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Nutrition

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Full-Text Articles in Medicine and Health Sciences

Implementation Of Nutritional Screening In Adults (Ages 19-65) With Major Depressive Disorder: An Integrative Review, Laurie S. Stephens Oct 2023

Implementation Of Nutritional Screening In Adults (Ages 19-65) With Major Depressive Disorder: An Integrative Review, Laurie S. Stephens

Doctoral Dissertations and Projects

The World Health Organization estimates the total percentage of depression at 3.8% and projects it to be the leading cause of global disability by 2030 (WHO, 2023). The economic burden for adults with major depressive disorder in the United States is estimated at a staggering annual cost of 236 billion dollars (Greenberg et al., 2018). Nutritional psychiatry is a growing subspecialty focused upon how diet can improve mental health outcomes. The evidence shows a correlation between diet and depression, influencing questions on how this translates to current dietary recommendations and treatment. An integrative review of current literature was performed to …


The Impact Of Modern Dietary Practices On Cancer Risk And Progression: A Systematic Review, Stephanie Nagy, Stephanie N. Petrosky, Michelle Demory Beckler, Marc M. Kesselman Oct 2023

The Impact Of Modern Dietary Practices On Cancer Risk And Progression: A Systematic Review, Stephanie Nagy, Stephanie N. Petrosky, Michelle Demory Beckler, Marc M. Kesselman

HPD Articles

Cancer is a leading cause of mortality around the world, despite continued advancements in the management of cancer. Recent research efforts have shifted to evaluating the role that modifiable risk factors play in cancer risk and development, as diet and nutrition have been found to play a significant role in the onset and progression of cancer. As a result, there has been an increasing focus on the impact of dietary modifications on preventing the onset, progression, and reoccurrence of cancer. In this systematic review, data were collected on three common diets, the Mediterranean diet (MD), ketogenic diet (KD), and plant-based …


Nutritional Knowledge, Attitudes, And Practices Among Family Physician Practitioners In Gulf Countries (Bahrain, Kuwait, Saudi Arabia, And Uae), Abeer S. Alzaben, Abeer A. Aljahdali, Lulua F. Alasousi, Ghadeer Alzaben, Lynne Kennedy, Anwar Alhashem Oct 2023

Nutritional Knowledge, Attitudes, And Practices Among Family Physician Practitioners In Gulf Countries (Bahrain, Kuwait, Saudi Arabia, And Uae), Abeer S. Alzaben, Abeer A. Aljahdali, Lulua F. Alasousi, Ghadeer Alzaben, Lynne Kennedy, Anwar Alhashem

All Works

Family physicians serve as pivotal points of contact within global healthcare systems. Nutrition plays a significant role in lifestyle and preventive medicine. With the rise of chronic and non-communicable diseases in Gulf Cooperation Council (GCC) countries, these physicians advise patients and the public on diet-related conditions. This descriptive cross-sectional study assessed the nutritional knowledge and practices across the GCC. Combining survey data from multiple GCC sites, a sample of family physicians was generated. Registered GCC family physicians received email invitations containing participant information, informed consent forms, and a self-administered online questionnaire. Analysis of data from four GCC countries involving 8751 …


Revisiting The Master Food Volunteer Program: Examining How To Enhance Nutrition Education In The United States, Stacey Viera, Lindsey Haynes-Maslow Sep 2023

Revisiting The Master Food Volunteer Program: Examining How To Enhance Nutrition Education In The United States, Stacey Viera, Lindsey Haynes-Maslow

The Journal of Extension

America’s diet-related illness crisis intersects with a lack of nutrition literacy, nutrition security, and systemic inequities. The Cooperative Extension Service’s (CES) national infrastructure could potentially provide equitable access to quality nutrition education in the US utilizing a Master Food Volunteer (MFV) model. This research brief examined preliminary evidence for the MFV model as a support for CES agents and paraprofessionals, and results show a paucity of evidence. Further research and a pilot program with pre-established measures for health-related knowledge and behaviors could elucidate the model’s potential to increase equitable access to evidence-based programming, nutrition, and implementation guidance.


