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  • 1.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    Institute of Social and Cultural Anthropology, School of Anthropology and Museum Ethnography, 51/53 Banbury Road, Oxford, OX2 6PE.
    Persson Osowski, Christine
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Public expressions of trust and distrust in governmental dietary advice in Sweden2019In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 29, no 8, p. 1161-1173Article in journal (Refereed)
    Abstract [en]

    We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice, or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice, or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and 'alternative' evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency’s advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.

  • 2.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Elmståhl, Helena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    University of Oxford.
    Persson Osowski, Christine
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Healthy eating as conceptualized in referral responses to Sweden’s updated dietary guidelines: excluding the complexity of everyday life2017Conference paper (Other academic)
    Abstract [en]

    National Dietary Guidelines have been published in many countries to support healthier food habits among the public. In Sweden, the guidelines are produced in a process involving experts and stakeholders under the responsibility of the National Food Agency. Stakeholder perspectives on the concept of state dietary advice was explored in this study, by analyzing 40 referral responses on updated guidelines in Sweden 2015. The study focused on ideas about how state dietary advice should be framed and what it should be based on. Thematic analysis was used and resulted in two main themes. 'Securing scientifically proven advice' represented a perspective of the guidelines as to be scientifically correct and verified, and built upon an underlying assumption to present an objective and optimal composition of foods and nutrients that will fit all. Arguments based on nutritional reductionism could be seen, which gave a delimited idea of what healthy food is. 'Getting the message across' represented a perspective of the guidelines to be easily understood by and inclusive to the end user. Clarity in advice was seen to be reached by explaining difficult words, defining amounts and exact mechanisms of why something is a good choice. Also this perspective added to excluding other values of food, especially qualitative ones. The construction of a healthy diet in these remittance responses builds upon a notion of an ideal diet composed on the basis of the best scientific proof and clearly presented so as to be easily understood and practiced. It was clearly based on an individualistic behavioral view making the individual responsible to make informed and good choices for a healthy diet. This approach may be questioned, as it is too simplified to include the complex reality of everyday life.

  • 3.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    Warwick Medical School, University of Warwick & Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford.
    'A holistic approach': Incorporating sustainability into biopedagogies of healthy eating in Sweden’s dietary guidelinesManuscript (preprint) (Other academic)
    Abstract [en]

    Dietary guidelines advise individuals on how to think and act in relation to food choices. As such, they can be considered a pedagogical tool, designed to promote a healthy lifestyle and eating patterns at the general population level. In this study, we critically examine the biopedagogies implicated in Sweden’s official dietary guidelines. Published in 2015, these guidelines take a “holistic approach” to food and eating, addressing the challenge of formulating dietary advice that considers both human health and environmental concerns. The guidelines therefore offer a potentially innovative, sustainability-driven approach to authoritative dietary advice. Applying Bacchi´s ‘What’s-the-problem-represented-to-be’ approach, we interrogate how the guidelines frame the interplay of public health concerns and environmental concerns in making food choices. We find that the biopedagogies of sustainable eating, as presented in these guidelines, implicate the subject position of the ideal eater. The ideal eater values sustainability, has high cultural capital, and draws on both taste and nutritional knowledge to make good food choices. However, while the ideal eater is expected to be aware of environmental issues, these are incorporated into the ideal eater’s choices only in addition to the primary concern of health. Thus, although the guidelines frame a “holistic approach” as the solution to both health and environmental concerns, in cases where health and environmental priorities conflict, the guidelines’ biopedagogies of sustainable eating align with earlier biopedagogies of healthy eating.

  • 4.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    Warwick Medical School, University of Warwick & Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    'Writing nutritionistically': A critical discourse analysis of lay people´s digital correspondence with the Swedish Food Agency.Manuscript (preprint) (Other academic)
    Abstract [en]

    This article analyzes lay people’s use of nutritionistic discourse in written correspondence with the Swedish Food Agency, an authority responsible for dietary advice. Examining 60 food related written digital messages, we apply a critical discourse analysis to parse the terms and grammar people use when constructing “food” in scientific terms. Findings show that message writers place nutrients at the discursive center and frequently use terms that indicate preciseness, such as numbers and amounts, reinforced by modality (auxiliary verbs) and transitivity (nominalizations). Messages therefore emphasize the what, but not the how, of eating, implying a focus on food as subject to regulation and control. As such, eating is discursively reduced to an act of ingesting nutrients that can be decontextualized and managed in isolation – as entities to increase or avoid separately. These discursive features preclude the conceptualization of food choice and eating as subjective experiences of feelings, taste, and tradition.

  • 5.
    Bergman, Karolin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Persson Osowski, Christine
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Elmståhl, Helena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Stakeholder responses to governmental dietary guidelines: Challenging the status quo, or reinforcing it?2018In: British Food Journal, ISSN 0007-070X, E-ISSN 1758-4108, Vol. 120, no 3, p. 613-624Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to explore how stakeholders in the food and nutrition field construct and conceptualise “appropriate” national dietary advice.

    Design/methodology/approach

    In total, 40 voluntarily written stakeholder responses to updated official dietary guidelines in Sweden were analysed thematically. The analysis explored the logics and arguments employed by authorities, interest organisations, industry and private stakeholders in attempting to influence the formulation of dietary guidelines.

    Findings

    Two main themes were identified: the centrality of anchoring advice scientifically and modes of getting the message across to the public. Stakeholders expressed a view of effective health communication as that which is nutritionally and quantitatively oriented and which optimises individuals’ capacities to take action for their own health. Their responses did not offer alternative framings of how healthy eating could be practiced but rather conveyed an understanding of dietary guidelines as documents that provide simplified answers to complex questions.

    Practical implications

    Policymakers should be aware of industrial actors’ potential vested interests and actively seek out other stakeholders representing communities and citizen interests. The next step should be to question the extent to which it is ethical to publish dietary advice that represents a simplified way of conceptualising behavioural change, and thereby places responsibility for health on the individual.

    Originality/value

    This research provides a stakeholder perspective on the concept of dietary advice and is among the first to investigate referral responses to dietary guidelines.

  • 6. Braet, Caroline
    et al.
    O'Malley, Grace
    Weghuber, Daniel
    Vania, Andrea
    Erhardt, Eva
    Nowicka, Paulina
    Mazur, Artur
    Frelut, Marie-Laure
    Ardelt-Gattinger, Elisabeth
    The Assessment of Eating Behaviour in Children Who Are Obese: A Psychological Approach. A Position Paper from the European Childhood Obesity Group2014In: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 7, p. 153-164Article in journal (Refereed)
    Abstract [en]

    Objective: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. Methods: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors’ combined clinical experience, a three-staged approach to assessment was agreed by consensus. Results: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three staged approach to assessing eating behaviours in the absence of hunger is described. Conclusions: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.

  • 7.
    Eiffener, Elodie
    et al.
    Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
    Eli, Karin
    Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK ; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
    Ek, Anna
    Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Sandvik, Pernilla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics.
    Somaraki, Maria
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics.
    Kremers, Stef
    Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
    Sleddens, Ester
    Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics. Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial2019In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 14, no 11, article id e12556Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.

    Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.

    Method: The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.

    Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z‐scores.

    Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.

  • 8. Ek, Anna
    et al.
    Chamberlain Lewis, Kathryn
    Ejderhamn, Jan
    Fisher, Philip A.
    Marcus, Claude
    Chamberlain, Patricia
    Nowicka, Paulina
    The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, p. 735-Article in journal (Refereed)
    Abstract [en]

    Background: While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.

