Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Susan C. McMillan, Ph.D., ARNP

Committee Member

Susan E. Kennel, Ph.D., PNP

Committee Member

Ming Ji, Ph.D.

Committee Member

Frances M. Sahebzamani, Ph.D., ARNP


adolescent, obesogenic environment, pediatric obesity


Despite a worsening obesity epidemic and despite the American Medical Association (AMA) declaring Obesity a disease (2013), few assessment tools exist that assist practitioners who are charged with identifying risk for development of OW/OB in children. The Center for Health Statistics (2017) reported a 40% rate in obesity in the adult population and 18.5% in children in the U.S. Successful weight loss maintenance after 1 to 2 years of non-invasive treatment is less than 1%, indicating obesity is nearly incurable, making prevention imperative. Assessing risk for OW/OB in children has proven difficult given the lack of validated tools. The purposes of this study were to evaluate the predictive validity and estimate the reliability of the Electronic Kids Dietary Index (E-KINDEX) to measure risk for development of overweight and obesity OW/OB in children aged 10 to 18. In addition, the relationship between quality of life perceptions and OW/OB in children was assessed.

Methods. E-KINDEX, a 30-item questionnaire encompassing three dietary domains of food quality, dietary behaviors (attitudes), and dietary habits (Lazarou et al., 2011), was administered to 50 child participants who, with their parents’ consent, agreed to participate. The children also completed the quality of life questionnaire. The range for E-KINDEX scores was 1 (worst) to 87 (best) for assessment of the obesogenic environment that encompasses the immediate environment of the individual, factors that influence food quality, choices, and behaviors. Predictive validity was evaluated using multiple regression, factor analysis, and receiver operating curve statistics in SPSS; reliability was analyzed using Cronbach’s alpha. Pearson product-moment correlations were used to measure strength of relationships among OW/OB, E-KINDEX scores, and quality of life perceptions in the sample.

Results. E-KINDEX overall score was significantly correlated with OW/OB (r = -340, n = 50, p = .008), as was Dietary Behaviors (r = -.593, n = 50, p =

Discussion. Predictive validity of E-KINDEX subscales and overall were supported through achievement of aims of the study. Correlations between both E-KINDEX scores and child weights were significant and reliability supported by Cronbach’s alpha. Limitations included small sample size of 50 and accuracy of children self-report data in the presence of parents. Parental weight did not correlate with E-KINDEX, but should be studied further relative to the Obesogenic Environment. Physical activity was high in both OW/OB and lean groups. Validated Physical Activity tools are needed.

Implications. Although refinement and further study are needed, E-KINDEX is a useful tool for clinicians to identify children at risk for the chronic disease of OW/OB before it develops, perhaps before risk factors become difficult to modify.