51
|
Bates CR, Bohnert AM, Buscemi J, Vandell DL, Lee KTH, Bryant FB. Family entropy: understanding the organization of the family home environment and impact on child health behaviors and weight. Transl Behav Med 2020; 9:413-421. [PMID: 31094439 DOI: 10.1093/tbm/ibz042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Child obesity is a major public health issue with a high disease burden. Although numerous contributing factors have been identified, the family home environment is a central context of influence that requires deeper understanding. The level of organization in the family home environment may influence obesity and obesogenic behaviors, but the literature has suffered from the lack of a strong overarching construct and model to guide this area of research. Family entropy is a conceptual framework that fills this gap by representing the level of organization across the home environment. The current study empirically assesses family entropy using factor analysis in a longitudinal sample of 968 children measured yearly from Grades 3 to 6 as part of the NICHD Study of Early Child Care and Youth Development. Mixed modeling using MPLUS examined the influence of family entropy on child weight both directly and indirectly through weight-related health behaviors (i.e., sleep and physical activity), and considered the moderating role of socioeconomic status (SES). Results suggest that family entropy is comprised of distinct elements of household organization and disorganization, which are moderately related. Household disorganization may be particularly detrimental to child sleeping behavior both concurrently and over time in families of both high and low SES. The study concludes with recommendations for advancing understanding of the home environment by using nuanced measurement strategies, and incorporating support for household organization within child obesity prevention and intervention efforts.
Collapse
Affiliation(s)
- Carolyn R Bates
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Amy M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Deborah L Vandell
- School of Education, University of California, Irvine, Irvine, CA, USA
| | - Kenneth T H Lee
- School of Education, University of California, Irvine, Irvine, CA, USA
| | - Fred B Bryant
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| |
Collapse
|
52
|
Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Elsie M Taveras
- Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
| |
Collapse
|
53
|
Sepúlveda AR, Solano S, Blanco M, Lacruz T, Veiga O. Feasibility, acceptability, and effectiveness of a multidisciplinary intervention in childhood obesity from primary care: Nutrition, physical activity, emotional regulation, and family. EUROPEAN EATING DISORDERS REVIEW 2019; 28:184-198. [PMID: 31802570 DOI: 10.1002/erv.2702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022]
Abstract
Childhood obesity is a growing problem with a complex aetiology, for which multidisciplinary interventions are required. Our programme describes a novel structured psychosocial family-based intervention targeting the emotional regulation in childhood obesity, using a train trip metaphor aimed at improving healthy lifestyles for the family. The aims were (a) to describe the feasibility and acceptability of this psychosocial family-based intervention among children with overweight or obesity in primary care and (b) to examine the effectiveness of the "ENTREN-F" programme (with family intervention) compared with the "ENTREN" programme (without family intervention) among Spanish children regarding anthropometric variables, physical activity, emotional well-being, and family functioning. Children were randomly allocated to either ENTREN-F programme (n = 30) or psychological intervention for children (ENTREN, n = 40), and assessments were carried out over time (T0 baseline vs. T1 post/6-month vs. T2 6-month follow-up). Both parent groups expressed high levels of satisfaction with the interventions. ENTREN-F resulted in higher adherence to treatment and was more effective in improving z-body mass index, reducing children's anxiety, and increasing family adaptability than the ENTREN programme. There were no significant changes in parents' emotional well-being and expressed emotion. Both groups improved in the children's emotional well-being and light physical activity. In summary, this multidisciplinary psychosocial family-based intervention was succesful.
Collapse
Affiliation(s)
- Ana R Sepúlveda
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Santos Solano
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Miriam Blanco
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Tatiana Lacruz
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Oscar Veiga
- Department of Physical Education, Sport & Human Motricity, Autonomous University of Madrid, Madrid, Spain
| |
Collapse
|
54
|
Njardvik U, Gunnarsdottir T, Olafsdottir AS, Craighead LW, Boles RE, Bjarnason R. Incorporating Appetite Awareness Training Within Family-Based Behavioral Treatment of Pediatric Obesity: A Randomized Controlled Pilot Study. J Pediatr Psychol 2019; 43:1017-1027. [PMID: 30010923 DOI: 10.1093/jpepsy/jsy055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To assess additive effects of incorporating appetite awareness training (AAT), a strategy to encourage eating in response to hunger and satiety cues, within a family-based behavioral treatment (FBT) for childhood obesity. Methods Total 84 families with a child with obesity in the age range of 8-12 years, Body Mass Index Standard Deviation Score (BMI-SDS) ≥ 2, and a participating parent were randomly allocated to two conditions; standard FBT was compared with FBT incorporating AAT strategies (FBT-AAT). Treatment consisted of group therapy sessions (held separately for children and parents) as well as single-family (parent-child dyad) sessions (24 sessions total) delivered over 18 weeks at a tertiary care outpatient clinic. One booster session was provided 1-year posttreatment and a final follow-up assessment was conducted at 2 years. The primary outcome was change in child standardized body mass index (BMI-SDS). Results The two conditions did not differ significantly at posttest, but the FBT-AAT group was at a significantly lower weight compared with FBT at both the first-year, F(1, 82) = 4.150, p<.05, and the second-year follow-ups, F(1, 82) = 14.912, p <.001. It was notable that over the second-year of follow-up, the FBT-AAT group continued to show improvement, whereas the FBT group did not. Conclusions Incorporating specific self-regulatory training in attending to hunger and fullness signals during a standardized family-based treatment may have enhanced the long-term maintenance of treatment effects. Findings are promising and warrant further study.
Collapse
Affiliation(s)
| | | | - Anna S Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland
| | | | - Richard E Boles
- Anschutz Medical Campus School of Medicine, University of Colorado
| | - Ragnar Bjarnason
- Faculty of Medicine, University of Iceland and Children's Medical Centre, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
55
|
Biggs BK, Tsai Owens M, Geske J, Lebow JR, Kumar S, Harper K, Grothe KB, Cunningham ML, Jensen TB, Clark MM. Development and initial validation of the Support for Healthy Lifestyle (SHeL) questionnaire for adolescents. Eat Behav 2019; 34:101310. [PMID: 31374335 PMCID: PMC6708506 DOI: 10.1016/j.eatbeh.2019.101310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
This study developed and provided initial validation for the Support for Healthy Lifestyle (SHeL), a set of scales designed to measure adolescent-perceived social support of healthy eating and physical activity. Item pool development utilized a prior focus group study of adolescents' perceptions of socially supportive behavior and a review of the literature on social support for health behavior change in adolescents. Exploratory factor analysis of the item pool completed by 220 adolescents, internal consistency estimates, and expert review of items and consensus resulted in 9 scales for the SHeL: Family Healthy Eating Support, Family Physical Activity Support, Family Hypocritical Control, Peer Health Eating Support, Peer Physical Activity Support, Peer Undermining, Professional Healthy Eating Support, Professional Physical Activity Support, and Professional General Support. Scale internal reliability estimates were α = 0.73-0.96. Supporting construct validity, the SHeL showed a pattern of stronger correlations between measures of the same source (parent/peer) and target behavior (healthy eating/physical activity) and stronger correlations with corresponding Sallis scales vis-à-vis other Sallis scales, with exceptions related to peer support for healthy eating. Divergent validity was somewhat limited, including in two instances, the SHeL scale was more strongly correlated with another SHeL scale. Supporting criterion validity, often the SHeL scales were correlated with related health behaviors. This study provided important psychometric information for a new measurement of social support for health behavior for adolescents. Further research with larger, more diverse, and treatment-seeking populations is needed to provide further validation of the SHeL and to begin to establish normative scores.
Collapse
Affiliation(s)
- Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Michele Tsai Owens
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, University of Washington Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Jennifer Geske
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jocelyn R Lebow
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kelly Harper
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Psychology, University of North Carolina at Greensboro, 1100 W Market St, Greensboro, NC 27403, USA
| | - Karen B Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Megan L Cunningham
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Teresa B Jensen
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
56
|
Loeb KL, Le Grange D, Celio Doyle A, Crosby RD, Glunz C, Laraque-Arena D, Hildebrandt T, Bacow T, Vangeepuram N, Gault A. Adapting family-based treatment for paediatric obesity: A randomized controlled pilot trial. EUROPEAN EATING DISORDERS REVIEW 2019; 27:521-530. [PMID: 31344751 DOI: 10.1002/erv.2699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/19/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This pilot study aimed to refine and test an adaption of family-based treatment (FBT) for eating disorders that addressed the distinct clinical needs of adolescents with overweight or obesity in the absence of eating disorder pathology. Our hypothesis was that FBT for paediatric obesity (FBT-PO) would be feasible to implement and superior to a nutrition education counselling (NEC) condition delivered to both parents and patients, thereby controlling for key information dissemination across groups while manipulating active therapeutic content and strategy. METHOD Seventy-seven adolescents were randomized to FBT-PO or NEC across two sites. RESULTS Results supported our core prediction, in that weight status among adolescent study participants receiving FBT-PO remained stable while increasing among participants randomized to NEC. Attrition was high in both conditions. CONCLUSIONS FBT-PO, while not seeming to yield a marked decrease in body mass index z-score, may arrest an otherwise-occurring weight-gain trajectory for these adolescents. This efficacy finding is consistent with the overall PO literature supporting parental involvement in the treatment of PO. Future research efforts should address retention in FBT-PO.