    Methods/design: This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).

    Discussion: This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.

  • 9.
    Ek, Anna
    et al.
    Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Delisle Nyström, Christine
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Chirita-Emandi, Adela
    Genetics Department, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania;“Louis Turcanu” Clinical Emergency Hospital for Children, Timisoara, Romania.
    Tur, Josep A.
    Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain; CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain.
    Nordin, Karin
    Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Bouzas, Cristina
    Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain; CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain.
    Argelich, Emma
    Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain; CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain.
    Martínez, J. Alfredo
    CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain; Department of Nutrition, Food Science, and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain; IMDEA Food Precision Nutrition, Madrid, Spain.
    Frost, Gary
    Section for Nutrition Research, Department of Medicine, Imperial College London, Hammersmith Campus, London, UK.
    Garcia-Perez, Isabel
    Division of Systems and Digestive Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK.
    Saez, Marc
    Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Campus de Montilivi, Girona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Instituto Carlos III, Madrid, Spain.
    Paul, Corina
    Pediatrics Department, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; 2nd Pediatrics Clinic, Clinical Emergency County Hospital Timisoara, Timisoara, Romania.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study – an intervention within the STOP project2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 945Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.

    METHODS/DESIGN: A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.

    DISCUSSION: This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.

  • 10.
    Ek, Anna
    et al.
    Karolinska Inst, Inst Environm Med, Dept Clin Sci Intervent & Technol, Div Pediat, Solna, Sweden.
    Lewis Chamberlain, Kathryn
    Oregon Social Learning Ctr, Eugene, OR, USA.
    Sorjonen, Kimmo
    Karolinska Inst, Inst Environm Med, Div Psychol, Dept Clin Neurosci, Solna, Sweden.
    Hammar, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Karolinska Inst, Inst Environm Med, Dept Biostat, Solna, Sweden.
    Etminan Malek, Mahnoush
    Karolinska Inst, Inst Environm Med, Dept Publ Hlth Sci, Solna, Sweden; Karolinska Univ Hosp, Astrid Lindgren Childrenk Hosp, Stockholm, Sweden.
    Sandvik, Pernilla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Inst Environm Med, Dept Clin Sci Intervent & Technol, Div Pediat, Solna, Sweden.
    Somaraki, Maria
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nyman, Jonna
    Karolinska Univ Hosp, Astrid Lindgren Childrenk Hosp, Stockholm, Sweden.
    Lindberg, Louise
    Karolinska Inst, Inst Environm Med, Dept Clin Sci Intervent & Technol, Div Pediat, Solna, Sweden.
    Nordin, Karin
    Karolinska Inst, Inst Environm Med, Dept Clin Sci Intervent & Technol, Div Pediat, Solna, Sweden.
    Ejderhamn, Jan
    Karolinska Univ Hosp, Astrid Lindgren Childrenk Hosp, Stockholm, Sweden.
    Fisher, Philip A
    Oregon Social Learning Ctr, Eugene, OR USA; Univ Oregon, Dept Psychol, Eugene, OR USA.
    Chamberlain, Patricia
    Oregon Social Learning Ctr, Eugene, OR USA.
    Marcus, Claude
    Karolinska Inst, Inst Environm Med, Dept Clin Sci Intervent & Technol, Div Pediat, Solna, Sweden.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Inst Environm Med, Dept Clin Sci Intervent & Technol, Div Pediat, Solna, Sweden.
    A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial2019In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 144, no 2, article id e20183457Article in journal (Refereed)
    Abstract [en]

    Background And Objectives: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST).

    Methods: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (−0.5) was assessed with risk ratios.

    Results: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: −0.45 to −0.15) compared with ST (0.07; 95% CI: −0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (−0.54; 95% CI: −0.77 to −0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST.

    Conclusion: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.

  • 11. Ek, Anna
    et al.
    Nordin, Karin
    Nyström, Christine Delisle
    Sandvik, Pernilla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet.
    Eli, Karin
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet.
    Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity.2019In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 145, article id 104488Article in journal (Refereed)
    Abstract [en]

    This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.

  • 12. Ek, Anna
    et al.
    Sorjonen, Kimmo
    Eli, Karin
    Lindberg, Louise
    Nyman, Jonna
    Marcus, Claude
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Div Pediat, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, article id e0147257Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Insight into parents' perceptions of their children's eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children's eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers' eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).

    MATERIALS AND METHODS: Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.

    RESULTS: 478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).

    DISCUSSION: The CEBQ is a valid instrument for assessing parental perceptions of preschoolers' eating behaviors. Parental pressure to eat was strongly associated with children's food avoidance. Parental restriction, however, was more strongly associated with parents' concerns about their children's weights than with children's food approach. This suggests that childhood obesity interventions should address parents' perceptions of healthy weight alongside perceptions of healthy eating.

  • 13. Ek, Anna
    et al.
    Sorjonen, Kimmo
    Eli, Karin
    Lindberg, Louise
    Nyman, Jonna
    Marcus, Claude
    Nowicka, Paulina
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet.
    Parental concern about child weight is an important mediator of the effect of child eating behaviors on parental feeding practices: Results from a sample of 478 preschoolers and their parents2015In: Proceedings of the 25th European Childhood Obesity Congress 2015 / [ed] Paulina Nowicka, Stockholm, 2015, p. 28-28Conference paper (Refereed)
    Abstract [en]

    Aim: To present a model for associations between preschoolers’ eating behaviors (measured with the Child Eating Behavior Questionnaire, CEBQ), and parental feeding practices (measured with the Child Feeding Questionnaire, CFQ).

    Methods: First, the original 8-factor structure of CEBQ was tested with Confirmatory factor analysis (CFA). Second, the associations between the two CEBQ dimensions of child eating (Food approach and Food avoidance) and the key CFQ parental feeding practices (Restriction and Pressure to eat) were examined with structural equation modelling (SEM). CFQ Concern for child weight and CFQ Perceived responsibility for child eating were used as mediators.

    Results: In a sample of 478 parents (81 % mothers, 87% of Nordic origin, 70 % with university degree) of children from Stockholm County (52 % girls, mean age 5.5 years, 20 % overweight/obese) the CFA demonstrated an acceptable fit (TLI=0.91, CFI=0.92, RMSEA=0.05) for a modified 8-factor structure. The SEM model, adjusted for child and parental characteristics, demonstrated that Food approach had a weak direct effect on Restriction, however, it had quite a strong (β: 0.30) indirect effect via concern, which resulted in a substantial total effect (β: 0.37). Further, there was a strong positive direct effect of Food avoidance on Pressure to eat (β: 0.71; p<0.001).

    Conclusion: The CEBQ proved to be a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental controling behaviour towards children with big appetites was especially pronounced when parents were concerned for child weight, implying that parental cognitions shouldn’t be forgotten when designing obesity interventions.

  • 14. Ek, Anna
    et al.
    Sorjonen, Kimmo
    Nyman, Jonna
    Marcus, Claude
    Nowicka, Paulina
    Child behaviors associated with childhood obesity and parents’ self-efficacy to handle them: Confirmatory factor analysis of the Lifestyle Behavior Checklist2015In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 12, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: The development of family-based programs for child weight management requires an understanding of parents’ difficulties in managing children’s eating and physical activity behaviors; however, knowledge about the specific behaviors that parents find most difficult to address is still limited. The Lifestyle Behavior Checklist (LBC) is an Australian instrument that assesses parents’ perceptions of children’s obesity-related behaviors (the Problem scale), and parents’ self-efficacy in dealing with these behaviors (the Confidence scale). Our aims were 1) to examine the psychometric properties (the factor structure, internal reliability, construct and discriminative validity) of the LBC in parents of preschoolers in Sweden, using the Child Feeding Questionnaire (CFQ) as a criterion measure, 2) to study associations between the LBC and socio-demographic factors.

