RECINTO UNIVERSITARIO MAYAGUEZ
Weight control does not seem to be an effective answer to the increasing incidence of obesity as studies have shown that within five years most people have regained whatever weight they lost. Finding a solution to childhood overweigh/obesity is especially challenging, because of a child's vulnerability to the stigmatization that all fat people experience. Suggesting, forcing, cajoling, or asking a child to lose weight emphasizes that the child is not acceptable as he or she is. The solution to this problem is to focus on health and the acceptance of the person that the child is. This frees the child to change his or her behavior. We understand that the increased incidence of obesity stems from the collective acceptance of (1) goverment policies favoring the use of private automobiles instead of multiple transportation options, which inclued walking or biking, (2) advertisements by multinational companies which create a gobally shared consensus of what constitutes beauty and the food life, and (3) the desire to look and act the way the users of advertized products are shown to look and act. Working symbiotically all three negatively affect the health and children. Participatory Action Research (PAR) , a specific form of Community Based Participatory Research, enables researchers to enter a community with an idea, convince the people that the idea is important for them to work on, and then help them develop sufficient collective efficacy to solve the problem. Our hypothesis is that PAR will improve the attitudes, norms and self-efficacy of adults and children so that the health of children in the community is improved. Specific Aim 1, reduce stigmatization of overweight children focuses on "You're a great person. What you look like is not important". Specific Aim 2, get adults and children to move more, capitalizes on the fact that children naturally want to run, jump, swirm, and play. Specific Aim 3, eat more fruits, vegetables, and low-fat milk, is based on findings that focusing on increasing these three groups, as opposed to focusing on reducing high-fat-high-sugar foods, resulted in decreased restraints on child eating, decreased weight concerns, and increased acceptance of the child by his/her parent. We will do a quasi-experimental two-sample, pre-post design pilot study using 2 intervened and 2 comparison communities in the Caguas Region of Puerto Rico (PR). We will measure the following intermediate dependent variables in 3rd to 6th graders: attitudes, self-esteem, acceptance or lack of acceptance of body size, and self efficacy; and in adults we will measure stigmatization. To evaluate the status of the children, we will use the following baseline and outcome dependent variables; height and weight to calculate the Body Mass Index (BMI), skinfolds, blood pressure, a Self Administered Physical Activity Checklist, step counts, and 24-hour Dietary Recalls. An outside evaluator will do continuous process evaluation to assess the level of application of PAR. Our long term goal is to establish programs to ameliorate the social, psychological, and physical environments of the community that lead to poor health in children.