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A Critical Assessment of the Development Process for a HACCP Implementation Manual for a Healthcare Foodservice Operation - The Dartmouth General Hospital

(Mount Saint Vincent University, 2001-10) Corbett, Lesley Erin;

The use of a food safety program in a healthcare foodservice operation is instrumental in safeguarding the health and welfare of patients, their families and staff from foodbome illness. The Hazard Analysis Critical Control Point (HACCP) system has become the most widely accepted program for controlling food safety. HACCP was designed by the food industry; however implementation of a HACCP program is relatively new to the foodservice industry. Objectives: To assess the HACCP readiness of the six sites comprising the Central Regional Health Board (CRHB), now known as the Capital District Health Authority (CDHA); to assess the food safety knowledge and practice of foodservice employees; to develop a HACCP implementation manual and HACCP education and training materials for the pilot site - Dartmouth General Hospital; to determine the relevance of the change management approach to HACCP implementation. Subjects There were five managers who participated in the study. A total of 78 questionnaires were distributed throughout the CDHA; 35 were completed and returned yielding a 45% response rate. Experimental method: Semi-structured interviews were conducted with the managers of each foodservice operation, followed by an on-site audit of each facility according to HACCP prerequisite guidelines. A practice and knowledge questionnaire was developed and administered to the foodservice staff of CDHA to determine their current food safety knowledge and practices. Findings & statistical significance: All sites were investigated on a site-by-site basis, and there were inadequacies detected in each area of the HACCP prerequisite programs. If HACCP certification were sought at the point in time when the on-site audit was conducted, no site would have satisfied the requirements. There was no formal sanitation program in place at any facility of the CDHA, nor was there a policy on training and/or retraining of employees in terms of food safety, hygiene and sanitation. There was no significant difference between both average practice and average knowledge scores at each site. Ninety-seven percent of respondents had completed the provincially recognized safe food-handling course. There were HACCP implementation tools developed to help ease the transition into a HACCP compliant establishment. Conclusions & implications: Based on the findings of this study, there needs to be an in- depth review of each site’s prerequisite programs, as they comprise 70% of an effective HACCP program. There also needs to be a sanitation program developed and implemented to protect against areas of contamination that may not be corrected or prevented by a HACCP program. The change management approach involves introducing a substantial change in the working environment of employees; therefore education, training and employee input are essential keys to success and compliance of the program. The more they participate, the more pride they will have in their HACCP program, therefore making the transition easier.

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(Mount Saint Vincent University, 2005-03) MacEwen, Melissa

Children and youth are at an impressionable age, and their eating habits and nutritional health are influenced by a variety of people in their immediate environment. Children and youth learn by example and the eating habits they acquire early in life are often carried into adulthood. Teachers are key role models for children and youth, and through daily routines they are given the opportunity to model and communicate valuable nutrition information. It is important to focus on Education students as they will become role models for children and youth. It is crucial to raise awareness of how their own healthful habits can have long term benefits on the health of children and youth. This research project explores the association between the food related beliefs, attitudes, knowledge, eating patterns and intended classroom food practices of BEd students. Each of these factors can potentially affect the development of heartily behaviors of children and youth. Teachers have the ability to play an important role to better the students’ day-to-day lifestyle at school. However, since health courses for education students are elective; many future teachers must rely on their previous knowledge and values for this important issue, whatever their perception may be. One hundred and three students (79% response rate) enrolled in both the elementary and secondary BEd program at Mount Saint Vincent University completed a self-administered questionnaire adapted from the TEENS Teaching Staff Survey. Univariate statistics were used to describe the variables involved, while mixed model analysis of variance was used to examine tlie association between the variables. Bandura’s Social Cognitive Theory (SCT) and Bronfenbrenner’s ecological model provided a theoretical framework for understanding the influence of social environmental factors on the development of health behavior. Study findings show that although 93% BEd students confirmed the importance of a healthy school food environment, two-thirds intended to use unhealthy classroom food practices (candy in particular), 65% reported high-fat or very high fat intakes and most (72%) respondents had mid-to-low nutrition knowledge levels. Respondents who demonstrated ‘less support for a healthy school environment’ were more likely to promote unhealthy classroom food practices. As well respondents who had high fat intakes and low perceived health were approximately 3 times as likely to use the cafeteria, canteen or vending machines than those with low fat intakes and high perceived health. Overall, results suggest that BEd students in this study recognize the importance of a healthy environment; however, they report knowledge, attitudes and behaviors which may act as barriers to their having a positive impact on student’s eating habits in their future role as teachers. It is important that school and health professionals continue to campaign for the development and implementation of policies and programs that support teachers in creating a healthy school environment. Research suggests that attention to the health related needs of teachers is required if significant and sustainable changes in the comprehensive school food environment are to be achieved. It is also important that teachers succeed as positive role models and contribute to normative practices that support the development of healthy eating behaviors. Study findings reinforce the need to have policies and programs that support teachers in establishing healthy classroom practices and compulsory nutrition education training for BEd students.