    Methods: The LBC and the CFQ (measuring parental feeding practices) were distributed to parents from 25 schools/preschools and to parents starting a childhood obesity intervention. To test the fit of the original four-factor model (misbehavior in relation to food, overeating, emotional correlates of being overweight, physical activity (24 items)) to the data, confirmatory factor analysis (CFA) was performed. Structural equation modelling was used to examine associations between the LBC and the CFQ and socio-demographic factors.

    Results: In a sample of 478 parents, a five-factor structure proved best fit to data, after excluding 6 items and allowing two pairs of error terms to correlate (TLI = 0.899; CFI = 0.918; RMSEA = 0.042; SRMR = 0.055). The Confidence scale indicated unidimensionality, therefore a hierarchical CFA with 5 first order factors and one second order factor was tested showing good fit. The validity of the LBC was proven by relevant associations with the CFQ and child weight status; parental responses differed depending on child weight status. The Confidence scale was not associated with any child or parent variables.

    Conclusions: In a large sample of Swedish parents of preschoolers, the LBC showed good psychometric properties, with relevant correlations to similar constructs. A five-factor structure showed best fit to data with moderate to high internal reliability. The LBC was shown to discriminate effectively between parents of normal weight children and parents of overweight/obese children.

  • 15. Eli, Karin
    et al.
    Howell, Kyndal
    Fisher, Philip A.
    Nowicka, Paulina
    “A little on the heavy side”: a qualitative analysis of parents’ and grandparents’ perceptions of preschoolers' body weights2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, article id e006609Article in journal (Refereed)
    Abstract [en]

    Objectives: Parents’ difficulties in perceiving children’s weight status accurately pose a barrier for family-based obesity interventions; however, the factors underlying weight misinterpretation still need to be identified. This study’s objective was to examine parents and grandparents’ perceptions of preschoolers’ body sizes. Interview questions also explored perceptions of parental responsibility for childhood obesity and appropriate contexts in which to discuss preschoolers’ weights.

    Design: Semistructured interviews, which were videotaped, transcribed and analysed qualitatively.

    Setting: Eugene and the Springfield metropolitan area, Oregon, USA

    Participants: Families of children aged 3–5 years were recruited in February—May 2011 through advertisements about the study, published in the job seekers’ sections of a classified website (Craigslist) and in a local newspaper. 49 participants (22 parents and 27 grandparents, 70% women, 60% with overweight/obesity) from 16 low income families of children aged 3–5 years (50% girls, 56% with overweight/obesity) were interviewed.

    Results: There are important gaps between clinical definitions and lay perceptions of childhood obesity. While parents and grandparents were aware of their preschoolers’ growth chart percentiles, these measures did not translate into recognition of children’s overweight or obesity. The participants spoke of obesity as a problem that may affect the children in the future, but not at present. Participants identified childhood obesity as being transmitted from one generation to the next, and stigmatised it as resulting from ‘lazy’ parenting. Parents and grandparents avoided discussing the children’s weights with each other and with the children themselves.

    Conclusions: The results suggest that clinicians should clearly communicate with parents and grandparents about the meaning and appearance of obesity in early childhood, as well as counteract the social stigma attached to obesity, in order to improve the effectiveness of family-based interventions to manage obesity in early childhood.

  • 16. Eli, Karin
    et al.
    Howell, Kyndal
    Fisher, Philip A.
    Nowicka, Paulina
    ‘‘Those Comments Last Forever’’: Parents and Grandparents of Preschoolers Recount How They Became Aware of Their Own Body Weights as Children2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 11, p. e111974-Article in journal (Refereed)
    Abstract [en]

    Background: Parents’ and grandparents’ willingness to talk about children’s body weights may be influenced by their own childhood experiences of body weight awareness and ‘weight talk’ in the family; however, little is known about how adults describe their recollected weight-related childhood experiences.

    Aims: This paper examines how parents and grandparents of preschoolers describe the emergence of their own body weight awareness in childhood or adolescence. The analysis highlights the sources that participants identify as having instigated their body weight awareness, the feelings and experiences participants associate with the experience of becoming aware of their body weights, and their framings of potential links between childhood experiences and attitudes and practices in adulthood.

    Methods: 49 participants (22 parents, 27 grandparents, 70% women, 60% with overweight/obesity) from sixteen low income families of children aged 3–5 years (50% girls, 56% with overweight/obesity) in the Pacific Northwest were interviewed. The interviews were videotaped, transcribed, and analyzed qualitatively.

    Results: Twenty-five participants (51%) said they became aware of their body weights in childhood or adolescence. Fourteen participants said their body weight awareness emerged through comments made by others, with the majority citing parents or peers. No participant described the emergence of body weight awareness in positive terms. Four participants directly linked their own negative experiences to the decision not to discuss body weight with their  preschoolers. All four cited critical comments from their parents as instigating their own body weight awareness in childhood.

    Conclusions: In most cases, participants associated their emergent awareness of body weight with overtly negative feelings or consequences; some participants said these negative experiences continued to affect them as adults. Since family-based childhood obesity interventions involve open discussion of children’s body sizes, the results suggest that clinicians should reframe the discussion to deconstruct obesity stigma and emphasize inclusive, affirmative, and health-focused messages.

  • 17. Eli, Karin
    et al.
    Howell, Kyndal
    Fisher, Philip
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    A question of balance: Explaining differences between parental and grandparental perspectives on preschoolers' feeding and physical activity2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 154, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Rationale: Although one quarter of US and UK families rely on grandparents as the main providers of informal childcare, grandparental perspectives on the feeding and physical activity of young children remain understudied.

    Objective: The study's aim was to elucidate parents' and grandparents' perspectives on young children's feeding and physical activity, and identify how they negotiate potential differences between these perspectives.

    Methods: We interviewed 22 parents and 27 grandparents from 16 families of children aged 3-5 years in the Pacific Northwest, US. Using familial homeostasis as a novel theoretical framework, the interviews were analyzed to assess differences between parental and grandparental perspectives on feeding and physical activity.

    Results: The analysis yielded six thematic categories: (1) disagreements about feeding stem from parents' and grandparents' differing definitions of healthy feeding; (2) differences between parents' and grandparents' feeding practices reflect differences in perceived caretaking roles; (3) parents and grandparents negotiate differences in feeding practices through grandparental compliance and parental compromise; (4) differences in preschoolers' physical activity are influenced by parents' and grandparents' own access to and engagement in physical activity; (5) parents and grandparents express few disagreements about preschoolers' screen-time; (6) parents and grandparents rarely discuss preschoolers' physical activity. The findings suggest that parental and grandparental decision-making about feeding and exercise is informed by ideas of what constitutes familial balance and a balanced lifestyle for a preschool aged child, rather than by the child's weight status.

    Conclusions: Parents and grandparents appear to engage in practices designed to preserve familial homeostasis, which may provide a compelling explanation for the persistent difficulties in implementing family-based childhood obesity interventions.