Collapse
Affiliation(s)
| | - Daniel Le Grange
- University of California, San Francisco, San Francisco, CA.,The University of Chicago, Chicago, IL
| | - Angela Celio Doyle
- Eating Disorders Center at the Evidence Based Treatment Centers of Seattle, Seattle, WA
| | - Ross D Crosby
- Sanford Research, Fargo, ND.,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | | | | | | | - Terri Bacow
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Allison Gault
- Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
57
|
Zoellner JM, You W, Hill JL, Brock DJP, Yuhas M, Alexander RC, Price B, Estabrooks PA. A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods. Contemp Clin Trials 2019; 84:105801. [PMID: 31260792 DOI: 10.1016/j.cct.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022]
Abstract
While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice - particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IDENTIFIERS: Clincialtrials.gov: NCT03245775.
Collapse
Affiliation(s)
- Jamie M Zoellner
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 304 Hutcheson Hall, 24060, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
| | - Donna-Jean P Brock
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Maryam Yuhas
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Ramine C Alexander
- Department of Family and Consumer Sciences, North Carolina A&T State University, Benbow 202-A, Greensboro, NC 27411, USA
| | - Bryan Price
- UVA Cancer Center, Community Outreach and Education, Main Street, Unit 102, Danville, VA 24541, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
| |
Collapse
|
58
|
Participants' Perceptions of "C.H.A.M.P. Families": A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122171. [PMID: 31248201 PMCID: PMC6617231 DOI: 10.3390/ijerph16122171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 01/07/2023]
Abstract
Background: Recently, our team implemented a 13-week group-based intervention for parents of children with obesity ("C.H.A.M.P. Families"). The primary objective of this study was to explore, qualitatively, parents' perspectives of their experiences in and influence of C.H.A.M.P. Families, as well as their recommendations for future paediatric obesity treatment interventions. Methods: Twelve parents (seven mothers, five fathers/step-fathers) representing seven children (four girls, three boys) with obesity participated in one of two focus groups following the intervention. Focus groups were audio recorded and transcribed verbatim and data were analyzed using inductive thematic analysis. Results: Findings showed that parents perceived their participation in C.H.A.M.P. Families to be a positive experience. Participants highlighted several positive health-related outcomes for children, families, and parents. Parents also underscored the importance and positive impact of the group environment, specific educational content, and additional program components such as free child-minding. Recommendations for future interventions were also provided, including greater child involvement and more practical strategies. Finally, parents identified several barriers including socioenvironmental issues, time constraints, and parenting challenges. Conclusions: Researchers developing family-based childhood obesity interventions should consider the balance of parent and child involvement, as well as emphasize group dynamics strategies and positive family communication.
Collapse
|
59
|
Farnesi BC, Perez A, Holt NL, Morrison KM, Gokiert R, Legault L, Chanoine JP, Sharma AM, Ball GDC. Continued attendance for paediatric weight management: A multicentre, qualitative study of parents' reasons and facilitators. Clin Obes 2019; 9:e12304. [PMID: 30775853 DOI: 10.1111/cob.12304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/02/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
Although prolonged engagement in paediatric weight management (PWM) is associated with positive treatment outcomes, little is currently known about enablers of long-term programme attendance. The purpose of our study was to explore families' reasons for and facilitators of their continued attendance at health services for PWM. Semi-structured, individual interviews were conducted with parents of children (10-17 year old; body mass index ≥85th percentile) who completed the active phase of treatment in one of four Canadian multidisciplinary clinics for PWM. Interview data were recorded digitally, transcribed verbatim and analysed thematically. Parents' (n = 40) reasons for continued clinic attendance included ongoing concerns (eg, parental concern about their child's health), actual and expected benefits from treatment (eg, lifestyle improvements) and perceived quality of care (eg, structured, comprehensive, tailored health services). Several logistical and motivational factors contributed to continued attendance, including flexible work schedules, flexible appointment times, financial resources and children's motivation for treatment. Helping families address treatment barriers and ensuring that weight management services meet families' treatment expectations are promising strategies to enhance retention in PWM to optimize health outcomes.
Collapse
Affiliation(s)
| | - Arnaldo Perez
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - Katherine M Morrison
- Department of Pediatrics and Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Hamilton, Canada
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, Canada
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| |
Collapse
|
60
|
The Effect of a Family-Based Dietary Intervention on Dietary Fiber Density in Children Aged 6 to 11 Years. TOP CLIN NUTR 2019. [DOI: 10.1097/tin.0000000000000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
61
|
Hayes JF, Balantekin KN, Conlon RPK, Brown ML, Stein RI, Welch RR, Perri MG, Schechtman KB, Epstein LH, Wilfley DE, Saelens BE. Home and neighbourhood built environment features in family-based treatment for childhood obesity. Pediatr Obes 2019; 14:e12477. [PMID: 30378768 PMCID: PMC6379099 DOI: 10.1111/ijpo.12477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Family-based behavioural weight loss treatment (FBT) for childhood obesity helps families develop strategies to facilitate healthy choices in their home and other environments (e.g. home neighbourhood). The current study examines how the home food environment, both pre-FBT and post-FBT, and the neighbourhoods in which families live are associated with child weight and weight-related outcomes in FBT. METHODS Parent-child dyads (n = 181) completed a 16-session FBT programme and completed home environment, anthropometric and child dietary/activity assessments at pre-FBT and post-FBT. Parents reported on availability of food, electronics and physical activity equipment in the home. The neighbourhood food and recreation environments around each dyad's residence was characterized using existing data within a geographic information system. RESULTS Families successfully made healthy home environment modifications during FBT. Regression models showed reducing RED (e.g. high-energy-dense and low-nutrient-dense) foods and electronics in the home during FBT had positive effects on child weight and weight-related outcomes. No neighbourhood food or recreation environment variables were significantly related to outcomes, although having a larger density of public recreation spaces was associated with increases in physical activity at the trend-level. CONCLUSIONS Modifying the home environment, specifically reducing RED foods and electronics, may be particularly important for FBT success.
Collapse
Affiliation(s)
- J F Hayes
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - K N Balantekin
- School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - R P K Conlon
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M L Brown
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - R I Stein
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - R R Welch
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - M G Perri
- University of Florida, Gainesville, FL, USA
| | - K B Schechtman
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - L H Epstein
- School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - D E Wilfley
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - B E Saelens
- Seattle Children's Research Institute and the University of Washington, Seattle, WA, USA
| |
Collapse
|
62
|
Davis AM, Beaver G, Dreyer Gillette M, Nelson EL, Fleming K, Swinburne Romine R, Sullivan DK, Lee R, Pettee Gabriel K, Dean K, Murray M, Faith M. iAmHealthy: Rationale, design and application of a family-based mHealth pediatric obesity intervention for rural children. Contemp Clin Trials 2019; 78:20-26. [PMID: 30630108 PMCID: PMC6387830 DOI: 10.1016/j.cct.2019.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/06/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022]
Abstract
Children in rural areas are disproportionately affected by pediatric obesity. Poor access to healthcare providers, lack of nutrition education, lower socioeconomic status, and fewer opportunities to be physically active are all unique barriers that contribute to this growing health concern. There are very few pediatric obesity interventions that have been developed that target this unique population. iAmHealthy is a family-based behavioral, nutrition and physical activity intervention developed with input from rural children and families that capitalizes on the innovative use of mobile health applications (mHealth). iAmHealthy is a 25-contact hour multicomponent intervention delivered over an 8-month period targeting 2nd-4th grade school children and their families. This paper describes the rationale, design, participant/school enrollment, and planned implementation of a randomized controlled trial of the iAmHealthy intervention in comparison to a monthly newsletter delivered through rural elementary schools. Child Body Mass Index z-score (BMIz) is the primary outcome, along with child 24-hour dietary recall, and child accelerometer-determined physical activity and sedentary behavior as secondary outcomes. The study will include 18 schools (with 8 children each) resulting in a final planned sample size of 144 children. This project also has a strong focus on dissemination and implementation science, and thus includes many measures related to the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Data collection is completed at baseline, end of intervention (8 months), and follow-up (20 months). This study is the first randomized controlled trial to deliver a rurally tailored, empirically supported, family-based behavioral intervention for pediatric obesity solely over mHealth. Registered with ClinicalTrials.gov NCT ID 03304249.
