{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T13:00:13Z","timestamp":1777294813356,"version":"3.51.4"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["R01NR017639"],"award-info":[{"award-number":["R01NR017639"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity Science &amp;amp; Practice"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity in childhood is complex; structural equation modeling (SEM) offers an approach to ascertain complicated relationships between weight and proximal (health behaviors, child health) and distal (family\/household, community) variables. The objective of the study was to use SEM to map the influence of different etiological clusters on obesity in childhood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Secondary analysis of baseline data from patients and parents enrolled in a multi\u2010site study of pediatric weight management was conducted. The primary outcome was weight status (utilizing percentage above the 95th percentile BMI, %95BMI). SEM was used to evaluate the influences of variables proximal and distal to child weight within the context of the Ecological Model of obesity in childhood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Complete data on 375 child\u2010parent dyads were imputed. Proximal factors (child stress and mobility, parent BMI) were significantly related to %95BMI; some distal factors (family level) did not have a direct effect on %95BMI, but did indirectly through proximal factors (such as child stress). Other distal factors (neighborhood deprivation represented by the Area Deprivation Index) were significantly related to %95BMI and family\u2010level factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Except for the distal factor of neighborhood deprivation, proximal factors were the drivers of weight status. Distal factors did have indirect effects via proximal factors. SEM provides a means to investigate the complex contributors to childhood obesity, and could identify key leverage points for intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/osp4.70124","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:00:00Z","timestamp":1772967600000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Proximal and Distal Factors Associated With Obesity in Childhood: An Exploratory Structural Equation Model"],"prefix":"10.1002","volume":"12","author":[{"given":"Joseph A.","family":"Skelton","sequence":"first","affiliation":[{"name":"Department of Pediatrics Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-1412","authenticated-orcid":false,"given":"Erinn T.","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah E.","family":"Hampl","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Center for Children's Healthy Lifestyles &amp; Nutrition Children's Mercy Kansas City and University of Missouri\u2010Kansas City School of Medicine  Kansas City Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ihuoma","family":"Eneli","sequence":"additional","affiliation":[{"name":"Center for Healthy Weight and Nutrition Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward H.","family":"Ip","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"SIT Study Research Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20108587(22)00047\u2010X"},{"key":"e_1_2_11_3_1","unstructured":"I. 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