  • 18.
    Eli, Karin
    et al.
    Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK.
    Hörnell, Agneta
    Department of Food and Nutrition, Umeå University, 901 87 Umeå, Sweden.
    Etminan Malek, Mahnoush
    Astrid Lindgren Children's Hospital, Department of Clinical Nutrition, Karolinska University Hospital Huddinge, 171 76 Stockholm, Sweden.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 57 Huddinge, Sweden.
    Water, juice, or soda?: Mothers and grandmothers of preschoolers discuss the acceptability and accessibility of beverages2017In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 112, p. 133-142Article in journal (Refereed)
    Abstract [en]

    Intake of sugary beverages is strongly associated with weight gain and obesity among children; however, differences between mothers' and grandmothers' attitudes and practices concerning young children's beverage consumption remain unclear. This is notable since about a quarter of families in the US and the UK rely on grandparents as the main providers of informal childcare. The aim of this study is to examine mothers' and maternal grandmothers' attitudes, knowledge, and practices regarding preschool-age children's beverage consumption. The analysis focuses on identifying intergenerational similarities and differences, given the potential impact that such differences might have on young children's beverage consumption habits. Twenty-two semi-structured interviews, representing eleven families, were analyzed using thematic analysis. The sample included all mother-maternal grandmother dyads from The Grandparents Study, which took place in Eugene, Oregon, USA. More than half of mothers and grandmothers met overweight/obesity criteria. Among the children (mean age 4.7 years; five girls and six boys), seven met overweight/obesity criteria. Most mothers and grandmothers were unemployed, and reported an annual household income below 30,000 USD. The analysis identified three thematic categories: 1) mothers and grandmothers agree about the hierarchy of healthiness between and within beverages, though juice occupies an ambivalent position; 2) mothers and grandmothers cite role modeling and the home environment as important in regulating preschoolers' beverage intake; 3) mothers and grandmothers balance between restricting sugar-sweetened beverages and using these beverages as treats. The results suggest that when mothers and grandmothers use soda, juice, and juice-drinks as treats, they do so within a wider dynamic of balancing practices, and within two intersecting domains: the hierarchy of beverages, including the still ambivalent status of juice as healthy or unhealthy, and the definition of ‘special occasion’.

  • 19. Eli, Karin
    et al.
    Nowicka, Paulina
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet.
    "What happens at Grandma's stays at Grandma's": Explaining differences between parental and grandparental perspectives on preschoolers' physical activity2015In: Proceedings of the 25th European Childhood Obesity Congress 2015 / [ed] Paulina Nowicka, 2015, p. 26-26Conference paper (Refereed)
    Abstract [en]

    Aim: While extensive evidence shows that family involvement is critically important in the prevention and treatment of childhood obesity, grandparental perspectives on physical activity of young children remain understudied. This is notable since nearly one quarter of US and UK families rely on grandparents as the main providers of informal childcare. Informal care has been linked to increased risk of overweight in preschoolers. The aim of this study was to assess differences between parental and grandparental perspectives on physical activity, and how such differences are negotiated in families.

    Methods: We interviewed 22 parents and 27 grandparents (70% women, 60% overweight/obese) from 16 families of children aged 3-5 years (50% girls, 56% overweight/obese) in the Pacific Northwest, US. The interviews were transcribed and analyzed qualitatively.

    Results: The analysis yielded three thematic categories: (1) differences in preschoolers’ physical activity are influenced by parents’ and grandparents’ own access to and engagement in physical activity; (2) parents and grandparents frame screen-time as an acceptable part of their preschoolers’ activities and rarely disagree about screen-time rules; (3) parents and grandparents perceive preschoolers as inclined toward physically active play and think of exercise as a non-issue for young children.

    Conclusions: The findings highlight that young children’s physical activity is rarely subject to familial discussion, suggesting that, parents’ and grandparents’ concepts of appropriate physical activity are less clearly defined. The findings also suggest that parental and grandparental decision-making about physical activity is informed by ideas of what constitutes a balanced lifestyle for a preschool aged child.

  • 20.
    Eli, Karin
    et al.
    Univ Oxford, Inst Social & Cultural Anthropol, Unit Biocultural Variat & Obes, Oxford, England.
    Sorjonen, Kimmo
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Solna, Sweden.
    Mokoena, Lincoln
    Karolinska Inst, Dept Publ Hlth Sci, Solna, Sweden.
    Pietrobelli, Angelo
    Univ Verona, Pediat Unit, Sch Med, Verona, Italy; Pennington Biomed Res Ctr, 6400 Perkins Rd, Baton Rouge, LA 70808 USA.
    Flodmark, Carl-Erik
    Skane Univ Hosp, Childhood Ctr Malmo, Childhood Obes Unit, Malmo, Sweden.
    Faith, Myles S
    SUNY Buffalo, Grad Sch Educ, Dept Counseling Sch & Educ Psychol, New York, NY USA.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Pediat, Stockholm, Sweden.
    Associations between maternal sense of coherence and controlling feeding practices: The importance of resilience and support in families of preschoolers2016In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 105, p. 134-143Article in journal (Refereed)
    Abstract [en]

    Sense of Coherence (SOC) measures an individual's positive, or salutogenic, orientation toward her/his capacities, environment, future, and life. SOC comprises three factors: comprehensibility (the sense of one's own life as ordered and understandable); manageability (the perception of available resources and skills to manage stressors); and meaningfulness (the overall sense that life is filled with meaning and purpose). In numerous studies, SOC has been associated with resilience to stress. However, associations between parental SOC and controlling feeding practices have yet to be studied. This study examines the validity of the SOC 13-item, 3-factor questionnaire, associations between SOC and maternal and child characteristics, and associations between SOC and use of pressuring or restrictive feeding, among mothers of 4-year-olds. 565 mothers (23.5% of foreign origin, 30.3% with overweight/obesity) recruited via the Swedish population registry (response rate: 65%), completed the SOC-13, the Child Feeding Questionnaire (CFQ), and a background questionnaire. The validity of SOC-13 was examined using confirmatory factor analysis; associations with background characteristics and feeding practices were tested with structural equation modeling. SOC-13 validity testing showed acceptable fit (TLI = 0.93, CFI = 0.94, RMSEA = 0.06, SRMR = 0.04) after allowing one pair of error terms to correlate. The Cronbach's alpha for meaningfulness was 0.73, comprehensibility 0.76, and manageability 0.75. SOC increased with mothers' Swedish background and education, and decreased with higher BMI. Child gender, age, and BMI, were not associated with SOC. Lower SOC was associated with controlling practices and with concern about child weight and eating. The associations between SOC and feeding suggest that SOC-related parameters could inform childhood obesity research, and that prevention should address the socioeconomic barriers that parents face in building resilience to stress.

  • 21. Farpour-Lambert, Nathalie J.
    et al.
    Baker, Jennifer L.
    Hassapiodu, Maria
    Holm, Jens-Christian
    Nowicka, Paulina
    O'Malley, Grace
    Weiss, Ram
    Childhood Obesity Is a Chronic Disease Demanding Specific Health Care - a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO)2015In: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 8, p. 342-349Article in journal (Refereed)
    Abstract [en]

    Childhood obesity is one of the greatest health challenges of the 21st century. The EASO COTF is convinced that classifying obesity as a chronic disease in children and adolescents is a crucial step for increasing individual and societal awareness, and for improving early diagnosis and intervention. Such a classification will enhance the development of novel preventive and treatment approaches, health care policies and systems, and the education of healthcare workers. The management of obesity prior to the appearance of co-morbidities may prevent their escalation into significant medical and psychosocial problems, and reduce their economic and societal impact. Childhood is a unique window of opportunity to influence lifetime effects on health, quality of life, prevention of non-communicable chronic diseases and disabilities. The Convention on the Rights of the Child by UNICEF states that parties shall strive to ensure that no child is deprived of his or her right of access to health care services. The EASO COTF is aiming to address these issues via educational activities for health care workers, identification of research agendas, and the promotion of collaborations among clinicians, researchers, health institutions, organizations and states across Europe.