Collapse
Affiliation(s)
- Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160, United States.
| | - Gretchen Beaver
- School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States
| | - Meredith Dreyer Gillette
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, Developmental and Behavioral Sciences, Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO 64108, United States
| | - Eve-Lynn Nelson
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Kandace Fleming
- Lifespan Institute, University of Kansas, Lawrence, KS 66045, United States
| | | | - Debra K Sullivan
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Robert Lee
- Department of Health Policy & Management, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, & Department of Women's Healthy, The University of Texas at Austin, Dell Medical School, Austin, TX, United States
| | - Kelsey Dean
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO 64108, United States; Department of Pediatrics, Developmental and Behavioral Sciences, Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO 64108, United States
| | - Megan Murray
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160, United States
| | - Myles Faith
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo - SUNY, 420 Baldy Hall, Buffalo, NY 14260, United States
| |
Collapse
|
63
|
Pfeifflé S, Pellegrino F, Kruseman M, Pijollet C, Volery M, Soguel L, Torre SBD. Current Recommendations for Nutritional Management of Overweight and Obesity in Children and Adolescents: A Structured Framework. Nutrients 2019; 11:nu11020362. [PMID: 30744122 PMCID: PMC6412470 DOI: 10.3390/nu11020362] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/27/2023] Open
Abstract
Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians and other practitioners in their decision making about the nutritional management of pediatric overweight and obesity. To construct this practice-based evidence-informed framework, we conducted a systematic review of the guidelines on nutritional management of pediatric overweight or obesity in 2 databases and in the grey literature. We analyzed and synthesized recommendations of 17 guidelines. We selected the recommendations that were common to at least 30% of the guidelines and added by consensus the recommendations relevant to clinical expertise. Finally, we structured the framework according to the Nutritional Care Process in collaboration with a specialized team of dietitians who assessed its validity in clinical practice. The framework contributes to facilitate the integration of evidence-based practice for dietitians by synthesizing the current evidence, supporting clinical expertise, and promoting structured care following Nutrition Care Process model for children and adolescents with obesity.
Collapse
Affiliation(s)
- Shawna Pfeifflé
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Fabien Pellegrino
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Maaike Kruseman
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Claire Pijollet
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Magali Volery
- CCNP-Centre de Consultations Nutrition et Psychothérapie, Rue du Vieux-Marché 8, 1207 Genève, Switzerland.
| | - Ludivine Soguel
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| |
Collapse
|
64
|
Cheney AM, Nieri T, Davis E, Prologo J, Valencia E, Anderson AT, Widaman K, Reaves C, Sullivan G. The Sociocultural Factors Underlying Latina Mothers' Infant Feeding Practices. Glob Qual Nurs Res 2019; 6:2333393618825253. [PMID: 30746425 PMCID: PMC6360473 DOI: 10.1177/2333393618825253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
In this study, we examined the sociocultural factors underlying infant feeding practices. We conducted four focus groups with 19 Latina mothers of children 0 to 2 years of age enrolled in Early Head Start programs in the United States over a 1-year period. We found these mothers considered both science- and family-based feeding recommendations. However, advice from family was often inconsistent with science- and nutrition-based recommended feeding practices. In the interest of showing respect and preserving harmonious relationships, some mothers accepted family advice instead of recommended practices while others employed strategies to follow recommended practices without offending. Nutrition educators need to consider the intersection of macro, organizational, and community factors with micro-level processes in shaping the implementation of recommended feeding practices within family systems. Nutrition interventions for Latino families should capitalize on Latina mothers’ strategies for navigating multiple information sources while preserving cultural values and family relationships.
Collapse
Affiliation(s)
- Ann M Cheney
- University of California, Riverside, Riverside, California, USA
| | - Tanya Nieri
- University of California, Riverside, Riverside, California, USA
| | - Elizabeth Davis
- University of California, Riverside, Riverside, California, USA
| | - Joe Prologo
- Early Head Start, San Bernardino, San Bernardino, California, USA
| | - Esmirna Valencia
- Riverside County Office of Education, Riverside, California, USA
| | | | - Keith Widaman
- University of California, Riverside, Riverside, California, USA
| | | | | |
Collapse
|
65
|
Baños RM, Oliver E, Navarro J, Vara MD, Cebolla A, Lurbe E, Pitti JA, Torró MI, Botella C. Efficacy of a cognitive and behavioral treatment for childhood obesity supported by the ETIOBE web platform. PSYCHOL HEALTH MED 2019; 24:703-713. [PMID: 30648879 DOI: 10.1080/13548506.2019.1566622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Recently, the prevalence of childhood obesity has increased alarmingly. Interventions combining eating habits, physical activity (PA), behavioral components, and family support have been shown to be effective, although variables such as self-efficacy beliefs and motivation seem to be important in achieving stable changes. Information and communication technologies (ICTs) can provide additional resources to traditional treatments. The objective is to analyze the efficacy of two treatments: a cognitive and behavioral treatment (CBT) focused on the promotion of healthy eating and PA habits, and this CBT intervention supported by a web platform (ETIOBE). Forty-seven obese children were randomized to these two conditions. Anthropometrical measures were evaluated before and after treatment and at follow-up. Self-efficacy and motivation questionnaires were filled out in the first and last intervention sessions. Mixed ANOVAs were performed for all variables. Simple mediation analyses were conducted to test whether the effect of condition on the post-intervention anthropometrical variable scores were mediated by self-efficacy. Results revealed that both treatments produced an improvement in the anthropometrical variables. CBT-E participants showed more PA self-efficacy as the treatment progressed and lower BMIz, lower fat mass, and higher lean mass. These results suggest that ICT help to improve the effects of childhood obesity interventions.
Collapse
Affiliation(s)
- Rosa María Baños
- a Department of Personality, Evaluation and Psychological Treatment , University of Valencia , Valencia , Spain.,b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain.,c Polibienestar Institute , University of Valencia , Valencia , España
| | - Elia Oliver
- a Department of Personality, Evaluation and Psychological Treatment , University of Valencia , Valencia , Spain
| | - Jessica Navarro
- a Department of Personality, Evaluation and Psychological Treatment , University of Valencia , Valencia , Spain.,b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain
| | - Mª Dolores Vara
- a Department of Personality, Evaluation and Psychological Treatment , University of Valencia , Valencia , Spain.,b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain
| | - Ausiàs Cebolla
- a Department of Personality, Evaluation and Psychological Treatment , University of Valencia , Valencia , Spain.,b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain
| | - Empar Lurbe
- b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain.,d Department of Basic and Clinical Psychology and Psychobiology of Jaume I , Castellón , Spain
| | - Julio Alvarez Pitti
- b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain.,d Department of Basic and Clinical Psychology and Psychobiology of Jaume I , Castellón , Spain
| | - Mª Isabel Torró
- b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain.,d Department of Basic and Clinical Psychology and Psychobiology of Jaume I , Castellón , Spain
| | - Cristina Botella
- b CIBER Physiopathology of Obesity and Nutrition (CIBEROBN) , Instituto Carlos III , Madrid , Spain.,e Department of Pediatrics , University General Hospital Consortium of Valencia , Valencia , Spain
| |
Collapse
|
66
|
Brock DJP, Estabrooks PA, Hill JL, Barlow ML, Alexander RC, Price BE, Marshall R, Zoellner JM. Building and Sustaining Community Capacity to Address Childhood Obesity: A 3-Year Mixed-Methods Case Study of a Community-Academic Advisory Board. FAMILY & COMMUNITY HEALTH 2019; 42:62-79. [PMID: 30431470 PMCID: PMC6713197 DOI: 10.1097/fch.0000000000000212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Guided by a community-based participatory research and systems-based approach, this 3-year mixed-methods case study describes the experiences and capacity development of a Community-Academic Advisory Board (CAB) formed to adapt, implement, and evaluate an evidence-based childhood obesity treatment program in a medically underserved region. The CAB included community, public health, and clinical (n = 9) and academic partners (n = 9). CAB members completed capacity evaluations at 4 points. Partners identified best practices that attributed to the successful execution and continued advancement of project goals. The methodological framework and findings can inform capacity development and sustainability of emergent community-academic collaborations.
Collapse
Affiliation(s)
- Donna-Jean P Brock
- Public Health Sciences (Ms Brock and Dr Zoellner) and Cancer Center (Mr Price), University of Virginia, Charlottesville; Departments of Health Promotions (Dr Estabrooks) and Epidemiology (Dr Hill), University of Nebraska Medical Center, Omaha; DukeImmerse, Office of Undergraduate Education, Duke University, Durham, North Carolina (Ms Barlow); Department of Family and Consumer Sciences, North Carolina A&T State University, Greensboro (Dr Alexander); and Sovah Health, Danville, Virginia (Ms Marshall)
| | | | | | | | | | | | | | | |
Collapse
|
67
|
LUSTOSA LCRDS, NASCIMENTO LM, LAVÔR LCDC, GOMES KRO, MASCARENHAS MDM, FROTA KDMG. Metabolic syndrome in adolescents and its association with diet quality. REV NUTR 2019. [DOI: 10.1590/1678-9865201932e190004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACT Objective Analyzing the prevalence of metabolic syndrome and its association with adolescent diet quality. Methods Cross-sectional research with 327 adolescents from public and private high schools of Teresina, Piauí. Socioeconomic, anthropometric, and food consumption data were analyzed to obtain the Brazilian Healthy Eating Index-Revised. Moreover, data related to metabolic syndrome (blood glucose, blood pressure, waist circumference, triglycerides, and high-density lipoprotein cholesterol) were also analyzed. Continuous variables were described by means, standard deviations, and 95% confi dence intervals. To verify the association between dependent and explanatory variables, we calculated the adjusted odds ratio. The level of signifi cance was set at p<0.05. Results The prevalence of metabolic syndrome was 3.3%, with low high-density lipoprotein cholesterol concentration being the most frequent alteration (50.5%). The mean score on the Brazilian Healthy Eating Index-Revised was 55.4 points. The worst scores were obtained in whole cereals, dark-green and orange vegetables, oils, milk and dairy products, and whole fruits. In contrast, total cereals, meat, eggs, and legumes had scores close to the maximum stipulated. The lowest tertile of dark-green, orange, and leguminous vegetables showed risk for low high-density lipoprotein cholesterol, and the second tertile was protective against high blood glucose levels. As for the milk group, its lower intake increased the chances for high triglyceride and blood pressure levels. Conclusion Despite the low prevalence of metabolic syndrome, there were significant alterations in its components,associated with less consumption of important Brazilian Healthy Eating Index-Revised items.