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Childhood obesity in the family environment: Family rules and the diet quality of New Brunswick school children

(Mount Saint Vincent University, 2005-04) Young, Margaret Hilary

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Mapping the Social Relations Shaping the Everyday Lives of Single Mothers who are Food Insecure in Nova Scotia

(Mount Saint Vincent University, 2005-10) MacAulay, Rita

In Canada, single mothers are particularly vulnerable to experiencing food insecurity: a situation that exists when there is limited or uncertain ability to access acceptable foods in a socially acceptable way. This study aimed to map out the social relations organizing the food security status of single mothers supported by Income Assistance (IA) in Nova Scotia. This informed recommendations for policy and program changes that would allow food insecurity to be more effectively addressed in Nova Scotia. Institutional Ethnography (IE) was used to guide this research. Data collection consisted of two stages. The first stage involved in-depth face-to-face interviews with seven single mothers on LA who were determined to have experienced food insecurity. The interviews were audio taped and content analysis of the transcripts was conducted with the assistance of NUD*IST QSR N6 software. Results identified that the mothers entered into relations that, together, worked to coordinate their food insecurity. These social relations were organized using Bronfenbrenner’s Ecological Systems Theory. Overall, however, the interviews suggested that income was the most basic organizing factor in coordinating the mothers’ food insecurity. The two main sources of the mothers’ income were the IA and Canada Child Tax Benefit (CCTB) programs. The second stage of this study aimed to explicate how these programs organized the mothers’ food insecurity. To accomplish this, three employees of the IA program took part in in-depth face-to-face interviews to determine how the IA and CCTB programs, including their policies, act, and regulations, were involved in this organization. Similarly, these interviews were audio taped and content analysis of the transcripts was conducted with the assistance of NUD*IST QSR N6 software. Key policy documents, namely the Employment Support and Income Assistance policy document, and information pertaining to the IA and CCTB programs provided more context of the organizing role of these programs. The findings of this research suggest that many social relations are organizing and reproducing the food insecurity experienced by the mothers. Gaps, referred to as lines of fault, were also found to exist between the mothers’ everyday experiences and public and organizational polices as well as programs and nutrition education materials and approaches intended to address their needs. Overall, the identified social relations worked together to maintain the mother’s state of food insecurity and the lines of fault that existed. These fault lines were also maintained due to the lack of participation in the policy process of those most affected by food insecurity and because of the short-term strategies the mothers undertook to cope with their food insecurity. These short-term strategies did not increase the mothers’ food security, and may have actually hidden the reality of the mothers’ experiences of food insecurity. These conclusions have serious consequences considering the impact that food insecurity has on the health and well being of those that experience it and the economic toll it can have on society. As such, public policy and programs, nutrition practice, and society as a whole must make immediate change and work to make system level change that will address the root causes of food insecurity. Results supported a call for action to change current neoliberal based social policies so that they are more inclusive of the needs and realities of those individuals that they aim to affect.

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Dietary Habits, Health Beliefs and Quality of Life among Chinese-Canadians