  • 22. Holm, Jens-Christian
    et al.
    Nowicka, Paulina
    Farpour-Lambert, Nathalie J.
    O'Malley, Grace
    Hassapidou, Maria
    Weiss, Ram
    Baker, Jennifer L.
    The Ethics of Childhood Obesity Treatment – from the Childhood Obesity Task Force (COTF) of European Association for the Study of Obesity (EASO)2014In: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 7, p. 274-281Article in journal (Refereed)
  • 23. Jacobsson, Amanda
    et al.
    Jörnvi, Anna
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Dietisters erfarenhet av motiverande samtal inom öppenvård2017In: Dietistaktuellt, Vol. 26, no 3, p. 48-53Article in journal (Other academic)
    Abstract [sv]

    Som dietist möter man människor i behov av en livsstilsförändring. Ett sätt att bidra till detta är genom motiverande samtal, på engelska motivational interviewing (MI). MI är en samtalsmetod som blivit uppmärksammad under de senaste åren av forskare och kliniker. Evidensen är blandad. En del studier visar att MI är en effektiv metod för att hjälpa människor att genomföra livsstilsförändringar, medan andra visar att MI inte är bättre i jämförelse med annan behandling. Majoriteten av forskningen har fokuserat på andra personalgrupper inom hälso- och sjukvården än dietister. I denna studie har vi därför tillfrågat 139 dietister i Sverige om deras erfarenheter av MI. Resultaten visar en genomgående positiv inställning till MI men indikerar också på ett antal brister och hinder till användningen. 

  • 24. Lindberg, Louise
    et al.
    Ek, Anna
    Nyman, Jonna
    Marcus, Claude
    Ulijaszek, Stanley
    Nowicka, Paulina
    Low grandparental social support combined with low parental socioeconomic status is closely associated with obesity in preschool-aged children: a pilot study2015In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310Article in journal (Refereed)
    Abstract [en]

    While the influence of parental socioeconomic status (SES) on children’s weight status is well known, the impact of other family-related aspects such as parental and grandparental social support is less understood. This study investigates the importance of parents’ SES and social support (functional and structural) for weight status in a clinical sample of preschoolers 4–6 years old with obesity (n = 39, 56% girls; 73% of parents were overweight/obese, 50% were of non-Swedish origin). Linear regression analyses, simple and multiple, were performed on SES and social support with child BMI SDS (body mass index standard deviation score) as the dependent variable. The results show that parents’ income and low emotional support from paternal grandparents were significantly associated with more severe obesity. The association between parental income and the child’s BMI SDS was stronger among parents who had low emotional support from their own parents. In conclusion, grandparental social support may be protective against childhood obesity.

  • 25.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Neuman, Nicklas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Kritisk dietetik: Att se mat och ätande bortom kalorier2017In: Dietistaktuellt, Vol. 26, no 3, p. 32-34Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Epidemiologiska studier visar att aspekter som låg utbildning, utländsk härkomst, hög arbetslöshet och boende i områden med lägre status är kopplade till större förekomst av ohälsa, exempelvis hjärtsjukdom, diabeteskomplikationer och fetma. Även vid sjukdomsrelaterad undernäring kan patientens sociala och ekonomiska situation vara avgörande för huruvida nutritionsbehandlingen ska lyckas. Men vilken verklighet och vilken vardag döljer sig bakom dessa samband? Hur ska dietister förhålla sig till det faktum att andra faktorer förutom omtanke om egen hälsa kan ha avgörande betydelse för patientens förmåga att göra hälsobefrämjande val? Bör vi ta ställning till och diskutera dessa frågor även utanför det rent nutritionsmässiga perspektivet?  

  • 26.
    Lövestam, Elin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Neuman, Nicklas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Kritisk dietetik: självreflektion, ödmjukhet och dialog2018In: DietistAktuellt, Vol. XXVII, no 2, p. 46-48Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tack vare medel från Vetenskapsrådet och Letterstedtska föreningen anordnade vi den 25 augusti konferensen ”The 1st Scandinavian Critical Dietetics Conference”, som syftade till att introducera ämnet kritisk dietetik i Sverige. I Dietistaktuellt nr 6 2017 skriver redaktören Magnus Forslin en personlig reflektion på åtta sidor där han angriper konferensen och de diskussioner som fördes där. Tonen i texten – kombinerat med associationer till bl a förintelseförnekelse och stalinism samt hånfulla illustrationer – inbjuder tyvärr inte till dialog. Istället för att ge oss in i en debatt på de premisserna tar vi tillfället i akt att kort och koncist lyfta några punkter om kritisk dietetik som vi gärna förtydligar. Då många av de antaganden och insinuationer som görs i artikeln saknar grund vill vi också bjuda in Dietistaktuellts läsare att själva ta del av konferensens presentationer, vilka ligger öppet på Institutionen för kostvetenskap, Uppsala Universitets webbplats.

  • 27. Malek, Mahnoush
    et al.
    Hörnell, Agneta
    Nowicka, Paulina
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet.
    Familial practices, attitudes and knowledge related to the child’s beverage consumption: A qualitative study with mothers and grandmothers of preschool children2015In: Proceedings of the 25th European Childhood Obesity Congress 2015 / [ed] Paulina Nowicka, Stockholm, 2015, p. 27-27Conference paper (Refereed)
    Abstract [en]

    Aim: To study maternal and grandparental attitudes, knowledge and practices regarding beverage consumption of preschool children.

    Methods: Twenty-two semi-structured interviews, representing 11 families, were analyzed using content analysis. The families consisted of a subsample (all mother-grandmother dyads) from “The Grandparents’ Study” performed in Eugene, Oregon, USA. Two thirds of the mothers and more than half of the grandmothers were overweight/obese. Among children (mean age 4.7 years; 45 % girls) 60% were overweight/obese.

    Results: The strategies used to influence children’s beverage consumption included parental involvement (e.g. offering healthy options, teaching about nutrition), restriction (of unhealthy beverages), moderation (of beverages perceived as healthy/partly healthy) and modeling (acting as a good role model). Both mothers and grandmothers used more than one of these strategies. While there was no clear difference in the choice of the strategies between mothers and grandmothers, the perceptions about what the children preferred to drink differed between the two generations. There was also a difference in views about beverages’ healthiness: more than half of the grandmothers perceived juice as healthy while none of the mothers did.

    Conclusions: The most distinct intergenerational difference was related to juice, with grandmothers being more positive. Increased knowledge regarding beverages may influence attitudes and behaviors of family members and ultimately impact upon children’s drinking habits. Further studies on how to implement familial practices in dietary treatment and how to effectively involve and educate members of the extended family are needed.