Collapse
|
68
|
"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122858. [PMID: 30558152 PMCID: PMC6313348 DOI: 10.3390/ijerph15122858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.
Collapse
|
69
|
Miller AL, Miller SE, Clark KM. Child, Caregiver, Family, and Social-Contextual Factors to Consider when Implementing Parent-Focused Child Feeding Interventions. Curr Nutr Rep 2018; 7:303-309. [PMID: 30353367 PMCID: PMC6237637 DOI: 10.1007/s13668-018-0255-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Interventions that aim to alter child eating behaviors often focus on parents as a proximal influence. Yet, parents can be difficult to engage. Therefore, intervention recommendations are often not implemented as designed. The goal of this review is to highlight factors at multiple contextual levels that are important to consider when developing interventions to address child eating, due to their implications for overcoming parent engagement challenges. RECENT FINDINGS Intervention studies suggest that parents are often the key to successfully changing child eating behaviors, and many interventions focus on feeding. Factors such as child eating phenotypes, parent stress, family system dynamics, and sociodemographic constraints have also been identified as shaping food parenting. Challenges at multiple contextual levels can affect the likelihood of parent engagement. Addressing factors at the child-, parent-, family-, and broader social-contextual levels of influence is essential in order to promote best practices for parent-focused feeding interventions.
Collapse
Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH-I, Room 3718, Ann Arbor, MI, 48109-2029, USA.
| | - Sara E Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH-I, Room 3718, Ann Arbor, MI, 48109-2029, USA
| | - Katy M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH-I, Room 3718, Ann Arbor, MI, 48109-2029, USA
| |
Collapse
|
70
|
Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
Collapse
Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
71
|
Green J, Wills A, Mansfield E, Sur D, Zenlea IS. Welcoming Feedback: Using Family Experience to Design a Pediatric Weight Management Program. J Patient Exp 2018; 6:142-149. [PMID: 31218260 PMCID: PMC6558948 DOI: 10.1177/2374373518786505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To describe an approach using principles of experience-based codesign (EBCD) and quality improvement (QI) to integrate family experience into the development of a pediatric weight management program. Methods Clinic development occurred in 3 plan, do, study, act (PDSA) cycles that were driven by family experience data. During these cycles, families were engaged in feedback sessions that informed program development. Staff reflected on feedback and designed and tested changes that would improve service delivery. Results The first PDSA cycle resulted in the fundamental program parameters and a formalized patient engagement strategy. The second cycle focused on pilot programming, and feedback was used to develop the structured group program. During the third cycle, feedback sessions were embedded into the structured group programs. Program changes included focusing on health rather than weight-based outcomes, adjusting the timing of program offerings, increasing experiential learning opportunities, and providing more opportunities for peer support. Conclusions Both EBCD and QI methodologies informed the process of family engagement and program development. This pragmatic approach might be useful for the development of other family-centered pediatric programs.
Collapse
Affiliation(s)
- Jennifer Green
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Alexandra Wills
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Deepy Sur
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ian S Zenlea
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
72
|
Salvy SJ, Dutton GR, Borgatti A, Kim YI. Habit formation intervention to prevent obesity in low-income preschoolers and their mothers: A randomized controlled trial protocol. Contemp Clin Trials 2018; 70:88-98. [PMID: 29802965 PMCID: PMC6060620 DOI: 10.1016/j.cct.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Low-income and racial/ethnic minority mothers and their young children are at increased risk for obesity. Lack of access to evidence-based obesity prevention and treatment services further contributes to these disparities. METHODS This two-arm, parallel, randomized controlled trial (RCT) tests the effectiveness of a simple obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to the existing home visitation services without obesity-related content on mothers' and children's obesity risks. HABITS focuses on habit formation and modifications of food and activity cues in the home to support habit formation. Habit formation is focused on improving five behaviors: 1) fruits/vegetables, 2) fried foods, 3) sugar-sweetened beverages, 4) physical activity and 5) self-monitoring. Participants will be 298 mothers (>50% African American; 100% low income) and their children (3-5yo at baseline) enrolled in a home visitation program in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 9 months. Assessments of mothers (weight, waist circumference, and habit strength of targeted behaviors), children (rate of weight gain), and the food/activity household environment will be conducted at enrollment, post-intervention (9 month), and one year post-intervention follow-up. DISCUSSION This research is poised to have a substantial impact because the delivery modalities of current obesity efforts disproportionally restrict the reach and engagement of underserved, low-income children and their caregivers who are most at-risk for health and obesity disparities.
Collapse
Affiliation(s)
- Sarah-Jeanne Salvy
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 616, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 615, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Alena Borgatti
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 640, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers 616, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| |
Collapse
|
73
|
Miller AL, Lumeng JC. Pathways of Association from Stress to Obesity in Early Childhood. Obesity (Silver Spring) 2018; 26:1117-1124. [PMID: 29656595 DOI: 10.1002/oby.22155] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study is to critically review the literature on early life stress in relation to obesity in humans, including the multiple biological and behavioral mechanisms through which early life stress exposure (birth to the age of 5 years) may associate with obesity risk during childhood. METHODS A review of the literature was conducted to identify studies on associations between early childhood stress and risk for obesity and the mechanisms of association. Multiple databases (PubMed, PsycInfo, Google Scholar) were used in the search as well as a "snowball" search strategy. All study designs were included. RESULTS Early life stress and adverse childhood experiences are associated with obesity and overweight in adults. Evidence is less consistent in children. Studies vary in the nature of the stress examined (e.g., chronic vs. acute), sample characteristics, and study designs. Longitudinal studies are needed, as the effects of early life stress exposure may not emerge until later in the life-span. Early life stress exposure is associated with biological and behavioral pathways that may increase risk for childhood obesity. CONCLUSIONS There is evidence that early life stress is associated with multiple biological and behavioral pathways in children that may increase risk for later obesity. Little work has detailed the interconnections among these mechanisms across development or identified potential moderators of the association. Mapping the mechanisms connecting early life stress exposure to obesity risk in young children longitudinally should be a priority for obesity researchers. Recommendations for developmentally sensitive approaches to research that can inform obesity prevention strategies are presented.
Collapse
Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
74
|
Warschburger P, Gmeiner M, Morawietz M, Rinck M. Evaluation of an approach-avoidance training intervention for children and adolescents with obesity: A randomized placebo-controlled prospective trial. EUROPEAN EATING DISORDERS REVIEW 2018; 26:472-482. [PMID: 29882616 DOI: 10.1002/erv.2607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/08/2022]
Abstract
This study evaluated the efficacy of approach-avoidance training as an additional treatment for children and adolescents with obesity seeking inpatient treatment. Two hundred thirty-two participants (8-16 years, 53.9% girls) were randomly assigned either to multisession approach-avoidance (IG) or to placebo training (CG). As outcomes, cognitive biases post intervention, body mass index, eating behaviour, food intake, self-regulation, and weight-related quality of life were assessed, also at 6- and 12-month follow-up. Modification of approach-avoidance bias was observed, but lacked in transfer over sessions and in generalization to attention and association bias. After 6 months, the IG reported less "problematic" food consumption, higher self-regulation, and higher quality of life; effects did not persist until the 12-month follow-up; no significant interaction effects were observed regarding weight course. Despite there was no direct effect on weight course, approach-avoidance training seems to be associated with promising effects on important pillars for weight loss. Further research concerning clinical effectiveness is warranted.