(Mount Saint Vincent University, 2006-05) Kwok, Stephanie Wai-Hai

Chinese are the largest Asian subgroup in Canada and to varying degrees have adopted eating and lifestyle patterns of North Americans (e.g. high-fat, low fruit/vegetable diets; sedentary). They may therefore be more susceptible to higher rates of chronic diseases, including cardiovascular, hypertension, diabetes, obesity, and/or certain types of cancers. Very few research studies have examined the relationships between dietary habits and health beliefs among Chinese immigrants in North America, and virtually no research has been done to determine how either of these factors affects quality of life. The purpose of this study is to identify the dietary habits, health beliefs, and quality of life of Chinese immigrants residing in Toronto, Ontario, and to determine the effects of these dietary and health-related practices on subjective quality of life. The WHOQOL-BREF quality of life assessment model, with the incorporation of a diet-related index, was used as a theoretical framework for this study. Using a probability sampling method, subjects were recruited from five of more than 50 organizations serving Chinese immigrants in the Greater Toronto Area. The study population consisted of 106 healthy immigrants originating from Mainland China, Hong Kong and Taiwan, ranging in ages from 45 to 64 years. A telephone interview (15-20 minutes) employing a cross-sectional questionnaire was used to solicit information regarding dietary habits, health beliefs and perceived quality of life. Each interview was conducted in participant’s native language (Cantonese or Mandarin). All data were analyzed through SPSS statistical software. MSVU Ethics Review Board approved the ethical issues of this research. This study indicated that dietary acculturation is a gradual and continuous process, which does not occur at the same rate for all immigrants. While breakfast was the first meal to be “Westernized” after immigration, largely for reasons of convenience, about 72% and 98% of the subjects chose Chinese staple foods (rice, stir-fry, noodles, and soups) for lunch and dinner, respectively. Contrary to traditional Chinese habits, 62% of participants snacked between meals. Participants reported regular intakes of fruits and vegetables (87%), and frequent practice of fat- reduced behaviours (70%) in their diet. Most participants (79%) incorporated both Chinese and Western foods and cooking methods in their diets. Traditional Chinese health belief acculturation is also a continuous process. Traditional health practices of food modification during and after illnesses, seasonal adjustment of foods, and the balance of ‘cold’ or {Yin) and ‘hot’ (or Yang) foods to promote good health were very prevalent. Participants commonly used foods such as ginger root, ginseng, Chinese black mushroom, walnut, bitter melon, pork liver, and sea cucumber for preventing and treating illnesses. Participants were also categorized into one of three groups; those exhibiting the strongest levels of agreement with the traditional Chinese health belief questions were categorized as THB- Strong. The other two groups were THB-Moderate and THB-Weak. Compared to THB- Moderate and THB-Weak, subjects in THB-Strong group less frequently reduced the amount of added oil in cooking and/or trimmed visible fats from meat, but were more likely to reduce the intakes of deep-fried and fried foods, replace high fat foods with lower fat alternatives, and reduce meals consumed at Chinese restaurants. This finding agrees with traditional Chinese cooking in that oil and fat are considered important components of flavour, and that traditional Chinese health belief emphasizes on avoid eating deep-fried and fried foods. A substantial number of participants were satisfied with their overall quality of life (75%) and general health (60%), had good perceived physical (84%) and psychological health (68%), social relationships (80%), and environmental well-being (76%). Simple regression models revealed that overall quality of life could be predicted based on participants’ perception of their physical state, psychological well-being, and environmental conditions, and was positively associated with the length of residency in Canada (p = 0.001), English language proficiency {p = 0.006), and moderate degree of traditional health beliefs (p = 0.04). General health can be predicted based on participants’ perception of their physical health, psychological well-being, and social relationships, and was positively associated with the male gender (p = 0.01) and English language proficiency (p = 0.03). Chinese media (88%), friends and family (68%) were their primary sources of nutrition information. However, only 16% of the female and 1% of the male respondents had sought nutrition advice from dietitians. Less than 30% of participants reported engaging in at least 60 minutes of light intensity activities daily as recommended by the Canada’s Physical Activity Guide. Male participants were found to be less physically active than their female counterparts. On a positive note, less than 3% of the participants reported that they had worried about not having enough money to buy foods in the past month. These subjects were relatively younger, had lower educational attainment and English proficiency, suggesting that the issues of food security for this group be assessed in future studies. This study is one of the first few studies to directly relate the nutrition aspects with perceived quality of life among healthy immigrants. It is also the first study applying a traditional Chinese health belief grouping for Chinese Canadians, helpful in understanding concerns and preferences regarding diet and health. Results will provide an important basis needed to design and implement nutrition interventions to encourage immigrants to maintain a healthful traditional Chinese diet and health beliefs, and to make wise decisions when selecting Western foods. Using these results, dietitians are strongly encouraged to take a more proactive role in disseminating nutrition messages to minority populations. And finally, this study lays the groundwork for future research on dietary practices, health beliefs and nutrition-related quality of life of Chinese Canadians.