  • 28. Mazur, Artur
    et al.
    Caroli, Margherita
    Radziewicz-Winnicki, Igor
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. European Childhood Obesity Group, Brindisi, Italy; Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Weghuber, Daniel
    Neubauer, David
    Dembiński, Łukasz
    Crawley, Francis P.
    White, Martin
    Hadjipanayis, Adamos
    Reviewing and addressing the link between mass media and the increase in obesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement.2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, p. 568-576Article in journal (Refereed)
    Abstract [en]

    This study reviewed the link between social media and the growing epidemic of childhood obesity in Europe. A task force from the European Academy of Paediatrics and the European Childhood Obesity Group searched published literature and developed a consensus statement. It found that there was evidence of a strong link between obesity levels across European countries and childhood media exposure and that parents and society needed a better understanding of the influence of social media on dietary habits.

    CONCLUSION: Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity.

  • 29.
    Neuman, Nicklas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    Institute of Social and Cultural Anthropology, Oxford University.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Feeding the extended family: Gender, generation, and socioeconomic disadvantage in food provision to children2019In: Food, Culture, and Society: an international journal of multidisciplinary research, ISSN 1552-8014, E-ISSN 1751-7443, Vol. 22, no 1, p. 45-62Article in journal (Refereed)
    Abstract [en]

    This paper examines how US parents and grandparents describe their provision of food to preschool-age children. Drawing on 49 interviews with 16 families, most of which were socio-economically disadvantaged, we argue that gender and generation intersect in everyday efforts to care for children’s eating. The analysis explores gendered divisions of foodwork, highlights the struggles of single mothers, and examines fathers’ redefinitions of the paternal role to include feeding and caring for children. At the core of the analysis, however, is the participants’ emphasis on grandmothers as sources of knowledge and support, with both fathers and mothers citing grandmothers and other women of earlier generations as culinary influences and as role models for good parenting. We thus discuss “feeding the extended family,” and conclude with a discussion about moving beyond the couple-focused paradigm of parenting in research on food and the gendered division of foodwork.

  • 30. Nowicka, Paulina
    Assessment of parental overt and covert control of child's food intake: A population-based validation study with mothers of preschoolers2014In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 15, p. 673-678Article in journal (Refereed)
    Abstract [en]

    Introduction: Overt and covert control are novel constructs representing two different parental feeding practices with regard to the child's ability to detect them. Preliminary research indicates that covert control is linked to a healthier diet and lower child weight status. In this study,we report the first psychometric validation of the original measures of overt and covert control outside the UK in a large sample of parents of preschoolers.

    Methods: Based on records from the population register, all mothers of 4-year-olds (n = 3007) from the third largest city in Sweden,Malmö, were contacted by mail. Out of those, 876 returned the measures of overt and covert control together with a background questionnaire and the Child Feeding Questionnaire (CFQ). Test–retest data were obtained from 64% (n = 563) of these mothers. The mean age of the mothers was 35.6 years; their mean BMI was 24.1, 31.5% were overweight or obese. The children were on average 4.5 years old; 48% were girls, 12.8% were overweight or obese.

    Results: While the fit for the original 9-item 2-factor model was poor, shorter 8- and 6-item versions were supported by confirmatory factor analysis (CFI N 0.95, RMSEA b 0.05). Internal and test–retest reliability of the shorter version was good (ICC= 0.65–0.71). Results also suggest that the factor structure and loadings were invariant (i.e., did not significantly differ) over time and between child sexes. Both overt and covert control factors were moderately correlated with CFQ monitoring. Overt control was also moderately related to CFQ pressure and weakly correlated with CFQ restriction. Covert control, on the other hand, was moderately related to restriction and not related with pressure. Correlations of both factors with child and parent BMI were very small.

    Conclusion: We found good psychometric properties of the revised versions of the overt and control behaviors in a multiethnic sample of mothers from Sweden. Future studies need to establish causal associations between overt and covert control and the obesity related outcomes.

  • 31. Nowicka, Paulina
    Dietitians and exercise professionals in a childhood obesity treatment team.2005In: Acta Paediatrica. Supplement, ISSN 0803-5326, Vol. 94, no 448, p. 23-29Article in journal (Refereed)
    Abstract [en]

    UNLABELLED: There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given.

    CONCLUSION: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.

  • 32.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Early obesity treatment: Motivational work with the parents of the youngest. Current evidence of effectiveness and practical examples.2016In: 1st European Obesity Summit, 2016, 2016Conference paper (Other academic)
  • 33.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Family members perceptions of “healthy” vs “unhealthy” practices andways to preserve familial homeostasis in making lifestyle decisions.2016In: 26th ECOG Congress, 2016Conference paper (Other academic)
  • 34.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Föräldraskap och fetma: Vad vet vi om gränssättning2015In: Proceedings of the 25th European Childhood Obesity Congress 2015 / [ed] Paulina Nowicka, 2015Conference paper (Other academic)
  • 35. Nowicka, Paulina
    Föräldratekniker mot fetma hos förskolebarn2014In: Nordisk Nutrition, ISSN 1654-8337, Vol. 4, p. 11-13Article in journal (Other (popular science, discussion, etc.))
  • 36.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Hur kan vi ta vara på föräldrar i behandlingen?: − Fem smakprov på familjeterapi2009In: Dietistaktuellt, Vol. 19, no 1, p. 7-10Article, review/survey (Other (popular science, discussion, etc.))
  • 37. Nowicka, Paulina
    et al.
    Bryngelsson, Susanne
    Sugars or sweeteners: Towards guidelines for their use in practice report from an expert consultation2006In: Scandinavian Journal of Food and Nutrition, ISSN 1748-2976, E-ISSN 1748-2984, Vol. 50, no 2, p. 89-96Article in journal (Refereed)
    Abstract [en]

    With the aim of suggesting recommendations regarding the practical implementation of sweeteners from a nutritional point of view for different groups of consumers, based on present scientific knowledge, the Swedish Nutrition Foundation (SNF) arranged a workshop focusing on the use of sugars and sweeteners in relation to obesity, diabetes, dental health, appetite, reward and addiction. The discussions and conclusions are summarized in this article. It was concluded that restrictions to keep the intake of refined sugars within the recommendations (10E%) should be achieved by limited intake of foods high in sugars, e.g. sweet drinks and candies, rather than other foods that provide less significant amounts of sugars. From a practical point of view it may be useful to restrict the intake of foods high in sugars, especially drinks, to a small amount and to a limited number of occasions, e.g. once or twice a week. Regarding sweeteners, the present intake is considered to be safe from a toxicological point of view. Non-caloric intense sweeteners may be useful for lowering the energy content of liquid and semi-solid foods. Sweeteners may also provide tooth-friendly alternatives within certain food categories, but do not reduce the erosive potential of acidic foods.

  • 38.
    Nowicka, Paulina
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Ek, Anna
    Beteendemodifikation och barnfetma. Vart står vi idag?2012In: Dietistaktuellt, Vol. XXI, no 1Article in journal (Other (popular science, discussion, etc.))
  • 39. Nowicka, Paulina
    et al.
    Eli, Karin
    Ng, Janet
    Apitzsch, Erwin
    Sundgot-Borgen, Jorunn
    Moving from Knowledge to Action: A Qualitative Study of Elite Coaches’ Capacity for Early Intervention in Cases of Eating Disorders2013In: International Journal of Sports Science & Coaching, ISSN 1747-9541, Vol. 8, no 2, p. 343-355Article in journal (Refereed)
    Abstract [en]

    This study investigates elite coaches’ attitudes toward eating disorders (ED), knowledge about ED, and early intervention skills when confronted with possible ED in their female athletes. We interviewed 18 coaches in Sweden responsible for athletes representing national teams in the three sports categories most at risk for ED: aesthetic, weight class, and endurance. The interviews revealed that, although most coaches knew athletes with ED, they did not perceive ED as a problem in their sport. The majority of coaches cited difficulties in identifying ED symptoms, especially symptoms associated with bulimia nervosa. Coaches also described several barriers in approaching the athletes, including the athletes’ denial of ED, lack of female colleagues on the team and the lack of easily accessible resources for treatment referral on both the national sports federation and the club levels. This study reveals that elite coaches have insufficient capacity to identify ED and conduct early intervention, resulting in delayed treatment.