Collapse
Affiliation(s)
| | | | | | - Mike Rinck
- Behavioural Science Institute, Radboud University of Nijmegen, The Netherlands
| |
Collapse
|
75
|
Abstract
The increased prevalence of adolescent obesity and associated short-term and long-term complications emphasize the need for effective treatment. In this Review, we aim to describe the evidence for, and elements of, behaviour management and adjunctive therapies and highlight the opportunities and challenges presented by obesity management in adolescence. The broad principles of treatment include management of obesity-associated complications; a developmentally appropriate approach; long-term behaviour modification (dietary change, increased physical activity, decreased sedentary behaviours and improved sleep patterns); long-term weight maintenance strategies; and consideration of the use of pharmacotherapy, more intensive dietary therapies and bariatric surgery. Bariatric surgery should be considered in those with severe obesity and be undertaken by skilled bariatric surgeons affiliated with teams experienced in the medical and psychosocial management of adolescents. Adolescent obesity management strategies are more reliant on active participation than those for childhood obesity and should recognize the emerging autonomy of the patient. The challenges in adolescent obesity relate primarily to the often competing demands of developing autonomy and not yet having attained neurocognitive maturity.
Collapse
Affiliation(s)
- Katharine S Steinbeck
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natalie B Lister
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| |
Collapse
|
76
|
Doyle J, Colville S, Brown P, Christie D. How adolescents decide on bariatric surgery: an interpretative phenomenological analysis. Clin Obes 2018; 8:114-121. [PMID: 29356351 DOI: 10.1111/cob.12236] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/07/2017] [Accepted: 07/22/2017] [Indexed: 12/31/2022]
Abstract
The National Institute of Clinical Excellence states that bariatric surgery may be considered for adolescents with severe obesity in 'exceptional circumstances'. However, it is not clear what is deemed to be exceptional, and there is a lack of long-term outcomes data or research, which would inform patient selection. This is an in-depth qualitative study involving five adolescents who had previously undergone bariatric surgery (between 1 and 3 years postoperatively) and four who were being assessed for the treatment. All patients were from one tertiary NHS weight management service offering bariatric surgery to adolescents. Participants were interviewed to explore how young people decide whether bariatric surgery is an appropriate intervention for them. Of the nine adolescents recruited, four were male and five female, aged between 17 and 20 years at the time of interview. Participants who had already undergone surgery did so between the ages of 16 and 18. The data were analysed using interpretative phenomenological analysis, and key themes were identified, such as (i) wanting a different future, (ii) experiences of uncertainty, (iii) managing the dilemmas and (iv) surgery as the last resort. The findings suggest that young people are prepared to accept a surgical solution for obesity despite numerous dilemmas. Young people choose this intervention as a way of 'normalizing' when they perceive there is nothing better available. It is argued that these findings may have implications for the counselling of young people living with overweight and obesity and for government policy.
Collapse
Affiliation(s)
- J Doyle
- Child and Adolescent Psychological Medicine, University College London Hospitals, NHS Foundation Trust, London, UK
| | - S Colville
- National Institute for Health and Care Excellence International, London, UK
| | - P Brown
- Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - D Christie
- Child and Adolescent Psychological Medicine, University College London Hospitals, NHS Foundation Trust, London, UK
| |
Collapse
|
77
|
Bates CR, Buscemi J, Nicholson LM, Cory M, Jagpal A, Bohnert AM. Links between the organization of the family home environment and child obesity: a systematic review. Obes Rev 2018. [PMID: 29520946 DOI: 10.1111/obr.12662] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Due to increasingly high rates of child overweight and obesity, it is important to identify risk and protective factors that may inform more effective prevention and intervention. The degree of organization in the family home environment is a studied, but not well-specified, factor that may impact child weight. Prior research on household organization has examined an array of constructs, including family routines, limit setting, household chaos, crowding and the broad home environment. This study systematically reviews literature on organization within the family home environment and weight among children ages 2-12. Six hundred thirty-seven studies were reviewed by four coders for eligibility, and 32 studies were included in the final synthesis. Overall, 84% of studies provided evidence for relations between at least one indicator of organization within the family home environment and child weight. Studies provided compelling evidence across several constructs, suggesting that the relevance of household organization to child weight extends beyond a single indicator. Directions for future work include (i) examining the mediating role of health behaviours, (ii) examining the moderating role of socioeconomic factors, (iii) broadening this evidence base across cultures and nationalities and (iv) integrating constructs to develop a comprehensive model of organization within the home environment.
Collapse
Affiliation(s)
- C R Bates
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - J Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - L M Nicholson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - M Cory
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - A Jagpal
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - A M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| |
Collapse
|
78
|
Bell Z, Seager I, Shader T, Fristad MA. Updating the Textbook: A Novel Approach to Training Graduate Students in Evidence-Based Youth Practices. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
79
|
Foster C, Moore JB, Singletary CR, Skelton JA. Physical activity and family-based obesity treatment: a review of expert recommendations on physical activity in youth. Clin Obes 2018; 8:68-79. [PMID: 29224232 DOI: 10.1111/cob.12230] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022]
Abstract
Targeting physical inactivity in children is pertinent to aiding in the decrease of childhood obesity rates. Only 33% of adolescents are obtaining the recommended goal of at least 60 min of physical activity per day. The objectives of this review are to summarize professional recommendations for physical activity and exercise in children and adolescents, and identify family-centred strategies that can be implemented by weight management clinicians. Clinically oriented recommendations and policy statements from professional organizations were identified through literature and internet searches, summarized using rubrics of aerobic, muscle strengthening and bone strengthening exercise, then examined for details on family-based focus, inclusion of child developmental stage and age, and application to the prevention and treatment of obesity. Current recommendations give guidelines for the amount of physical activity that children should acquire and how many days a week activities should occur. However, available guidelines need an improved approach to addressing the role of the parents and caregivers in targeting physical activity and weight management in youth. Efforts must be taken in order to make sure that the types of physical activity offered are both suitable and enjoyable. Sports, games, free play and other age appropriate activities are adequate ways to increase moderate to vigorous physical activity in children. Differentiating physical activities types in accordance with developmental stage, level of enjoyment, and family characteristics is needed to establish sustainable habits. One paediatric obesity program has developed approaches to teaching families fun and engaging ways to be active together.
Collapse
Affiliation(s)
- C Foster
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - J B Moore
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - C R Singletary
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
80
|
Smith JD, Berkel C, Jordan N, Atkins DC, Narayanan SS, Gallo C, Grimm KJ, Dishion TJ, Mauricio AM, Rudo-Stern J, Meachum MK, Winslow E, Bruening MM. An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness-implementation trial (Raising Healthy Children study). Implement Sci 2018; 13:11. [PMID: 29334983 PMCID: PMC5769381 DOI: 10.1186/s13012-017-0697-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pediatric obesity is a multi-faceted public health concern that can lead to cardiovascular diseases, cancers, and early mortality. Small changes in diet, physical activity, or BMI can significantly reduce the possibility of developing cardiometabolic risk factors. Family-based behavioral interventions are an underutilized, evidence-based approach that have been found to significantly prevent excess weight gain and obesity in children and adolescents. Poor program availability, low participation rates, and non-adherence are noted barriers to positive outcomes. Effective interventions for pediatric obesity in primary care are hampered by low family functioning, motivation, and adherence to recommendations. METHODS This (type II) hybrid effectiveness-implementation randomized trial tests the Family Check-Up 4 Health (FCU4Health) program, which was designed to target health behavior change in children by improving family management practices and parenting skills, with the goal of preventing obesity and excess weight gain. The FCU4Health is assessment driven to tailor services and increase parent motivation. A sample of 350 families with children aged 6 to 12 years who are identified as overweight or obese (BMI ≥ 85th percentile for age and gender) will be enrolled at three primary care clinics [two Federally Qualified Healthcare Centers (FQHCs) and a children's hospital]. All clinics serve predominantly Medicaid patients and a large ethnic minority population, including Latinos, African Americans, and American Indians who face disparities in obesity, cardiometabolic risk, and access to care. The FCU4Health will be coordinated with usual care, using two different delivery strategies: an embedded approach for the two FQHCs and a referral model for the hospital-based clinic. To assess program effectiveness (BMI, body composition, child health behaviors, parenting, and utilization of support services) and implementation outcomes (such outcomes as acceptability, adoption, feasibility, appropriateness, fidelity, and cost), we use a multi-method and multi-informant assessment strategy including electronic health record data, behavioral observation, questionnaires, interviews, and cost capture methods. DISCUSSION This study has the potential to prevent excess weight gain, obesity, and health disparities in children by establishing the effectiveness of the FCU4Health and collecting information critical for healthcare decision makers to support sustainable implementation of family-based programs in primary care. TRIAL REGISTRATION NCT03013309 ClinicalTrials.gov.