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Body esteem, eating attitudes, and adherence in adolescents with cystic fibrosis from Atlantic Canada.

(Mount Saint Vincent University, 2006-09) Faulkner, Colleen

A study was conducted to investigate the influence of body esteem, nutritional status, nutritional intake, and eating attitudes on adherence to dietary therapy and enzymes in adolescents and young adults with cystic fibrosis. Nine adolescents aged 12.5 to 18 years from the CF clinics at the IWK (Halifax, NS) and the Janeway (St. John’s, NL) participated in the study. The participants completed the following surveys/tools: a Three-Day Food Diary, The Eating Attitudes Test-26 (EAT-26), The Body Esteem Scale for Adolescents and Adults (BBS), and The Adherence Survey. Nutritional analysis determined that study participants had an average caloric intake of 2174 Cal. Only one participant met the adjusted Estimated Energy Requirement (EER + 20%), and was classified as being adherent to dietary therapy. The average Body Mass Index (BMIp) was at the 52"‘' percentile, and the average percent Ideal Body Weight (%IBW) was 100. None of the participants were classified as stunted, according to their height-for-age, but one was classified as wasted, according to his/her BMIp value. BBS scores determined that participants have a relatively positive body esteem, with a mean score of 52.67, 57.25% of the highest possible score. Eating attitudes were also positive, for the most part. However, EAT-26 scores did reveal that one participant was at risk of developing an eating disorder, having a score over 20. In the study, adherence was defined as taking the same dose, or more, of a treatment as prescribed by a doctor and/or dietitian. Adherence to vitamins and nutritional supplements, when prescribed, was extremely poor, at 0%. Adherence to enzymes taken with meals and snacks was similar to rates in the literature, with 56% being adherent. Common reasons cited for non-adherence included forgetfulness, an absence of positive results, time and effort consuming, and a dislike of taking the treatment in front of others. Due to the small sample size, two-tailed independent sample t-tests revealed no statistical significance between adherence, body esteem, eating attitudes, caloric intake, BMIp, and %IBW. Therefore, results of the study indicate that in the population of all adolescents with CF, based on the results of this study, one cannot predict differences in BBS, EAT-26, EER, BMIp, or %IBW based on the individuals’s adherence category.

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The Media and the Message: Providing Reliable, Relevant and Cost Effective Nutrition Information to Varsity Athletes

(2007-09) Weaver, Candace; Mann, Linda

Varsity athletes lack the basic nutrition knowledge necessary for performance, recovery and health in general. This lack of knowledge puts them at risk of nutrition deficiencies, detrimental to health if not addressed. Furthermore, many universities struggle to find funding to support nutrition education programs that could alleviate this problem. While previous research has focused on identifying varsity athletesÃ¢ levels of nutrition knowledge and dietary practices, little research has been done on the development and assessment of education approaches for this group. The purpose of this study was to determine if the Spiral Technology Action Research (STAR) Model could be used to develop relevant, specific, accessible, and costeffective sports nutrition education materials for MSVU varsity athletes. Using the principles of Participatory Action Research (PAR), and based on the STAR Model, this research also explored the use of Internet-based media to develop and assess nutrition messages created with and for varsity athletes. With approval from the MSVU University Research Ethics Board, eight MSVU athletes volunteered to participate in focus groups to select the topics for the nutrition education messages and the media for their delivery. Feedback from participants revealed that they liked being a part of the process, and in particular being able to select the topics and the media used. Involving the athletes in the development and planning of the messages, established their relevance, accessibility and specificity. This study was the first to address an alternate approach of providing cost effective nutrition education to varsity athletes.

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A Study of the Factors Associated with Initiation and Maintenance of Weight Loss

(2007-09) LeBlanc, Rebecca J.; Taper, Janette

Traditional nutrition counselling and commercial weight loss programs that focus solely on encouraging lifestyle changes to decrease caloric consumption and increase caloric expenditure without considering other factors such as coping responses and social support tend to result in initial weight loss success. However, weight regain occurs in the vast majority of individuals. Few programs consider that program effectiveness may be impacted by the existence of factors that can lead individuals to initiate and maintain weight loss. This qualitative pilot study identified the factors that led individuals to initiate and maintain weight loss. The purpose was to explore the beliefs and experiences of individuals who were trying to lose or had already lost a significant amount of body weight. Results revealed twenty-two factors that led individuals to initiate and maintain weight loss with the most prominent factors being various triggers such as health, appearance, emotional and lifestyle triggers. The presence of support systems, experiencing internal motivation and wanting to role model for their children were also important factors in their decision to initiate and continue their weight loss journey. The results of this study will assist health professionals in assessing a clients’ readiness to adopt strategies and lifestyle changes to lose weight. By having an understanding of the reasons why individuals seek assistance in losing weight, health professionals can modify their weight management programs to better counsel overweight and obese individuals and help predict who will be successful at weight loss.