  • 40.
    Nowicka, Paulina
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Eli, Karin
    Sorjonen, Kimmo
    Mokoena, Lincoln
    Pietrobelli, Angelo
    Flodmark, Carl-Erik
    Faith, Myles S.
    Maternal sense of coherence and controlling feeding practices: The importance of resilience and support for families with preschoolers.2016In: The European Obesity Summit 2016, 2016Conference paper (Refereed)
    Abstract [en]

    Stress, and the responses it elicits, is central to decision-making and emotional wellbeing throughout a person’s life. Antonovsky’s theoretical formulation of the Sense of Coherence (SOC) has been associated with individuals’ ability to cope with stress. Comprised of three interrelated subscales – comprehensibility, manageability, and meaningfulness – the SOC questionnaire measures an individual’s orientation toward her/his capacities, environment, future, and life. Specifically, comprehensibility measures the person’s sense that her/his own life is ordered and understandable; manageability measures the person’s perception that resources and skills to manage stressors are readily available; and meaningfulness measures the person’s overall sense that life is filled with meaning and purpose, and that it is, therefore, worthwhile to manage stressors. The study is the first to analyze associations between parental SOC and controlling feeding practices. The study aims to examine the validity of the SOC 13-item questionnaire (SOC-13), associations between SOC and maternal and child characteristics, and associations between SOC and use of pressuring or restrictive feeding, among mothers of 4-year-olds. 565 mothers (23.5% of foreign origin, 30.3% with overweight/obesity) recruited via the Swedish population registry (response rate: 65%), completed the SOC–13, the Child Feeding Questionnaire (CFQ) and a background questionnaire. The validity of SOC-13 was examined using confirmatory factor analysis; associations with background characteristics and feeding practices were tested with structural equation modeling. SOC-13 validity testing showed acceptable fit (TLI = 0.93, CFI = 0.94, RMSEA = 0.06, SRMR = 0.04) after allowing one pair of error terms to correlate. SOC increased with mothers’ Swedish background and level of education, and decreased with higher BMI. Child characteristics were not associated with SOC. Lower SOC was associated with controlling feeding practices and with concern about child weight and eating. In conclusion, resilience to stress may reduce the likelihood that mothers would engage in counterproductive practices, such as restrictive or pressuring feeding, even in the presence of concern about the child’s weight. The links between SOC and feeding practices suggest that SOC-related parameters can inform studies on childhood obesity prevention, and that obesity programs should address the structural barriers that parents face in building resilience to stress.

  • 41.
    Nowicka, Paulina
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Flodmark, Carl-Erik
    Barnövervikt i praktiken. Evidensbaserad familjeviktskola2006 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 42. Nowicka, Paulina
    et al.
    Flodmark, Carl-Erik
    Family in pediatric obesity management. A literature review.2008In: International Journal of Pediatric Obesity, ISSN 1747-7166, E-ISSN 1747-7174, Vol. 3 S1, p. 44-50Article in journal (Refereed)
    Abstract [en]

    A dramatic increase in prevalence of pediatric obesity has occurred in most countries over the past few decades. This is of particular significance given the fact that overweight children and adolescents are at increased risk for multiple medical co-morbidities, as well as psychosocial and behavioral difficulties. While considerable attention has recently been paid to identifying obesity and the importance of associated co-morbidities, there has been less focus on considerations related to effective interventions. Interventions aimed at childhood obesity include prevention and treatment. Both prevention and treatment need improvement to be useful in the clinical setting. Few investigators have demonstrated that treatment is effective. The aim of this review is to examine the effectiveness of family-based interventions in obese pediatric subjects and to explore what specific components of family-based programs are of particular significance when treating obese children. A literature search was performed and relevant studies are presented. A majority of the studies support the use of family-based treatment. Furthermore, to develop a fully interactive model, more focus is needed on the specific techniques used in evidence-based programs.

  • 43. Nowicka, Paulina
    et al.
    Flodmark, Carl-Erik
    Family therapy as a model for treating childhood obesity: Useful tools for clinicians2011In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 16, no 1, p. 129-145Article in journal (Refereed)
    Abstract [en]

    More than 15 percent of children in Europe are overweight; another 5 percent are obese. The high prevalence of obesity emphasizes the necessity of developing evidence-based treatment programs that are useful in a clinical setting. Management of childhood obesity is commonly based on lifestyle interventions where nutrition, physical activity, and behavior modification are the main targets. To incorporate lifestyle interventions, many childhood obesity treatment models use different psychological models, such as behavior modification or cognitive behavior therapy. This paper presents the key lessons from a research program on an empirically supported family-therapy-based treatment, Standardized Obesity Family Therapy (SOFT). SOFT is based on systemic and solution-focused theories and has shown positive effects on the child with respect to degree of obesity, physical fitness, self-esteem, and family functioning in several studies. The distinguishing features of SOFT are the focus on family interactions as an important source for implementing and maintaining lifestyle changes, the multidisciplinary team approach, and a limited number of sessions (three to four per year). The main aim of this paper is to provide tools for clinicians in the field of obesity who work with families, alone or in a multidisciplinary team.

  • 44. Nowicka, Paulina
    et al.
    Flodmark, C-E
    Physical activity - key issues in treatment of childhood obesity.2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 454, p. 39-45Article in journal (Refereed)
    Abstract [en]

    Changes in physical activity with the aim of increasing energy expenditure are usually an important component of childhood obesity treatment. Physical activity also has several other aspects that are positive for the obese child's health, such as improving the metabolic profile and psychological well being. The aim of this paper is to give a short review of what we know about physical activity in paediatric obesity treatment. In addition, practical recommendations will be presented which a health care provider can suggest to obese children and their families with a special focus on daily activity, participation in physical education classes and sports, sedentary behaviours, active commuting to school and how to get family and friends involved in supporting the child.

  • 45. Nowicka, Paulina
    et al.
    Höglund, Peter
    Birgerstam, Pirjo
    Lissau, Inge
    Pietrobelli, Angelo
    Flodmark, Carl-Erik
    Self-esteem in a clinical sample of morbidly obese children and adolescents2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 1, p. 153-158Article in journal (Refereed)
    Abstract [en]

    Aim: To study self-esteem in clinical sample of obese children and adolescents.

    Methods: Obese children and adolescents aged 8–19 years (n = 107, mean age 13.2 years, mean BMI 32.5 [range 22.3–50.6], mean BMI z-score 3.22 [range 2.19–4.79]; 50 boys and 57 girls) were referred for treatment of primary obesity. Self-esteem was measured with a validated psychological test with five subscales: physical characteristics, talents and skills, psychological well-being, relations with the family and relations with others. A linear mixed effect model used the factors gender and adolescence group, and the continuous covariates: BMI z-scores, and BMI for the parents as fixed effects and subjects as random effects.