Collapse
Affiliation(s)
- Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Cady Berkel
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Shrikanth S. Narayanan
- Department of Electrical Engineering and Computer Science, University of Southern California, CA, Los Angeles USA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Kevin J. Grimm
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Thomas J. Dishion
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Anne M. Mauricio
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Jenna Rudo-Stern
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Mariah K. Meachum
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Emily Winslow
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Meg M. Bruening
- Department of Nutrition, Arizona State University, Tempe, AZ USA
| |
Collapse
|
81
|
Hayes JF, Balantekin KN, Altman M, Wilfley DE, Taylor CB, Williams J. Sleep Patterns and Quality Are Associated with Severity of Obesity and Weight-Related Behaviors in Adolescents with Overweight and Obesity. Child Obes 2018; 14:11-17. [PMID: 28850274 PMCID: PMC5743029 DOI: 10.1089/chi.2017.0148] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Inadequate sleep duration, sleep patterns, and sleep quality have been associated with metabolic, circadian, and behavioral changes that promote obesity. Adolescence is a period during which sleep habits change to include less sleep, later bedtimes, and greater bedtime shift (e.g., difference between weekend and weekday bedtime). Thus, sleep may play a role in adolescent obesity and weight-related behaviors. This study assesses sleep duration, quality, and schedules and their relationships to relative weight and body fat percentage as well as diet, physical activity, and screen time in adolescents with overweight/obesity. METHODS Adolescents between 12 and 17 years old (n = 186) were weighed and measured, reported typical sleep and wake times on weekdays and weekends, and responded to questionnaires assessing diet, physical activity, and screen time habits. RESULTS Controlling for sleep duration, later weekend bedtime and greater bedtime shift were associated with greater severity of overweight (β = 0.20; β = 0.16) and greater screen time use (β = 0.22; β = 0.2). Later bedtimes on the weekdays and weekends were associated with fewer healthy diet practices (β = -0.26; β = -0.27). In addition, poorer sleep quality was associated with fewer healthy diet habits (β = -0.21), greater unhealthy diet habits (β = 0.15), and less physical activity (β = -0.22). Sleep duration was not associated with any weight or weight-related behavior. CONCLUSIONS Sleep patterns and quality are associated with severity of overweight/obesity and various weight-related behaviors. Promoting a consistent sleep schedule throughout the week may be a worthwhile treatment target to optimize behavioral and weight outcomes in adolescent obesity treatment.
Collapse
Affiliation(s)
| | | | - Myra Altman
- Department of Psychiatry, Washington University, St. Louis, MO
| | | | - C. Barr Taylor
- Center for mHealth, Palo Alto University and Stanford Medical Center, Palo Alto, CA
| | - Joanne Williams
- School of Health and Social Development, Deakin University, Melbourne, Australia
| |
Collapse
|
82
|
Tripicchio GL, Ammerman AS, Neshteruk C, Faith MS, Dean K, Befort C, Ward DS, Truesdale KP, Burger KS, Davis A. Technology Components as Adjuncts to Family-Based Pediatric Obesity Treatment in Low-Income Minority Youth. Child Obes 2017; 13:433-442. [PMID: 28727927 PMCID: PMC6913110 DOI: 10.1089/chi.2017.0021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Strategies to treat pediatric obesity are needed, especially among high-need populations. Technology is an innovative approach; however, data on technology as adjuncts to in-person treatment programs are limited. METHODS A total of 64 children [body mass index (BMI) ≥85th percentile, mean age = 9.6 ± 3.1 years, 32.8% female, 84.4% Hispanic] were recruited to participate in one of three cohorts of a family-based behavioral group (FBBG) treatment program: FBBG only, TECH1, and TECH2. Rolling, nonrandomized recruitment was used to enroll participants into three cohorts from May 2014 to February 2015. FBBG began in May 2014 and received the standard, in-person 12-week treatment only (n = 21); TECH1 began in September 2014 and received FBBG plus a digital tablet equipped with a fitness app (FITNET) (n = 20); TECH2 began in February 2015 and received FBBG and FITNET, plus five individually tailored TeleMed health-coaching sessions delivered via Skype (n = 23). Child BMI z-score (BMI-z) was assessed at baseline and postintervention. Secondary aims examined weekly FBBG attendance, feasibility/acceptability of FITNET and Skype, and the effect of technology engagement on BMI-z. RESULTS FBBG and TECH1 participants did not show significant reductions in BMI-z postintervention [FBBG: β = -0.05(0.04), p = 0.25; TECH1: β = -0.006(0.06), p = 0.92], but TECH2 participants did [β = -0.09(0.02), p < 0.001] and TeleMed session participation was significantly associated with BMI-z reduction [β = -0.04(0.01), p = 0.01]. FITNET use and FBBG attendance were not associated with BMI-z in any cohort. Overall, participants rated the technology as highly acceptable. CONCLUSIONS Technology adjuncts are feasible, used by hard-to-reach participants, and show promise for improving child weight status in obesity treatment programs.
Collapse
Affiliation(s)
- Gina L. Tripicchio
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cody Neshteruk
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Myles S. Faith
- Department of Counseling, School, and Educational Psychology, University at Buffalo-SUNY, Buffalo, NY
| | - Kelsey Dean
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MD.,Children's Mercy Hospital, Kansas City, MD
| | - Christie Befort
- Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Dianne S. Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kimberly P. Truesdale
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kyle S. Burger
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ann Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MD.,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
83
|
Taylor JH, Xu Y, Li F, Shaw M, Dziura J, Caprio S, Tamborlane WV, Nowicka P, Savoye M. Psychosocial predictors and moderators of weight management programme outcomes in ethnically diverse obese youth. Pediatr Obes 2017; 12:453-461. [PMID: 27384496 PMCID: PMC5568975 DOI: 10.1111/ijpo.12165] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/01/2016] [Accepted: 05/08/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND An important area of research in childhood obesity is the identification of factors that predict or moderate the responses to obesity intervention programmes, yet few studies have examined the impact of self-esteem and family functioning on obesity treatment outcomes. OBJECTIVES We sought to determine whether baseline self-esteem and family functioning predicted or moderated childhood obesity intervention outcomes at 6 months. METHODS From 2009 to 2011, seventy-five 10-16 year old, racially/ethnically diverse obese youths with abnormal glucose tolerance were randomized to 6 months of an intensive family-based obesity lifestyle intervention (Bright Bodies) or routine outpatient Clinic Care. We examined youth self-concept, parent-rated family functioning and 6-month outcomes (youths' glucose tolerance, weight, body mass index and percent fat). We set the significance threshold as P ≤ 0.05 for moderator and predictor analyzes. RESULTS Having poor family functioning and self-concept scores indicating high anxiety and low self-esteem at baseline predicted poor 6-month outcomes overall (Bright Bodies and Clinic Care groups combined). Additionally, baseline self-esteem and family functioning moderated treatment effects such that Bright Bodies outperformed Clinic Care in youths with low self-esteem and poorly functioning families, whereas youths with high self-esteem and high-functioning families did similarly well with either intervention. DISCUSSION Our findings suggest intensive family-based lifestyle programmes are particularly beneficial for youth with low self-esteem and poorly functioning families.
Collapse
Affiliation(s)
- J H Taylor
- Yale Child Study Center, New Haven, CT, USA
- Yale Department of Psychiatry, New Haven, CT, USA
| | - Y Xu
- Yale School of Public Health, New Haven, CT, USA
| | - F Li
- Yale School of Public Health, New Haven, CT, USA
| | - M Shaw
- Yale Pediatric Endocrinology, New Haven, CT, USA
| | - J Dziura
- Yale School of Public Health, New Haven, CT, USA
| | - S Caprio
- Yale Pediatric Endocrinology, New Haven, CT, USA
| | | | - P Nowicka
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - M Savoye
- Yale Pediatric Endocrinology, New Haven, CT, USA
| |
Collapse
|
84
|
Battle of plates: a pilot study of an approach–avoidance training for overweight children and adolescents. Public Health Nutr 2017; 21:426-434. [DOI: 10.1017/s1368980017002701] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveApproach–avoidance training (AAT) is a promising approach in obesity treatment. The present study examines whether an AAT is feasible and able to influence approach tendencies in children and adolescents, comparing implicit and explicit training approaches.Design/Setting/SubjectsFifty-nine overweight children and adolescents (aged 8–16 years; twenty-six boys) participated in an AAT for food cues, learning to reject snack items and approach vegetable items. Reaction times in the AAT and an implicit association test (IAT) were assessed pre- and post-intervention.ResultsA significant increase in the AAT compatibility scores with a large effect (η2=0·18) was found. No differences between the implicit and explicit training approaches and no change in the IAT scores were observed.ConclusionsAutomatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.
Collapse
|
85
|
Zenlea IS, Thompson B, Fierheller D, Green J, Ulloa C, Wills A, Mansfield E. Walking in the shoes of caregivers of children with obesity: supporting caregivers in paediatric weight management. Clin Obes 2017; 7:300-306. [PMID: 28703480 DOI: 10.1111/cob.12202] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/08/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
To incorporate the perspectives and experiences of family caregivers of children with obesity, the KidFit Health and Wellness Clinic, a paediatric weight management programme, embedded feedback opportunities into various stages of programme development. Caregivers were eligible to participate if their children had completed initial 4-week group-based pilot programming or were currently receiving treatment in 10 or 12 week group-based programming. Data were collected through feedback session discussions, audio-recorded, transcribed verbatim and analysed thematically. In total, 6 caregivers participated in the pilot group feedback session and 32 caregivers participated in the structured group feedback sessions. Caregivers reported that healthy lifestyle strategies first communicated by clinic staff to children during group sessions provided expert validation and reinforcement when discussing similar messages at home. Caregivers reported feeling isolated and blamed for causing their children's obesity and appreciated the supportive forum that group-based programming provided for sharing experiences. Since experiences of blame and isolation can burden caregivers of children with obesity, paediatric weight management programmes might consider including peer support opportunities and discussion forums for ongoing social support in addition to education about lifestyle change.