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A Father's Influence of His Daughter's Perception of Her Body Image and Dieting Practices

(2007-10) Andrews, Denika; Taper, Janette

Body image and diet have been an area of concern in young females for a number Body image and diet have been an area of concern in young females for a number of years. In 2000, it was reported that 50% of adolescent girls had dieted and that an even higher percentage wished that they were thinner 1. Body image, as defined by Stokes et al., is the concept of one's body that is formed as one begins to observe and compare the self to others. Based on an increase in media awareness and other societal pressures to be thin, it can be speculated that in the future an even higher percentage of adolescent females will have dieted. In today's society there is a constant pressure to achieve the cultural ideal of a thin, pre-pubertal type body. Society portrays this ideal in television shows, music videos and magazines. Unfortunately, young girls are striving to attain this ideal body and will often go to extreme measures.Family relationships are one of the main influences on an adolescent girl's development of self-image including body image perception and dieting habits. The family is the primary agency for socialization7,8. Parents provide information to their children as well as act as role models. The literature reports the results of investigations on both maternal and paternal influences on a daughter's body image and diet; however, there is more emphasis on the same-sex parent-child relationship. Ample research has been conducted regarding a mother's influence on her daughter's body image and diet, while the strength of a father-son relationship has also been studied in detail. It is important to determine if a daughter feels that her father is influential in her self-image development as he is the primary male role model in her life and adolescence is when a daughter needs her father's parenting the most. The purpose of this study was to determine how adolescent females feel about their bodies, and what factors influence their body image development. This study assessed the father-daughter relationship and determined if its influence, if any, on the development of body image and safe diet habits in young adolescent females.With ethics approval, ten adolescent females were recruited from Exploits Valley High School via purposive sampling. The researcher gave a brief presentation to random classes, with participants volunteering at their leisure. Once ten participants had volunteered, and parental consent was obtained, the study began. Each female participated in an in-depth semi-structured interview which allowed participants to share their experiences in an unbiased setting.Thematic analysis of the transcribed interviews organized the data into five major themes: body image, dieting practices, relationships, influences and pressures andc ommunication. These themes were further broken down into a variety of sub-themes. The data indicated that overall these young females have a positive sense of self with minor episodes of body dissatisfaction. Participants identified three major influences on their body image and diet: peers, parents and the media. This study also indicated that the majority of participants felt a closer relationship with their father, than with their mother. The felt a sense of closeness, playfulness and trustworthiness all which lead to their father's having a positive impact on their lives in various ways. This research provides a good initial understanding of the father-daughter relationship and its effect on the daughter's development of body image and dieting habits. Although this was a small study, results provide solid information which can help guide Dietitians in their counseling of young females on weight related issues, such as weight management and eating disorders. It is essential to include both parents in dietetic counseling with regards to weight management, healthy eating and eating disorders, as it was determined that both the mother, and the father, have an impact on the overall eating habits and nutrition knowledge of these young females. of years. In 2000, it was reported that 50% of adolescent girls had dieted and that an even higher percentage wished that they were thinner 1. Body image, as defined by Stokes et al.2, is the concept of oneÃ¢ s body that is formed as one begins to observe and compare the self to others. Based on an increase in media awareness and other societal pressures to be thin, it can be speculated that in the future an even higher percentage of adolescent females will have dieted. In todayÃ¢ s society there is a constant pressure to achieve the cultural ideal of a thin, pre-pubertal type body. Society portrays this ideal in television shows, music videos and magazines. Unfortunately, young girls are striving to attain this ideal body and will often go to extreme measures2,3. Family relationships are one of the main influences on an adolescent girlÃ¢ s development of self-image including body image perception and dieting habits4,5,6. The family is the primary agency for socialization7,8. Parents provide information to their children as well as act as role models. The literature reports the results of investigations on both maternal and paternal influences on a daughterÃ¢ s body image and diet; however, there is more emphasis on the same-sex parent-child relationship. Ample research has been conducted regarding a motherÃ¢ s influence on her daughterÃ¢ s body image and diet, while the strength of a father-son relationship has also been studied in detail. It is important to determine if a daughter feels that her father is influential in her self-image development as he is the primary male role model in her life and adolescence is when a daughter needs her fatherÃ¢ s parenting the most The purpose of this study was to determine how adolescent females feel about their bodies, and what factors influence their body image development. This study assessed the father-daughter relationship and determined if its influence, if any, on the development of body image and safe diet habits in young adolescent females. With ethics approval, ten adolescent females were recruited from Exploits Valley High School via purposive sampling. The researcher gave a brief presentation to random classes, with participants volunteering at their leisure. Once ten participants had volunteered, and parental consent was obtained, the study began. Each female participated in an in-depth semi-structured interview which allowed participants to share their experiences in an unbiased setting. Thematic analysis of the transcribed interviews organized the data into five major themes: body image, dieting practices, relationships, influences and pressures and communication. These themes were further broken down into a variety of sub-themes. The data indicated that overall these young females have a positive sense of self with minor episodes of body dissatisfaction. Participants identified three major influences on their body image and diet: peers, parents and the media. This study also indicated that the majority of participants felt a closer relationship with their father, than with their mother. The felt a sense of closeness, playfulness and trustworthiness all which lead to their fatherÃ¢ s having a positive impact on their lives in various ways. This research provides a good initial understanding of the father-daughter relationship and its effect on the daughterÃ¢ s development of body image and dieting habits. Although this was a small study, results provide solid information which can help guide Dietitians in their counseling of young females on weight related issues, such as weight management and eating disorders. It is essential to include both parents in dietetic counseling with regards to weight management, healthy eating and eating disorders, as it was determined that both the mother, and the father, have an impact on the overall eating habits and nutrition knowledge of these young females.

