feature-food-and-nutrient-intake-data/. Accessed April 20, 2018.

² Powell LM, Nguyen BT. Fast-food and full service restaurant consumption among children and adolescents: Effect on energy, beverage, and nutrient intake. JAMA Pediatrics, 2013: 167(1), 14-20.

³ Batada A, Wootan MG. Kids' Meals II: Obesity and poor nutrition on the menu. Center for Science in the Public Interest. https://cspinet.org/sites/default/files/attachment/cspi-kids-meals-2013.pdf. Published 2013. Accessed April 20, 2018.

⁴ Ribakove S, Almy J, Wootan M. Soda on the Menu. Improvements Seen but More Change Needed for Beverages on Restaurant Children's Menus. Center for Science in the Public Interest. https://cspinet.org/sites/default/files/attachment/Soda%20on%20the%20Menu.pdf. Published July 2017. Accessed April 20, 2018.

⁵ Ibid.

⁶ Craig M, Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016 [Published online March 23, 2018]. JAMA. doi: 10.1001/jama.2018.3060.

⁷ Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: A meta-analysis. Diabetes Care. 2010; 33(11): 2477-83.

⁸ Trust for America's Health and the Robert Wood Johnson Foundation. The State of Obesity. Better Policies for a Healthier America. https://stateofobesity.org/childhood/. Published February 2018. Accessed April 20, 2018.

⁹ Office of the Surgeon General. The Surgeon General's call to action to prevent and decrease overweight and obesity. Rockville, MD: U.S. Department of Health and Human Services. 2001; Food and Nutrition Board and Board on Health Promotion and Disease Prevention. Preventing childhood obesity: Health in the balance. Washington, DC: The National Academies Press; 2005: 67-69.

¹⁰ Hu FB. Resolved: There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews 2013; 14(8): 606-19.

¹¹ Almy, Jessica. "Jack in the Box Removes Soda from its Kids' Menus." Statement of CSPI Senior Nutrition Policy Counsel Jessica Almy. https://cspinet.org/new/201602101.html. Published February 10, 2016. Accessed April 20, 2018.

¹² Harris J, Hyary M, Seymour N, Choi Y. Are Fast-Food Restaurants Keeping Their Promises to Offer Healthier Kids' Meals? Rudd Report, University of Connecticut Rudd Center for Food Policy and Obesity. http://www.uconnruddcenter.org/files/Pdfs/272-9%20_%20Rudd_Healthier%20Kids%20Meals%20Report_Final%20Round_Web-150dpi_080117.pdf. Published August 2017. Accessed April 20, 2018.

¹³ Ibid.

¹⁴ Harris, JL, Schwartz, MB, Munsell, C et al. Fast food FACTS 2013: Measuring progress in nutrition and marketing to children and teens. Rudd Center for Food Policy and Obesity. http://www.fastfoodmarketing.org/media/fastfoodfacts_report.pdf. Published 2013. Accessed April 20, 2018.

¹⁵ Otten JJ. Food marketing: Using toys to market children's meals. Minneapolis, MN: Healthy Eating Research. http://healthyeatingresearch.org/wp-content/uploads/2014/07/her_marketing_toys_AUGUST_14.pdf. Published August 2014. Accessed April 20, 2018.

¹⁶ Ibid.

¹⁷ Moran AJ, Block JP, Goshev SG, Bleich SN, Roberto CA. Trends in Nutrient Content of Children's Menu Items in U.S. Chain Restaurants. Am J Prev Med. 2017;52(3):284-291.

¹⁸ Center for Science in the Public Interest. Restaurant Chains Urged to Dump Soda from Kids' Menus. https://cspinet.org/new/201401301.html. Published January 30, 2014. Accessed April 20, 2018.

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Kids' Meals: What's the Problem? Growing bodies need healthy food to thrive. Busy parents with limited time to prepare food at home often rely on restaurant meals to feed their children. Restaurant food and drinks account for about 25 percent of children's calorie intake, 1 often in the form of so-called "kids' meals" which are combinations packaged and marketed by chains especially for 2-11 year olds.

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This article give facts about childhood obesity, it also talks about how many people in the worlds population.

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This article talks about how schools are telling parents that their child is over weight and has to see a doctor. In the article it states, ¨......., about 17 percent, or 12.5 million, of children and teens in the U.S. ages 2 – 19 years are obese. Since 1980, obesity prevalence among children and teens has almost tripled.¨

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Receiving report cards from schools is a standard practice that helps parents stay informed about their child's academic performance. But now, schools in some states have been going one step further and are also letting parents know how their child's weight measures up.

A new report released this week in Pediatrics has spurred debate around this issue as it states that Body Mass Index (BMI) screenings in schools and subsequently informing parents about their child's weight category is a necessary step in the fight against the childhood obesity epidemic.

Twenty one states, not currently including Washington, have enacted policies or made recommendations about collecting height and weight data and assessing body composition in schools. In some states, like Massachusetts and Arkansas, a confidential letter that has been dubbed a "fat letter" is mailed to parents whose child has a high BMI, informing them of their child's weight status and advising them to talk with a doctor.