Collapse
Affiliation(s)
- I S Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - B Thompson
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - D Fierheller
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - J Green
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - C Ulloa
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - A Wills
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - E Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
86
|
Burke NL, Shomaker LB, Brady S, Reynolds JC, Young JF, Wilfley DE, Sbrocco T, Stephens M, Olsen CH, Yanovski JA, Tanofsky-Kraff M. Impact of Age and Race on Outcomes of a Program to Prevent Excess Weight Gain and Disordered Eating in Adolescent Girls. Nutrients 2017; 9:nu9090947. [PMID: 28846646 PMCID: PMC5622707 DOI: 10.3390/nu9090947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 01/23/2023] Open
Abstract
Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.
Collapse
Affiliation(s)
- Natasha L Burke
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, 303 Behavioral Sciences Building, 1570 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Sheila Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - James C Reynolds
- Radiology and Imaging Sciences Department, Warren Grant Magnuson Clinical Center, National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Campus Box 8134, St. Louis, MO 63110, USA.
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Mark Stephens
- Department of Family and Community Medicine, Pennsylvania State University, 1850 E. Park Avenue, Suite 207, State College, PA 16803, USA.
| | - Cara H Olsen
- Department of Preventative Medicine & Biometrics, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
87
|
Frontini R, Canavarro MC, Moreira H. Family cohesion and psychopathological symptoms in pediatric obesity: Is there an indirect effect? CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1316199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Roberta Frontini
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Helena Moreira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
88
|
Sorgente A, Pietrabissa G, Manzoni GM, Re F, Simpson S, Perona S, Rossi A, Cattivelli R, Innamorati M, Jackson JB, Castelnuovo G. Web-Based Interventions for Weight Loss or Weight Loss Maintenance in Overweight and Obese People: A Systematic Review of Systematic Reviews. J Med Internet Res 2017; 19:e229. [PMID: 28652225 PMCID: PMC5504341 DOI: 10.2196/jmir.6972] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Weight loss is challenging and maintenance of weight loss is problematic. Web-based programs offer good potential for delivery of interventions for weight loss or weight loss maintenance. However, the precise impact of Web-based weight management programs is still unclear. OBJECTIVE The purpose of this meta-systematic review was to provide a comprehensive summary of the efficacy of Web-based interventions for weight loss and weight loss maintenance. METHODS Electronic databases were searched for systematic reviews and meta-analyses that included at least one study investigating the effect of a Web-based intervention on weight loss and/or weight loss maintenance among samples of overweight and/or obese individuals. Twenty identified reviews met the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess methodological quality of reviews. All included reviews were of sufficient methodological quality (R-AMSTAR score ≥22). Key methodological and outcome data were extracted from each review. RESULTS Web-based interventions for both weight loss and weight loss maintenance were more effective than minimal or control conditions. However, when contrasted with comparable non-Web-based interventions, results were less consistent across reviews. CONCLUSIONS Overall, the efficacy of weight loss maintenance interventions was stronger than the efficacy of weight loss interventions, but further evidence is needed to more clearly understand the efficacy of both types of Web-based interventions. TRIAL REGISTRATION PROSPERO 2015: CRD42015029377; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42015029377 (Archived by WebCite at http://www.webcitation.org/6qkSafdCZ).
Collapse
Affiliation(s)
- Angela Sorgente
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,eCampus University, Faculty of Psychology, Como, Italy
| | - Federica Re
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Susan Simpson
- University of South Australia, School of Psychology, Social Work & Social Policy, Adelaide, Australia
| | - Sara Perona
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Alessandro Rossi
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Marco Innamorati
- European University of Rome, Rome, Italy.,Skinner Institute, Rome, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| |
Collapse
|
89
|
Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8573725. [PMID: 28656151 PMCID: PMC5474545 DOI: 10.1155/2017/8573725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 01/17/2023]
Abstract
Objective The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were (1) changes in body composition; (2) adherence to a Mediterranean diet; and (3) physical performance. Method The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures. Results After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance. Conclusion A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents.
Collapse
|
90
|
Stoner A, Jastrowski Mano K, Weisman S, Hainsworth K. Obesity impedes functional improvement in youth with chronic pain: An initial investigation. Eur J Pain 2017; 21:1495-1504. [DOI: 10.1002/ejp.1051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - S.J. Weisman
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee USA
| | - K.R. Hainsworth
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee USA
| |
Collapse
|
91
|
Reece LJ, Sachdev P, Copeland RJ, Thomson M, Wales JK, Wright NP. Intra-gastric balloon as an adjunct to lifestyle support in severely obese adolescents; impact on weight, physical activity, cardiorespiratory fitness and psychosocial well-being. Int J Obes (Lond) 2017; 41:591-597. [PMID: 27795553 PMCID: PMC5382282 DOI: 10.1038/ijo.2016.192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Severe adolescent obesity (body mass index (BMI) >99.6th centile) is a significant public health challenge. Current non-invasive treatments, including community-based lifestyle interventions, are often of limited effectiveness in this population, with NICE guidelines suggesting the use of bariatric surgery as the last line of treatment. Health professionals are understandably reluctant to commission bariatric surgery and as an alternative, the use of an intra-gastric balloon as an adjunct to a lifestyle programme might offer a reversible, potentially safer and less invasive option. OBJECTIVES Explore the use of an intra-gastric balloon as an adjunct to a lifestyle support programme, to promote weight loss in severely obese adolescents. Outcomes included weight loss, waist and hip measurements, psychosocial outcomes including health-related quality of life (HRQoL) and physical self perceptions, physical activity and cardiorespiratory fitness. METHOD Non-randomised pilot study. RESULTS Twelve severely obese adolescents (5 males, 7 females; mean age 15 years; BMI >3.5 s.d.; puberty stage 4 or more) and their families were recruited. Mean weight loss at 12 months (n=9) was 3.05 kg±14.69; d=0.002, P=0.550, and a BMI Z-score (n=12) change of 0.2 s.d.; d=0.7, P=0.002 was observed at 6 months with a large effect, but was not sustained at 12 months (mean change 0.1 s.d.; d=0.3, P=0.146). At 24 months (n=10), there was a weight gain from baseline of +9.9 kg±1.21 (d=0.4; P=0.433). Adolescent and parent HRQoL scores exceeded the minimal clinical important difference between baseline and 12 months for all domains but showed some decline at 24 months. CONCLUSION An intra-gastric balloon as an adjunct to a lifestyle support programme represents a safe and well-tolerated treatment approach in severely obese adolescents, with short-term effects on weight change. Improvements in psychosocial health, physical activity and cardiorespiratory fitness were maintained at 12 months, with varying results at 24 months.
Collapse
Affiliation(s)
- L J Reece
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - P Sachdev
- Academic Unit of Child Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - R J Copeland
- The National Centre for Sport and Exercise Medicine and The Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - M Thomson
- Department of Gastroenterology, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - J K Wales
- Service Group Director Endocrinology & Nephrology, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - N P Wright
- Department of Endocrinology, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| |
Collapse
|
92
|
Eg M, Frederiksen K, Vamosi M, Lorentzen V. How family interactions about lifestyle changes affect adolescents' possibilities for maintaining weight loss after a weight-loss intervention: a longitudinal qualitative interview study. J Adv Nurs 2017; 73:1924-1936. [PMID: 28160321 DOI: 10.1111/jan.13269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
AIM This study aims to examine how family interactions related to lifestyle changes influence adolescents' potential for maintaining weight loss after participating in a weight-loss treatment programme. BACKGROUND Obesity among adolescents is a large and complex health problem worldwide. Family support is crucial if adolescents are to benefit from weight-loss intervention. DESIGN Qualitative research interviews with families who participated in a weight-loss programme. METHODS The sample consisted of 10 families selected among participants in a 1-year multidisciplinary family-based weight-loss programme. Three rounds of semi-structured interviews stretching over 5 years (2010-2015) were transcribed verbatim, then analyzed using Kvale and Brinkmann's framework for working with qualitative research interviews. FINDINGS Five years after the intervention ended, we found that a family's interactions were a key factor in how the family handled challenges involved in changing its diet and increasing physical activity and that daily activities in modern families influenced their interaction, as activities demanded so much of the family that it was difficult to sustain the lifestyle changes necessary for the adolescent to maintain achieved weight loss. Supporting the adolescent was far more difficult than families expected; more time-consuming and also a cause of family conflicts. Siblings who did not need to lose weight played a major, but overlooked, role. CONCLUSION The family's interactions and its handling of lifestyle changes were important to the adolescent's maintained weight loss. It is fundamental that the entire family is supportive, regardless of family structure and these issues ought to be addressed in future interventions.
