Key Points Question Does a multijurisdictional, multilevel, multicomponent community intervention decrease young child overweight and obesity in the US-Affiliated Pacific region? Findings Among 27 communities and 8371 children in this randomized clinical trial, the Children’s Healthy Living Program decreased overweight and obesity prevalence by 3.95% among children aged 2 to 8 years in the US-Affiliated Pacific region. Meaning A multilevel, multicomponent approach reduced young child overweight and obesity.

Children’s readiness to use technology supports the idea of children using mobile applications for dietary assessment. Our goal was to determine if children 3–10 years could successfully use the mobile food record (mFR) to capture a usable image pair or pairs. Children in Sample 1 were tasked to use the mFR to capture an image pair of one eating occasion while attending summer camp. For Sample 2, children were tasked to record all eating occasions for two consecutive days at two time periods that were two to four weeks apart. Trained analysts evaluated images. In Sample 1, 90% (57/63) captured one usable image pair. All children (63/63) returned the mFR undamaged. Sixty-two children reported: The mFR was easy to use (89%); willingness to use the mFR again (87%); and the fiducial marker easy to manage (94%). Children in Sample 2 used the mFR at least one day at Time 1 (59/63, 94%); Time 2 (49/63, 78%); and at both times (47/63, 75%). This latter group captured 6.21 ± 4.65 and 5.65 ± 3.26 mean (±SD) image pairs for Time 1 and Time 2, respectively. Results support the potential for children to independently record dietary intakes using the mFR.

We estimated overweight and obesity (OWOB) prevalence of children in US-Affiliated Pacific jurisdictions (USAP) of the Children's Healthy Living Program compared with the contiguous United States. We searched peer-reviewed literature and government reports (January 2001–April 2014) for OWOB prevalence of children aged 2 to 8 years in the USAP and found 24 sources. We used 3 articles from National Health and Nutrition Examination Surveys for comparison. Mixed models regressed OWOB prevalence on an age polynomial to compare trends (n = 246 data points). In the USAP, OWOB prevalence estimates increased with age, from 21% at age 2 years to 39% at age 8 years, increasing markedly at age 5 years; the proportion obese increased from 10% at age 2 years to 23% at age 8 years. The highest prevalence was in American Samoa and Guam.

This study is part of the Children’s Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2–8 years) were recruited via community-based sampling from select communities in Guam. Children’s demographic and health behavior information; dietary intake; and anthropometric measurements were collected. Logistic regression, odds ratio, t-tests, and chi-square tests were used to determine differences and assess covariates of OWOB. The results indicate that 58% of children were living below the poverty level, 80% were receiving food assistance, and 51% experienced food insecurity. The majority of children surveyed did not meet recommendations for: sleep duration (59.6%), sedentary screen-time (83.11%), or fruit (58.7%) and vegetable (99.1%) intake, and consumed sugar sweetened beverages (SSB) (73.7%). OWOB affected 27.4% of children. Children affected by OWOB in this study were statistically more likely (p = 0.042) to suffer from sleep disturbances (p = 0.042) and consume marginally higher amounts (p value = 0.07) of SSB compared to children with healthy weight. Among Other Micronesians, children from families who considered themselves ‘integrated’ into the culture were 2.05 (CI 0.81–5.20) times more likely to be affected by OWOB. In conclusion, the OWOB prevalence among 2–8-year-olds in Guam was 27.4%; and compared with healthy weight children, children with OWOB were more likely to have educated caregivers and consume more SSBs. Results provide a basis for health promotion and obesity prevention guidance for children in Guam.

The Pacific Tracker (PacTrac) is a new dietary assessment program that can be used to evaluate dietary data for nutrition studies in the Pacific Islands. PacTrac is a modification of the Interactive Healthy Eating Index (IHEI) developed by the US Department of Agriculture's Center for Nutrition Policy and Promotion as an online interactive dietary assessment tool for use by the public. Creation of PacTrac required several modifications to the IHEI, including a function to save data to allow for later access and addition of Pacific Island foods. Sources for Pacific Island foods included the Cancer Research Center of Hawaii (CRCH) Food Composition Table (FCT) and recipes from Guam and the Commonwealth of the Northern Mariana Islands (CNMI). Initially, 344 foods in the CRCH FCT were added to the IHEI. Feedback from pilot sessions indicated it was too large and therefore difficult to navigate. Therefore, we removed the original IHEI database (over 7000 foods) and replaced it with the CRCH FCT (2778 foods) plus 85 recipes from Guam and 40 recipes from CNMI. We are currently using PacTrac to evaluate dietary data in Hawaii, Guam and CNMI.