Childhood obesity: A significant health problem

According to the Centers for Disease Control and Prevention, about 17 percent, or 12.5 million, of children and teens in the U.S. ages 2 - 19 years are obese. Since 1980, obesity prevalence among children and teens has almost tripled.

"Childhood obesity is one of the most significant health problems affecting children and teens today and it can greatly impact a child's quality of life and risk for developing chronic diseases later in life," said Mollie Grow, MD, MPH, a pediatrician at Seattle Children's Hospital. "Addressing this issue is imperative and we need to provide parents with the information and resources to help them recognize if their child has an issue and address it."

Knowledge is power

Grow believes that using schools to support parents with knowledge about their child's health status and informing them about helpful resources is reasonable and important from a public health standpoint. Especially since she says that, as a pediatrician, it can be difficult to monitor a child's health since children over age 5 only come for check-ups once a year, or sometimes even less.

"The goal is that every child is seen and screened by a health care provider at least once each year, but the reality is that not all kids come in for their yearly check-up," said Grow. "Unfortunately, it's often the high risk kids that miss appointments."

Grow said that the information can be very helpful to raise parents' awareness. Many studies have shown that parents are often not aware of their child's BMI and they often don't recognize or they underestimate their child's weight status.

"This is information that parents otherwise wouldn't have if they don't recognize their child may be at an unhealthy weight, which we know happens, or if they haven't been to their pediatrician, which we also know happens," said Grow.

Therefore, she says that allowing schools to screen kids' health status and then send letters home to parents can be very useful, but only if it's done right.

"The more we can do to proactively address childhood obesity is critical, but it must be done in a way that is discrete, very respectful and supportive," said Grow. "Ideally, the letters provide more comprehensive information to families beyond BMI and include information about their child's fitness levels, as well as useful resources that can help parents address the issue."

This process can prompt families to be aware of their child's health status and give them the opportunity to be proactive about assessing the issue. Arkansas, which has the longest experience with providing children's BMI information directly to families, has seen parents increase their child's enrollment in sports and exercise classes, as well as make nutrition changes.

Grow also said that the health screening should be done in a private setting at school so kids don't feel stigmatized when measured. The goal is to reduce the possibility of bullying and create a culture of respect at school. No schools should tolerate teasing or bullying because of a child's weight. Families should also not engage in or tolerate teasing based on weight at home, which tends to only make people feel worse and not motivated.

What parents can do

If parents become aware or are concerned that their child may be at an unhealthy weight, it is important for them to visit their pediatrician. The doctor can then assess their child's risk, putting it in the context of the child's overall health and the family's medical history. Grow cautions that BMI is far from perfect for diagnosis and so it is important to talk with a doctor to interpret what the level means for each person.

The family can then decide with their doctor how to best move forward toward a healthy lifestyle for their child so their weight status doesn't become a problem.

Here are a few tips Grow recommends to parents to help children and teens lead healthy lives:

7-5-2-1-0 for a healthy lifestyle - Parents should encourage kids to eat breakfast seven days a week, eat five servings of fruits and vegetable a day, keep screen time to two hours a day or less, be active for at least one or more hours a day and aim for no soda and other sugar-sweetened drinks.

More physical activity and fewer sugary drinks - Grow said that these two areas can really make a difference in improving a child's health.

Make physical activity fun or part of a routine - Parents can look for physical activity resources through their local community centers and the YMCA. It is important that kids find an activity that they enjoy, like playing a sport, or that is part of their daily routine, like biking or walking to school, so they are more likely to keep up with it.

Support physical activity - Parents should be supportive of physical activity in terms of getting kids to activities, doing activities as a family and encouraging outdoor play, as well as providing verbal encouragement.

Obesity Program at Seattle Children's

Seattle Children's Obesity Program comprehensively addresses both obesity prevention and treatment through clinical care, advocacy and community programs, research and education.

At Children's specialty clinics, health care providers evaluate children and teens who have concerns about being overweight, are overweight or obese. The Child Wellness Clinic sees children ages 2 to 11 years and the Adolescent Wellness Clinic cares for youth ages 12 to 21 years.

Children's is also actively engaged in community programs. In a partnership with the YMCA, Children's offers the ACT! program (Actively Changing Together), a healthy lifestyle program available for overweight and obese youth, 8 to 14 years old, who have a BMI greater than the 85th percentile. The program teaches families ways to improve nutrition and increase physical activity to develop healthy lifestyles.

In addition, Fit 4 You is a program offered at Odessa Brown Children's Clinic (OBCC) that promotes healthy lifestyles during well-child visits. Families can learn about healthy eating and attend nutrition and cooking classes among other activities.

The hospital also partners with the local Puget Consumers Co-op (PCC), which comes to the hospital quarterly and provides patient families with ingredients to make healthy recipes, like kaleidoscope salad, and raises money for both Fit4You and the ACT! program.

Resources:
For more information about Seattle Children's Obesity Program or to arrange an interview with Dr. Grow, please contact the public relations team at 206-987-4500 or press@seattlechildrens.org.

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Fat letters from schools spur childhood obesity debate

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Receiving report cards from schools is a standard practice that helps parents stay informed about their child's academic performance. But now, schools in some states have been going one step further and are also letting parents know how their child's weight measures up.