Multisystem collaboration and actions are needed to tackle childhood obesity, especially in the most vulnerable. This review aimed to describe the regulatory and operational framework associated with four delivery systems (social protection, food, education and health) for obesity prevention in children in need in Greece, and to synthesise related evidence of effectiveness, implementation, barriers and facilitators. The Joanna Briggs Institute (JBI) guidelines for scoping reviews were used, and identified policy interventions were categorised into delivery systems in addition to the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Peer‐reviewed journal articles and grey literature describing the Greek regulatory and operational framework addressing obesity in children in need (2–18 years old) considering the EU policy environment, were searched. 28 policy interventions were identified, and only one of them referred specifically to children in need. Most interventions were delivered through the health system and in 16 policy interventions nutrition was the targeted behaviour; two policies targeted physical activity, while 10 interventions targeted both nutrition and physical activity. Limited information was identified in terms of policy implementation and effectiveness, and even less for impact. Important barriers for implementation included sociocultural determinants and procurement issues for food provision/assistance policies. In Greece, children in need are an understudied population group, and there is a lack of evidence of enabling environments to tackle obesity. This review provides consolidated evidence of the policy interventions in Greece for the first time, with the likelihood of stimulating further action at the national level and of supporting related discussion at the European level.

Background/Objectives: Policy implementers play a crucial role in the effective delivery of policies aiming at promoting a healthy lifestyle in the most vulnerable populations. This study aimed to explore (a) policy implementers’ knowledge and perceptions of the policy framework promoting physical activity and healthy nutrition among children in need in Greece, and (b) self-perceived barriers and facilitators of the framework implementation. The term children in need refers to children who are at risk of poverty and/or social exclusion. Methods: A qualitative study design was employed consisting of semi-structured interviews with 25 policy implementers, who represented four delivery systems (health, social protection, food, and education sectors) from three geographical regions in Greece. Interviews were completed between November and December 2023. Thematic analysis was conducted using inductive and deductive approaches to identify key themes, following data management in the N-VIVO 14 software. Results: Commonly mentioned policies that study participants were involved in included school- and/or community-level-based behavioral interventions. Participants perceived policy implementation efforts that often relied on individual initiatives as inconsistent. Most participants argued that existing policies were not tailored to the needs of children in need. Major self-perceived barriers included limited personnel training, limited facilities and infrastructure, and lack of incentives or opportunities to encourage active participation. Major self-perceived facilitators included personnel motivation, integration of nutrition and physical education into school curricula, and provision of free school meals, which was associated with regular school attendance of children from the Roma communities. Conclusions: Individual, sociocultural, and structural issues are shown to persist across different delivery systems indicating the complexity of tackling obesogenic environments, especially among children in need. This is the first study in Greece to provide evidence on self-perceived barriers and facilitators and could inform ongoing national and European efforts to address obesogenic environments in children in need.

Background: Parental weight status is a key predictor of childhood obesity. However, limited evidence exists on how longitudinal changes in parental BMI influence children's weight trajectories, particularly in families at elevated risk for type 2 diabetes. Objectives: To investigate children's body mass index‐for‐age z ‐score (BMIz) changes over a 2‐year period, associated with independent and cumulative changes in parents' BMI. Methods: In the Feel4Diabetes study, data from 12 280 children (age: 8.2 ± 1.0 years) and their parents were analysed to assess changes in child BMI‐for‐age z ‐scores over 2 years in relation to parental BMI changes. Analyses were adjusted for study design and baseline socio‐demographic factors and were conducted in both the total sample (all‐families) and high‐risk for type 2 diabetes families (HR‐families). Results: In the all‐families dataset, a 1 kg/m ² independent decrease in maternal and paternal BMI was associated with a −0.037 (−0.041, −0.033) and −0.027 (−0.031, −0.023) change in child's BMIz [mean (95% CI)]. The joint parental effect was stronger [−0.32 (−0.36, −0.28)], particularly in HR‐families [−0.34 (−0.42, −0.26)]. Conclusions: Parental BMI reductions, especially when both parents are involved, contribute to favourable BMI changes in children. The changes were more pronounced in HR‐families, underscoring the need for interventions targeting the whole family in populations at elevated risk for type 2 diabetes.

Background/Objectives: The prevalence of obesity is high among children living with disability. The present study aimed to examine the perceptions of parents and caregivers of children living with disability regarding children’s energy balance related behaviors (EBRBs) and their determinants. Methods: Parents/caregivers of children living with disability (n = 45) from Thessaly, Crete and Attica Regions of Greece, participated in semi-structured interviews between November and December 2023. The interviews were recorded, transcribed and transferred to N-VIVO software. The results were analyzed according to the framework of the socio-ecological model, using deductive thematic analysis. Results: Parents/caregivers reported that eating habits of children living with disability and their physical activity levels were poorer compared to the general population. At an individual level, certain disabilities may affect children’s food preferences and parents’ ability to prepare healthy foods. At a familial level, financial difficulties may influence healthy eating, whereas some parents/caregivers act as children’s role models to encourage them to be physically active. Home food environments may also influence children’s eating patterns and peer influence on their EBRBs. At a community level, lack of trained personnel, available amenities/equipment and food education initiatives and the availability of unhealthy foods in school canteens were described as major barriers to healthy EBRBs. At an organizational level, lack of accessible/safe facilities, the marginalization/stigma that children living with disability may experience and lack of dietitians/nutritionists in health centers were named as the main factors influencing children’s EBRBs. Conclusions: The findings of this study highlight the importance of designing multi-sectoral policy interventions to promote healthy EBRBs and tackle obesity in children living with disability in Greece.

Background: While the importance of folic acid supplementation during pregnancy in the prevention of neural tube defects in offspring is well established, its potential role in pediatric asthma development remains unclear, with limited evidence to date. Objective: To identify perinatal and environmental factors that modify the association between maternal folic acid intake and pre-adolescent asthma. Methods: Cross-sectional analysis of the Healthy Growth Study that consisted of 2332 pre-adolescents (mean age 11 years; asthma n = 451); 50% boys attending elementary schools in Greece. Questionnaires were used to collect data on sociodemographic, perinatal, and environmental characteristics as well as asthma prevalence and maternal folic acid supplementation during pregnancy (trimesters 1, 2, and 3). Logistic regression models explored the association between maternal folic acid supplementation and pre-adolescent asthma, accounting for perinatal and environmental exposures. Results: Adjusted regression models showed that maternal folic acid supplementation during the third trimester was associated with 34% increased odds of pre-adolescent asthma. Stratified analyses per perinatal and environmental factors revealed significantly higher asthma odds with folic acid supplementation during the second and third trimesters among pre-adolescents born < 37 weeks; non-smoking mothers; in pre-adolescents attending schools of low socioeconomic level; and in neighborhoods having less traffic and more parks. Contrastingly, in appropriate for gestational age (AGA), an infant’s first-trimester supplementation increased asthma odds. Conclusions: Maternal folic acid supplementation, particularly in later trimesters, was modestly associated with increased odds of pre-adolescent asthma, modified by perinatal and environmental factors. Future research should explore whether continued folic acid supplementation beyond the first trimester carries differential risks or benefits in asthma.