Nutrition-Related Experiences Of Women With Perinatal Depression During The Covid-19 Pandemic: A Qualitative Study, Dahlia Stott, Cynthia Klobodu, Lisa A. Chiarello, Bobbie Posmontier, Mona Egohail, Pamela A. Geller, June Andrews Horowitz, Brandy-Joe Milliron Sep 2023

Nutrition-Related Experiences Of Women With Perinatal Depression During The Covid-19 Pandemic: A Qualitative Study, Dahlia Stott, Cynthia Klobodu, Lisa A. Chiarello, Bobbie Posmontier, Mona Egohail, Pamela A. Geller, June Andrews Horowitz, Brandy-Joe Milliron

College of Nursing Faculty Papers & Presentations

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to …


Convenience Over Nutrition For Recreation League Youth Sport Team Snack And Mealtime Choices, Morgan Ashley M.S., R.D., Tony Weaver Ph.D., Andrew Ramsey M.S., Lauren Haldeman Ph.D. Sep 2023

Convenience Over Nutrition For Recreation League Youth Sport Team Snack And Mealtime Choices, Morgan Ashley M.S., R.D., Tony Weaver Ph.D., Andrew Ramsey M.S., Lauren Haldeman Ph.D.

Journal of Human Sciences and Extension

Fifty-six percent of school-aged children participate in team sports, yet there is limited evidence on how participation in youth sports impacts the dietary behaviors of participants and their families. Our team surveyed parents and caregivers of children participating in recreation league youth sports (n = 178) to assess the foods and beverages offered as team snacks and factors that influence team snack choices. Juice was the most popular beverage, and crackers were the most popular snack reported by parents. Convenience, followed by cost and child preference, were the most frequently reported factors influencing team snack choices. Survey items also included …


Partner Discussion Using An Ehr And Chatgpt, Anne Bodensteiner Aug 2023

Partner Discussion Using An Ehr And Chatgpt, Anne Bodensteiner

AI Assignment Library

This assignment requires students to complete a worksheet using a simulated EHR (which is a subscription software purchase) and meet with a partner to discuss AI in nutrition care and compare their results to the worksheet with answers they get from ChatGPT.


Accepting Educational Responsibility For Social Justice: Homeless Mothers’ And Children’S Need Of Education About Health And Nutrition, Smita Guha Aug 2023

Accepting Educational Responsibility For Social Justice: Homeless Mothers’ And Children’S Need Of Education About Health And Nutrition, Smita Guha

Journal of Vincentian Social Action

The goal is to improve health and nutrition among new mothers and their children who were living in shelters. The mothers received workshops and booklets consisting of information, quick and healthy recipes, and learned how to prepare home-made meals with a low budget. The mothers realized nutritious foods are important for them and their children. They learned how to manage time to make nutritious food at the residence. Children regardless of their background, are our future and we need to pay attention to their needs now so that future problems could be prevented. The significance of this study is immense …


Understanding Cultural Perceptions Of Health In Middle School Females For Obesity Prevention: A Case Study, Tien Vo, Egenia Dorsan, J. Mitchell Vaterlaus, Lori A. Spruance Jun 2023

Understanding Cultural Perceptions Of Health In Middle School Females For Obesity Prevention: A Case Study, Tien Vo, Egenia Dorsan, J. Mitchell Vaterlaus, Lori A. Spruance

Journal of Social, Behavioral, and Health Sciences

The purpose of this study was to understand acculturation and race/ethnicity influences in the home and school environment that affect physical activity and nutrition in female adolescents attending middle school. A convenience sample of eight female adolescents (n = 2 Asian American, n = 2 Black, n =2 Latinx/Hispanic, and n = 2 White) was interviewed individually via Zoom. Responses regarding acculturation, physical activity, and nutrition in the home and school environment were analyzed using qualitative case study analysis. Three themes were identified: 1) experiences related to home, health, and culture, 2) the intersection between school meals and personal …


Factors Associated With Food Choice Motivations Among Urban High School Students In Indonesia, Syarifah Aqilah, Anuchit Phanumartwiwath, Nutta Taneepanichskul Jun 2023

Factors Associated With Food Choice Motivations Among Urban High School Students In Indonesia, Syarifah Aqilah, Anuchit Phanumartwiwath, Nutta Taneepanichskul

Journal of Health Research

Background: This study aimed to examine what reasons motivated urban high school students to choose certain foods, and to identify factors associated with food choice motivations.