Collapse
Affiliation(s)
- Marianne Eg
- Department of Paediatrics, Regional Hospital Viborg, Denmark.,The Centre for Research in Clinical Nursing, Denmark.,Section for Nursing, Department of Public Health, Aarhus University, Denmark
| | - Kirsten Frederiksen
- Section for Nursing, Department of Public Health, Aarhus University, Denmark
| | - Marianne Vamosi
- Section for Nursing, Department of Public Health, Aarhus University, Denmark
| | - Vibeke Lorentzen
- Section for Nursing, Department of Public Health, Aarhus University, Denmark.,Centre for Nursing Research - Viborg, Denmark.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
| |
Collapse
|
93
|
Determinants of self-regulation in obesity: formation of implicit food preferences. HEALTH PSYCHOLOGY REPORT 2017. [DOI: 10.5114/hpr.2017.63823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The objective of this study was to investigate whether motor behavior can impact self-regulation of food intake in individuals with obesity. We utilized purposeful movement of the hand as a means to influence tendencies to approach and avoid foods compatible and incompatible with the weight loss goals. <br />
<br />
<b>Participants and procedure</b><br />
One hundred individuals with obesity (BMI ≥ 30) participated in this study. The participants were randomized into 2 experimental groups. The first experimental group was induced to prefer dietary foods and to avoid fattening foods. The second experimental group was induced to prefer fattening food and to avoid dietary food. <br />
<b>Results</b><br />
Experimental group 1 chose dietary products and avoided fattening items more often than group 2. We observed the increased importance of goals to lose weight and improve body shape as a result of manipulation consistent with its direction.<br />
<br />
<b>Conclusions</b><br />
Implicit manipulation of food preferences by approach/avoidance tasks can alter food preferences and attitudes.
Collapse
|
94
|
Thomason DL, Lukkahatai N, Kawi J, Connelly K, Inouye J. A Systematic Review of Adolescent Self-Management and Weight Loss. J Pediatr Health Care 2016; 30:569-582. [PMID: 26818905 DOI: 10.1016/j.pedhc.2015.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/13/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this review is to evaluate self-management interventions among overweight and obese adolescents to direct future research and practice. METHODS Studies published between 2008 and 2014 were identified by electronic database searches. The Jadad Scoring of Quality Reports of Randomized Clinical Trials was used to evaluate the quality of the studies with subsequent reviews. RESULTS Out of 69 studies, 10 randomized controlled trials were reviewed after all inclusion and exclusion criteria were met. Quality scores ranged from 7 to 11 out of 13 (M = 9.2, SD = 1.13). For the majority of studies, self-management strategies for weight loss were found to be significant for a mix of behavioral, psychological, anthropometric, and metabolic outcomes. DISCUSSION Findings indicated that interventions were most successful when incorporating family members. Self-management interventions that include a combination of appropriate diet, physical activity, and behavioral strategies with a family component are recommended.
Collapse
|
95
|
Skjåkødegård HF, Danielsen YS, Morken M, Linde SRF, Kolko RP, Balantekin KN, Wilfley DE, Júlíusson PB. Study Protocol: A randomized controlled trial evaluating the effect of family-based behavioral treatment of childhood and adolescent obesity-The FABO-study. BMC Public Health 2016; 16:1106. [PMID: 27769209 PMCID: PMC5073413 DOI: 10.1186/s12889-016-3755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children’s family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice. Methods Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6–18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m2), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires. Discussion This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity. Trial registration ClinicalTrails.gov NCT02687516. Registered 16th of February, 2016 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3755-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hanna F Skjåkødegård
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.
| | | | - Mette Morken
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Sara-Rebekka F Linde
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Rachel P Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine N Balantekin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychology, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychology, Washington University School of Medicine, St. Louis, MO, USA
| | - Pétur B Júlíusson
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
96
|
Koppen IJN, Kuizenga-Wessel S, Saps M, Di Lorenzo C, Benninga MA, van Etten-Jamaludin FS, Tabbers MM. Functional Defecation Disorders and Excessive Body Weight: A Systematic Review. Pediatrics 2016; 138:peds.2016-1417. [PMID: 27531145 DOI: 10.1542/peds.2016-1417] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Several studies have suggested an association between functional defecation disorders (FDDs) and overweight/obesity in children. OBJECTIVE To synthesize current evidence evaluating the association between FDDs and overweight/obesity in children. DATA SOURCES PubMed, Medline, and Embase were searched from inception until January 25, 2016. STUDY SELECTION Prospective and cross-sectional studies investigating the association between FDDs and overweight/obesity in children 0 to 18 years were included. DATA EXTRACTION Data generation was performed independently by 2 authors and quality was assessed by using quality assessment tools from the National Heart, Lung, and Blood Institute. RESULTS Eight studies were included: 2 studies evaluating the prevalence of FDDs in obese children, 3 studies evaluating the prevalence of overweight/obesity in children with FDDs, and 3 population-based studies. Both studies in obesity clinics revealed a higher prevalence of functional constipation (21%-23%) compared with the general population (3%-16%). In 3 case-control studies, the prevalence of overweight (12%-33%) and obesity (17%-20%) was found to be higher in FDD patients compared with controls (13%-23% and 0%-12%, respectively), this difference was significant in 2/3 studies. One of 3 population-based studies revealed evidence for an association between FDDs and overweight/obesity. Quality of 7/8 studies was rated fair or poor. LIMITATIONS Due to heterogeneity of the study designs, we refrained from statistically pooling. CONCLUSIONS Although several studies have revealed the potential association between FDDs and excessive bodyweight in children, results across included studies in this review differ strongly and are conflicting. Therefore, this systematic review could not confirm or refute this association.
Collapse
Affiliation(s)
- Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Sophie Kuizenga-Wessel
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| | - Miguel Saps
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Carlo Di Lorenzo
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| | | | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| |
Collapse
|
97
|
Current status on obesity in childhood and adolescence: Prevalence, etiology, co-morbidities and management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.obmed.2016.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
98
|
Warschburger P, Kroeller K, Haerting J, Unverzagt S, van Egmond-Fröhlich A. Empowering Parents of Obese Children (EPOC): A randomized controlled trial on additional long-term weight effects of parent training. Appetite 2016; 103:148-156. [DOI: 10.1016/j.appet.2016.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/02/2016] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
|
99
|
Abstract
Behavioral economics (BE) suggests that food and activity choices are governed by costs, available alternatives, and reinforcement. This article reviews basic, translational, and intervention research using a BE framework with overweight or obese children up to age 18. We address BE concepts and methods, and discuss developmental issues, the continuum of BE intervention approaches, findings of studies focused on increasing the cost of unwanted behaviors (ie, energy-dense food intake and sedentary behavior) and decreasing the cost of desired behaviors (ie, healthy food intake and PA), and our team's recent basic behavioral studies using BE approaches with minority adolescents.
Collapse
|
100
|
Broccoli S, Davoli AM, Bonvicini L, Fabbri A, Ferrari E, Montagna G, Panza C, Pinotti M, Storani S, Tamelli M, Candela S, Bellocchio E, Giorgi Rossi P. Motivational Interviewing to Treat Overweight Children: 24-Month Follow-Up of a Randomized Controlled Trial. Pediatrics 2016; 137:peds.2015-1979. [PMID: 26702030 DOI: 10.1542/peds.2015-1979] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatrician-led motivational interviewing can be an effective way of controlling BMI in overweight children in the short term. Its long-term efficacy is unknown. The primary aim was to determine whether the short-term (12-month) impact of family pediatrician-led motivational interviews on the BMI of overweight children could be sustained in the long term (24 months), in the absence of any other intervention. METHODS Children were recruited in 2011 by family pediatricians working in the province of Reggio Emilia, Italy, and randomly allocated to receive either 5 interviews delivered over a 12-month period or usual care. Eligible participants were all 4- to 7-year-old overweight children resident in the province of Reggio Emilia who had been receiving care from the pediatrician for ≥ 12 months. The primary outcome of this study was individual variation in BMI between the baseline visit and the 24-month follow-up, assessed by pediatricians not blinded to treatment group allocation. RESULTS Of 419 eligible families, 372 (89%) participated; 187 children were randomized to receive intervention and 185 to usual care. Ninety-five percent of the children attended the 12-month follow-up, and 91% attended the 24-month follow-up. After the 12-month intervention period, BMI in the intervention group increased less than in the control group (0.46 and 0.78, respectively; difference -0.32; P = .005). At the 24-month follow-up, the difference had disappeared (1.52 and 1.56, respectively; difference -0.04; P = .986). CONCLUSIONS The intervention lost its effectiveness within 1 year of cessation. Sustainable boosters are required for weight control and obesity prevention.
Collapse
Affiliation(s)
- Serena Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy;
| | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| | | | | | | | | | - Mirco Pinotti
- Primary Health Care, Local Health Authority, Reggio Emilia, Italy
| | - Simone Storani
- Promotion Health Researchers, League Against Cancer, Reggio Emilia, Italy
| | - Marco Tamelli
- Promotion Health Researchers, League Against Cancer, Reggio Emilia, Italy
| | - Silvia Candela
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| |
Collapse
|