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Brody GH, Yu T, Miller GE, Ehrlich KB, Chen E. Preventive parenting intervention during childhood and young black adults' unhealthful behaviors: a randomized controlled trial. J Child Psychol Psychiatry 2019; 60:63-71. [PMID: 30203840 PMCID: PMC10589912 DOI: 10.1111/jcpp.12968] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Lifestyle variables such as drug use and excessive weight gain contribute to adult morbidity and mortality. This study was designed to determine whether participation in a preventive intervention designed to enhance supportive parenting can reduce drug use and body mass index (BMI) in young Black adults from disadvantaged neighborhoods. METHOD This study was conducted in the rural southeastern United States. Black parents and their 11-year-old children (517 families) were assigned randomly to the Strong African American Families (SAAF) prevention trial or a control condition. Data assessing neighborhood socioeconomic status and supportive parenting were obtained when the youths were ages 11 and 16. When youths were ages 19-21 and 25, drug use and BMI were measured. RESULTS As hypothesized, significant three-way interactions were detected among neighborhood disadvantage, prevention condition, and gender for BMI (B = 3.341, p = .009, 95% CI [0.832, 5.849]) and substance use (B = -0.169, p = .049, 95% CI [-0.337, -0.001]). Living in a disadvantaged neighborhood during adolescence was associated with increased drug use among young men in the control group (simple-slope = 0.215, p < .003) but not among those in the SAAF condition (simple-slope = 0.030, p = .650). Neighborhood disadvantage was associated with elevated BMI among young women in the control group (simple-slope = 3.343, p < .001), but not in the SAAF condition (simple-slope = 0.204, p = .820). CONCLUSIONS The results suggest that participation during childhood in a preventive intervention to enhance supportive parenting can ameliorate the effects of life in a disadvantaged neighborhood on men's drug use and women's BMI across ages 19-25 years. These findings suggest a possible role for parenting enhancement programs in narrowing health disparities.
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Affiliation(s)
- Gene H. Brody
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Gregory E. Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Katherine B. Ehrlich
- Center for Family Research, University of Georgia, Athens, GA, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
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"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.
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Song M, Lee CS, Lyons KS, Stoyles S, Winters-Stone KM. Assessing the feasibility of parent participation in a commercial weight loss program to improve child body mass index and weight-related health behaviors. SAGE Open Med 2018; 6:2050312118801220. [PMID: 30302248 PMCID: PMC6170954 DOI: 10.1177/2050312118801220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 08/26/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives: Little is known about how children’s health might be affected by parents’
participation in commercial weight loss programs. Given that more than
3.2 million people subscribe to just one commercial weight loss program,
Weight Watchers, any secondary effects on children’s
weight-related health behaviors (e.g. dietary behaviors, physical activity,
and sedentary time) and body mass index from parent participation in
commercial weight loss programs may have significant public health
implications. This study examined the feasibility of conducting a study to
assess such effects. Methods for recruitment and retention, and perceived
acceptability and satisfaction among participants in small-scale preliminary
study, were evaluated. Changes in body mass index and health behaviors among
the parent–child dyads were also measured to test whether a larger-scale
study would be warranted. Methods: This was an 8-week, pre–post observational feasibility study involving 20
parent–child dyads where both members had overweight or obesity. Physical
and behavioral data were collected at baseline and 8 weeks from both members
of the dyads. Parenting data were collected at the same time periods through
parents’ self-report. Bivariate correlation was used to quantify the
associations in changes for dyad members. Results: Feasibility goals for retention and perceived acceptability/satisfaction
among participants were met. We reached approximately 80% of our enrollment
goal. Parents showed a significant decrease in body mass index of 0.53
points (p < 0.05), while children showed a significant increase in raw
body mass index (0.42, p < 0.05) and body mass index percentile (0.59,
p < 0.05). However, correlation between changes in parent body mass index
and changes in children body mass index percentile was positively correlated
(r = 0.24, p = 0.31). A decrease in parent intake of total fat was
associated with a decrease in the intake of fat in their children (r = 0.47,
p < 0.05). Conclusion: Our findings support the viability of a larger-scale follow-up to assess the
potential of using parent-only commercial weight loss program as a mechanism
for improving health behaviors and body mass index in children with
overweight or obesity.
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Affiliation(s)
- MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:136-154. [PMID: 30062718 DOI: 10.1111/pedi.12738] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Carmel E Smart
- Department of Paediatric Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia.,School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | | | | | | | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Niermann CYN, Spengler S, Gubbels JS. Physical Activity, Screen Time, and Dietary Intake in Families: A Cluster-Analysis With Mother-Father-Child Triads. Front Public Health 2018; 6:276. [PMID: 30324100 PMCID: PMC6172305 DOI: 10.3389/fpubh.2018.00276] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/06/2018] [Indexed: 01/27/2023] Open
Abstract
Background: The co-occurrence of multiple health behaviors such as physical activity, diet, and sedentary behavior affects individuals' health. Co-occurence of different health behaviors has been shown in a large number of studies. This study extended this perspective by addressing the co-occurrence of multiple health behaviors in multiple persons. The objective was to examine familial health behavioral patterns by (1) identifying clusters of families with similar behavior patterns and (2) characterizing the clusters by analyzing their correlates. Methods: Cross-sectional data were collected from 198 families (mother, father, and child). Mothers, fathers, and children completed questionnaires assessing health related behaviors (physical activity, consumption of “healthy” and “unhealthy” foods, and screen time), the perception of Family Health Climate (regarding physical activity and nutrition) and demographics. Twelve variables (four health behaviors of three family members) were included in a cluster analysis conducted with Ward's Method and K-means analysis. Chi-square tests and analyses of variance were performed to characterize the family clusters regarding their demographics and their perception of Family Health Climate. Results: Three clusters of families with specific behavioral patterns were identified: “healthy behavior families” with levels of physical activity and consumption of healthful foods above average and levels of media use and consumption of sweets below average; “unhealthy behavior families” with low levels of consumption of healthful foods and high levels of screen time; “divergent behavior families” with unhealthier behavioral patterns in parents and healthier screen time and eating behaviors combined with low physical activity levels in children. