Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeannette R. Ickovics

Subject Area(s)

Public health, Medicine

Abstract

Efforts to prevent and treat childhood obesity have had only modest results. Novel strategies are needed. The aims and hypotheses of this thesis are to: 1) Document the self-reported receipt of lifestyle counseling from physicians and other health care providers by BMI status. We hypothesize that despite recommendations for universal lifestyle counseling, few children will be counseled by their health care providers, though children who are obese will report receiving the most counseling. 2) Test the hypothesis that psychological resiliency (i.e., "shift and persist") protects low socioeconomic status children from obesity. Physical assessments and health surveys were collected from two school-based samples of children (N = 959 and N = 1,523). Multivariate logistic regression and multivariate linear regression were used to address aims one and two respectively. For lifestyle counseling, nearly one-quarter of healthy weight children received no counseling. Overweight children received counseling at rates similar to their healthy weight peers, while obese children were more likely to be counseled. As expected, among children low in resiliency, lower socioeconomic status was associated with significantly higher BMI z-scores (p < .05). However, among children high in resiliency, there was no association of socioeconomic status with BMI z-score (p = .16), suggesting that resiliency may be protective. Future research should to explore how best to leverage interventions we already know to be effective in fighting childhood obesity, such as lifestyle counseling, and also investigate novel means of approaching childhood obesity, including promoting psychological resiliency.

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