Methods: A cross-sectional study was conducted from April to May 2020 in Depok, Indonesia. A total of 433 high school students in grades 10–12 were recruited. Food choice motivations were identified using a questionnaire, and defined using exploratory factor analysis. Possible factors associated with motivations were evaluated using multiple linear regression.

Results: Five food choice motivations were identified and classed as: F1, health and religion; F2, price and convenience; F3, comfort; F4, weight control; …


Nutrition In Times Of Crisis: A Qualitative Study In Siargao Island, Philippines, During The Covid-19 Pandemic, Gideon Lasco, Vincen Gregory Yu, Julie Madelo Compra, Phetdavanh Leuangvilay, Rapeepong Suphanchaimat, Yunting Zhang, Charina Javier May 2023

Nutrition In Times Of Crisis: A Qualitative Study In Siargao Island, Philippines, During The Covid-19 Pandemic, Gideon Lasco, Vincen Gregory Yu, Julie Madelo Compra, Phetdavanh Leuangvilay, Rapeepong Suphanchaimat, Yunting Zhang, Charina Javier

Development Studies Faculty Publications

Objectives

Despite the public-health significance of both malnutrition and crises, little has been done to explore the convergence of the two domains and develop ways to improve policies and practices, especially in rural communities. This article remedies that knowledge gap by focusing on nutrition-related changes, responses, and practices during crisis situations in Siargao Island, Philippines, using the COVID-19 pandemic as a backdrop.

Methods

Forty-six (46) semi-structured interviews were conducted among parents, caregivers, local health workers, and local officials of Del Carmen, Siargao Island. Principles of thematic analysis were applied to data analysis using NVivo 12. Afterwards, the preliminary data were …


A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller May 2023

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …


The Influence Of Nutrition On The Gut Microbiota And Psychiatric Disorders: A Review, Megha Bhagavan, Francis Jenney May 2023

The Influence Of Nutrition On The Gut Microbiota And Psychiatric Disorders: A Review, Megha Bhagavan, Francis Jenney

Research Day

The symbiotic harboring of gut microorganisms within the gastrointestinal tract has a profound influence on host physiology, well-being, and disease pathology. More specifically, the gut bacteria are able to interact with dietary components from foods chosen by the host and consequently relay their beneficial or precarious effects locally and systemically. The gut bacteria have the capacity to maintain a healthy gut microbiome or perpetuate intestinal imbalance, known as gut dysbiosis. Gut dysbiosis has both local effects in gastrointestinal pathologies, such as intestinal bowel syndrome (IBS) and intestinal bowel disorder (IBD), as well as systemic pathologies, such as type II diabetes, …


Usage And Influence Of Dietary Supplementation Amongst Adolescent Athletes, Allison Harlow, Jennifer Walker, Aubrey Wagstaff May 2023

Usage And Influence Of Dietary Supplementation Amongst Adolescent Athletes, Allison Harlow, Jennifer Walker, Aubrey Wagstaff

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

OBJECTIVE The purpose of this study was to investigate the use of dietary supplements or ergogenic aids amongst high school athletes.


Assessing The Snap Consumer Environment At Farmers Markets, Gabrielle C. Young, Sarah Misyak, Meredith Ledlie Johnson, Natalie E. Martin, Elena Serrano May 2023

Assessing The Snap Consumer Environment At Farmers Markets, Gabrielle C. Young, Sarah Misyak, Meredith Ledlie Johnson, Natalie E. Martin, Elena Serrano

The Journal of Extension

The SNAP at Farmers Market Environmental Assessment was developed as a tool for market managers to examine SNAP participant accessibility for redeeming SNAP benefits at farmers markets. By completing the SNAP at Farmers Market Environmental Assessment, the tool can serve as a guide for providing practical next steps for market improvement. Extension practitioners and researchers, including SNAP-Ed staff, can use the assessment tool to support policy, systems, and environment change efforts that promote access to local, high-quality foods by SNAP consumers, the redemption of SNAP benefits, and potentially increased sales at farmers markets.