    Results: Age and gender, but neither the child’s BMI z-score nor the BMI of the parents were significant covariates. Self-esteem decreased (p < 0.01) with age on the global scale as well as on the subscales, and was below the normal level in higher ages in both genders. Girls had significantly lower self-esteem on the global scale (p = 0.04) and on the two subscales physical characteristics (p < 0.01) and psychological well-being (p < 0.01).

    Conclusion: Self-esteem is lower in girls and decreases with age. In treatment settings special attention should be paid to adolescent girls.

  • 46. Nowicka, Paulina
    et al.
    Höglund, Peter
    Pietrobelli, Angelo
    Lissau, Inge
    Flodmark, Carl-Erik
    Family Weight School treatment: 1-year results in obese adolescents.2008In: International Journal of Pediatric Obesity, ISSN 1747-7166, E-ISSN 1747-7174, Vol. 3, no 3, p. 141-147Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to evaluate the efficacy of a Family Weight School treatment based on family therapy in group meetings with adolescents with a high degree of obesity.

    METHODS: Seventy-two obese adolescents aged 12-19 years old were referred to a childhood obesity center by pediatricians and school nurses and offered a Family Weight School therapy program in group meetings given by a multidisciplinary team. Intervention was compared with an untreated waiting list control group. Body mass index (BMI) and BMI z-scores were calculated before and after intervention.

    RESULTS: Ninety percent of the intervention group completed the program (34 boys, 31 girls; baseline age = 14.8 +/- 1.8 years [mean +/- standard deviation, SD], BMI = 34 +/- 4.0, BMI z-score = 3.3 +/- 0.4). In the control group 10 boys and 13 girls (baseline age = 14.3 +/- 1.6, BMI = 34.1 +/- 4.8, BMI z-score = 3.2 +/- 0.4) participated in the 1-year follow-up. Adolescents in the intervention group with initial BMI z-score < 3.5 (n = 49 out of 65, baseline mean age = 14.8, mean BMI = 33.0, mean BMI z-score = 3.1), showed a significant decrease in BMI z-scores in both genders (-0.09 +/- 0.04, p = 0.039) compared with those in the control group with initial BMI z-score < 3.5 (n = 17 out of 23, mean baseline age = 14.1, mean baseline BMI = 31.6, mean baseline BMI z-score = 3.01). No difference was found in adolescents with BMI z-scores > 3.5.

    CONCLUSIONS: Family Weight School treatment model might be suitable for adolescents with BMI z-score < 3.5 treated with a few sessions in a multidisciplinary program.

  • 47. Nowicka, Paulina
    et al.
    Lanke, Jan
    Pietrobelli, Angelo
    Erwin, Apitzsch
    Flodmark, Carl-Erik
    Sports camp with six months of support from a local sports club as a treatment for childhood obesity2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 8, p. 793-800Article in journal (Refereed)
    Abstract [en]

    Aims: Although childhood obesity is becoming increasingly prevalent, treatment options are limited and the continued development of effective treatment strategies is necessary. It is equally important to explore involvement of other resources in society, such as sports associations. This study was designed to investigate the possibility of reducing the degree of obesity in obese children by focusing on physical activity as an intervention. Methods: Seventy-six children (40 boys) aged 8–12 years (mean age 10.5 years, mean body mass index (BMI) 28.9, standard deviation (SD) 3.0; mean BMI z-score 3.24, SD 0.49) were invited to participate in a one-week sports camp and six-month support system. After the camp a sports coach from a local sports club supported the child during participation in a chosen sport for six months.Weight, height, body composition (using dual energy x-ray absorptiometry and magnetic resonance imaging), and lifestyle (using a questionnaire) were measured at baseline and after 12 months. Data were pooled from two camps, one with a self-selected control group and one randomized controlled trial. Results: Twelve months after the camp the intervention group had a significant decrease in BMI z-score (baseline BMI z-score 3.22; follow up 3.10, p¼0.023). The control group also reduced their BMI z-score (baseline BMI z-score 3.27; follow up 3.18, p¼0.022). No differences were found in baseline values, follow-up values, or changes in BMI z-score between groups, nor between boys and girls. Conclusions: The focus on physical activity as an intervention had no effect on degree of obesity when compared with a waiting list control group.

  • 48. Nowicka, Paulina
    et al.
    Marcus, Claude
    Beteendemodifikation – enda rimliga terapin vid fetma hos barn och vuxna2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 11, no 49, p. 2581-2585Article in journal (Refereed)
    Abstract [sv]

    Beteendemodifierande fetmabehandling bygger på det självklara – om man äter mindre och rör sig mer så går vikten ner. De framsteg som gjorts inom detta behandlingsområde summeras, med fokus på barn.

  • 49. Nowicka, Paulina
    et al.
    Pietrobelli, Angelo
    Flodmark, Carl-Erik
    Low-intensity family therapy intervention is useful in a clinical setting to treat obese and extremely obese children.2007In: International Journal of Pediatric Obesity, ISSN 1747-7166, E-ISSN 1747-7174, Vol. 2, no 4Article in journal (Refereed)
    Abstract [en]

    AIMS: To study the influence of low-intensity solution-focused family therapy with obese and extremely obese pediatric subjects on body mass index (BMI) z-scores and self-esteem.

    MATERIALS AND METHODS: Fifty-four obese children, aged 6-17 years, were referred to an outpatient obesity clinic. The families received solution-focused family therapy provided by a multidisciplinary team. Height and weight were recorded; BMI and BMI z-scores were derived. Self-esteem was assessed with a validated questionnaire, "I Think I Am." Parents completed "The Family Climate Scale" assessing family dynamics.

    RESULTS: Eighty-one percent of the children (n =44, mean age 11.9 years, mean BMI z-score 3.67, range 2.46-5.48) and their parents participated in the follow-up. Eleven children were treated for 6-12 months, and 33 for more than 12 months. On average, the families received 3.8 family therapy sessions. Intervention resulted in a mean decrease in BMI z-score of 0.12 (p =0.0001). Self-esteem on the global scale improved after intervention (p =0.002), and also on sub-scales, depicting physical characteristics (p <0.001), psychological well-being (p =0.026), and relations with others (p =0.046). The Family Climate Scale showed improvement in the sub-scales for Expressiveness (p = 0.002) and Chaos (p =0.002).

    CONCLUSIONS: Solution-focused family therapy provided by a multidisciplinary team to obese and extremely obese children may prove useful in the clinical setting, with a positive impact on obesity and self-esteem.

  • 50. Nowicka, Paulina
    et al.
    Santoro, Nicola
    Liu, Haibei
    Lartaud, Derek
    Shaw, Melissa
    Goldberg, Rachel
    Guandalini, Cindy
    Savoye, Mary
    Rose, Paulina
    Sonia, Caprio
    Utility of Hemoglobin A1c for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents2011In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 34, no 6, p. 1306-1311Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE—Hemoglobin A1c (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.

    RESEARCH DESIGN AND METHODS—We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of ;2 years in 218 subjects.

    RESULTS—At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (A1C,5.7%), 21% at risk for diabetes (A1C 5.7–6.4%), and 1% with diabetes (A1C .6.5%). In the at risk for diabetes category, 47% were classified with prediabetes or diabetes, and in the diabetes category, 62% were classified with type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1C was 0.81 (95%CI 0.70–0.92). The threshold for identifying type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1C and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.

    CONCLUSIONS—The American Diabetes Association suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1C by itself represents a poor diagnostic tool for prediabetes and type 2 diabetes in obese children and adolescents.

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