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Achieving Healthy Body Weights in the Teenage Years: Evidence-based Practice Guidelines for Community Nutrition Interventions

(2007-10) Rudd, Brenna; Glanville, Theresa

Background: Adolescent obesity has become a significant public health problem. Conservative estimates, based on self-reported data, indicate overweight and obesity rates among Canadian adolescents aged 12 to 17 soared from 14% in 1978/79 to 29% in 2004. This persistent upward trend has serious long-term implications on the physical and psychological well being of adolescents and accounts for billions of dollars in health care costs. For this reason, prevention has been recognized as a priority health issue. While interventions have begun to target school-aged children and adults in clinical settings, few advances have been made to halt the escalating problem among adolescents. This population has unique needs with increasing independence transitioning into adulthood. Reversing the trend requires comprehensive interventions that mitigate personal, social and environmental barriers to healthy lifestyle choices. There is currently little consensus on best practices for dietetic adolescent obesity prevention and management. Community strategies are recommended as the most efficacious and feasible way to reach the greatest number of youth and support healthy lifestyle development. Evidence based guidelines are currently not available and are needed to guide nutrition practice in this area. Methods: A thorough systematic review and evidence analysis yielded 48 prevention and treatment interventions meeting the studies inclusion criteria. The evidence was graded and drafted into recommendations and an algorithm guideline displaying how each recommendation relates to nutrition intervention. A panel of independent, national experts assessed the guidelines for validity, acceptability and applicability with a tool adapted from the AGREE Collaborations Appraisal of Guidelines for Research and Evaluation Instrument. These experts covered different areas of expertise, including community nutrition, public health, adolescent health, academia and endocrinology. Results: The research findings confirm the need for comprehensive strategies, which include components of nutrition education and physical activity, address social and environmental influences and use schools as delivery vehicles for health promotion and health education. For obesity treatment interventions, promising strategies incorporated diet plans, family involvement and behaviour modification techniques in multidisciplinary interventions. Computer based strategies and peer modelling may also be developmentally appropriate strategies for health promotion health in the adolescent population. Conclusions: The results of this study indicate several interventions conducted over the past 10 years have had a positive effect in preventing or reducing adolescent obesity over the short and/or long term. The findings support the development of comprehensive, multi-disciplinary obesity prevention and treatment interventions and the use of peer modeling, family based and computer based strategies.

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