Food Insecurity Screening In People With Cystic Fibrosis, Rebecca Edwards, Lauren Tate, Ana Cairns, Cheryl Coyne, Kathleen Walker, Kim Violette, Ann Ladner, Jessica D'Amico May 2023

Food Insecurity Screening In People With Cystic Fibrosis, Rebecca Edwards, Lauren Tate, Ana Cairns, Cheryl Coyne, Kathleen Walker, Kim Violette, Ann Ladner, Jessica D'Amico

Costas T. Lambrew Research Retreat 2023

Background: Adequate nutrition is a cornerstone in the management of cystic fibrosis (CF). Malabsorption secondary to pancreatic insufficiency and increased energy demands related to lung disease can increase energy requirements over twofold for a person with CF. Food insecurity (FI) affects approximately 10% of Mainers (1). Per the Cystic Fibrosis Foundation, there may be up to a threefold increase in the prevalence of FI in the CF population (2). To address this issue, we implemented FI screening in the adult and pediatric CF programs to identify the prevalence of FI within our population and to offer immediate interventions.


Healthy Links – Addressing Social Determinants Of Health And Improving Cardiac Health With Medically Tailored Meals, Emily Follo, Katherine Sharp, Mylan Cohen May 2023

Healthy Links – Addressing Social Determinants Of Health And Improving Cardiac Health With Medically Tailored Meals, Emily Follo, Katherine Sharp, Mylan Cohen

Costas T. Lambrew Research Retreat 2023

Introduction:

• Social determinants of health (SDOH) strongly influence risk factors for cardiac disease, especially in rural areas

• Medically-tailored meals have shown promising results for reducing hospitalizations

• Some state insurance programs are covering medically-tailored meals given beneficial outcome studies

• This project builds upon prior Healthy Links programs to expand our reach to rural patients


Development Of A Multifactorial Virtual Fall Prevention Tool For Community Dwelling Older Women, Eduardo Gutierrez, Jacob James Nogra, Carol Sparks, Bradley Voels May 2023

Development Of A Multifactorial Virtual Fall Prevention Tool For Community Dwelling Older Women, Eduardo Gutierrez, Jacob James Nogra, Carol Sparks, Bradley Voels

UNLV Theses, Dissertations, Professional Papers, and Capstones

Falls are the leading causes of injury-related death in adults over the age of 65, with women sustaining more than twice the rate of fall-related fractures as men. Reduced access to in-person falls prevention programs during the COVID-19 pandemic created a need for a user-friendly guide to existing online fall prevention resources targeted at this vulnerable population. The first aim of this study was to create and make widely available a website with evidence-based resources that address a range of modifiable fall risk factors, and the second was to test its feasibility in a convenience sample of older women. The …


Vitamin D In The Prevention And Treatment Of Oral Cancer: A Scoping Review, Man Hung, Konstantinia Almpani, Bao Thao, Kaili Sudweeks, Martin S. Lipsky May 2023

Vitamin D In The Prevention And Treatment Of Oral Cancer: A Scoping Review, Man Hung, Konstantinia Almpani, Bao Thao, Kaili Sudweeks, Martin S. Lipsky

Institute on Aging Publications

Introduction: Oral cancer is a serious health problem with an increasing incidence worldwide. Researchers have studied the potential anti-cancerous action of vitamin D and its association with several cancers including oral cancer. The purpose of this scoping review is to synthesize the existing literature on the role of vitamin D on oral cancer. Methods: A scoping review of the literature was conducted using the framework developed by Arkey and O’Malley and the PRISMA-ScR guidelines. Nine databases were searched for peer-reviewed human studies published in English that either investigated the association of vitamin D with, or its impact on either the …


Inadequacies In Nutritional Counseling In The Perinatal Population, Tiffany Fry May 2023

Inadequacies In Nutritional Counseling In The Perinatal Population, Tiffany Fry

Doctor of Nursing Practice Scholarly Projects

Abstract

Obesity continues to increase at unprecedented levels and warrants immediate provider attention at the perinatal level to improve the health of the present and future generations. Reduction of this condition can reduce risk factors leading to morbidity and mortality. Guidelines exist for the prevention and management of obesity, yet little focus is placed on prevention in the perinatal population. Lack of consistent and healthy lifestyle in the perinatal population has the potential to not only place the mother at risk for obesity but also her unborn child. The overall purpose of the scholarly project is to identify any potential …


Validation Of The Arabic Version Of The Food Safety And Hygiene Questionnaire Among Nutrition Student, Nada El Darra, Dina Cheaib, Leila Itani Apr 2023

Validation Of The Arabic Version Of The Food Safety And Hygiene Questionnaire Among Nutrition Student, Nada El Darra, Dina Cheaib, Leila Itani

BAU Journal - Health and Wellbeing

There is shortage of data on food safety knowledge and practices among Lebanese food handlers due to the lack of a reliable tool. The aim of the current study is to determine the reliability as well as the validity of an adopted Arabic version of the Osaili et al (2013) food safety questionnaire. Translation and back translation and testing equivalence were done using standard accepted procedures. A total of 110 undergraduate Nutrition and Dietetics students completed the questionnaire consisting of five subscales that covers major food safety concepts including personal hygiene, safe storage, cross contamination prevention, knowledge of health problems …


The Impact Of Nutrition On The Mental And Physical Health Of Young Adults, Dareena El-Far Apr 2023

The Impact Of Nutrition On The Mental And Physical Health Of Young Adults, Dareena El-Far

WRIT: Journal of First-Year Writing

Upon close examination by nutritional professionals, concern has arisen regarding the typical contents of a young adult diet. In terms of the rate at which young adults choose to consume nutritionally-dense food items, the rate at which nutrition-deficient junk food items are chosen over the former is significantly higher. Among further examinations of this issue by researchers, it has become evident that the nutritional decisions made by young adults are increasingly associated with several social, commercial, mental, educational, and economic influences. As a consequence of these factors, research has uncovered a connection between the consumption of a poor diet and …


Wellness Review 2022, Part 2, Martin Huecker, Brian A. Ferguson, Jacob Shreffler Apr 2023

Wellness Review 2022, Part 2, Martin Huecker, Brian A. Ferguson, Jacob Shreffler

Journal of Wellness

Introduction: Similar to prior reviews, the Journal of Wellness editors searched the literature from the second half of 2022 for an interesting and impactful selection of publications on wellness in healthcare professionals.

Methods: Editors conducted a standard keyword search in Pubmed, focusing chiefly on large journals, interventional trials, and other prospective research. We included papers published between July 1, 2022 and December 31, 2022.

Literature in Review: Finding several hundred publications, we excluded editorials, reviews, and some smaller, less generalizable papers. A final 25 significant studies focusing on wellness in medical professionals were sorted into the following categories: logistics, creativity …


Accessibility Of On-Campus Food Pantries: A Comparative Review, Jayden Parrott Apr 2023

Accessibility Of On-Campus Food Pantries: A Comparative Review, Jayden Parrott

Honors Projects

This project explores ways in which food pantries across Ohio college campuses are accommodating for those with food restrictions such as food allergies, religious diets, or personal choice (vegan/vegetarian). Food insecurity is a widespread issue that affects many Americans. College students especially bear the burden of this issue. Food pantries are a common institution to combat food insecurity, and these work for many of the individuals that use them. Those with special dietary needs, however, may find more difficulty when accessing these resources. Having a food allergy or being on a religious or personal diet may impact how you can …


How Lifestyle Implementations Affect The Health Of Obese Women Compared To Women Who Are Not Obese, Chloe Hensley, Callie Marshall, Adela Robles, Adrianna Winseman Apr 2023

How Lifestyle Implementations Affect The Health Of Obese Women Compared To Women Who Are Not Obese, Chloe Hensley, Callie Marshall, Adela Robles, Adrianna Winseman

Epsilon Sigma at-Large Research Conference

Obesity is a major risk factor for many health problems, including cardiovascular disease and diabetes. It is anticipated that the prevalence of obesity in the United States will grow as time passes. The objective of this study is to compare the health of obese women who engage in regular exercise to that of nonobese women. This literature review is drawn from eight library-based research articles at East Tennessee State University (ETSU). The search engine covers topics such as obesity, postmenopausal women, physical activity, nutrition, health, fitness, and lifestyle. Taking nutritional supplements and increased physical exercise minimizes the likelihood of health …


The Rising Rates Of Pediatric Health Conditions Due To Lack Of Nutrition Education, Amanda Healy Apr 2023

The Rising Rates Of Pediatric Health Conditions Due To Lack Of Nutrition Education, Amanda Healy

Nursing | Student Research Posters

Statistics show that there is an increase in childhood health conditions related to nutrition. Throughout the United States, the rates of childhood obesity have drastically increased along with the rates of type two diabetes. There is correlation between these two chronic problems in pediatric patients, but not all pediatrics diagnosed with DM2 are obese. Furthermore, there is a correlation between this increase of obesity/DM2 and the lack of nutrition education in schools. The public school system in the United States does not have the funding to provide adequate nutrition education to the children which is leading to substantial health consequences. …


Freestyle: A Guide To Making Swimming Nutrition Simple, Megan Wills Apr 2023

Freestyle: A Guide To Making Swimming Nutrition Simple, Megan Wills

Undergraduate Theses

Nutrition plays a critical role in the performance of an athlete. Although academic research surrounding the topic has increased, there is a disproportionate increase in materials created for the athletes themselves. Regarding competitive swimming, the scope of athlete-friendly instructional materials is even more limited. Therefore, there is an inherent disconnect between the academic research on the topic of competitive swimming nutrition and the athletes who need the information. The purpose of this project is to bridge the gap between the research and the content accessible for athletes themselves. Using an interpretive and simplistic approach, the available academic research was used …


Habits For Health: A Holistic Approach To Women's Well-Being, Katelyn Helms Apr 2023

Habits For Health: A Holistic Approach To Women's Well-Being, Katelyn Helms

OTD Capstone Projects

The New Beginnings Center is a nonprofit organization that offers a holistic approach to a healthy lifestyle including instruction regarding nutrition and exercise training. They offer a 12-week program for women of all backgrounds 18+ that empowers women through fitness and lifestyle changes. They have also recently started a program called Iron souls which offers the same education and empowerment for teenagers. The objective for this project was to provide the most updated review of literature regarding the interrelationship between hormones and health. This included how reproductive hormones influenced energy levels, losing weight, and building muscle. Additionally, the relationship between …


Nutritional Management: Head And Neck Cancer, Christina Eagle Apr 2023

Nutritional Management: Head And Neck Cancer, Christina Eagle

Masters Theses/Capstone Projects

Nutritional management in head and neck cancer patients will help to promote treatment compliance and reduction of treatment-related co-morbidities.


Exploring Modern Trends And Prevention Strategies For Childhood Obesity: A Comprehensive Literature Review, Anya E. Bogen Apr 2023

Exploring Modern Trends And Prevention Strategies For Childhood Obesity: A Comprehensive Literature Review, Anya E. Bogen

Honors Theses

This literature review seeks to provide an overview of the current research on childhood obesity. The study examines the prevalence and causes of childhood obesity, including genetic, environmental, and behavioral factors. The review also discusses the health consequences associated with childhood obesity, such as the increased risk for chronic diseases and psychological and social problems. Additionally, the review explores the effectiveness of interventions designed to prevent childhood obesity, including individual lifestyle modifications, education from health practitioners and school programs, and global, national, and state programs to promote wellness. The literature review concludes that childhood obesity is a complex and multifactorial …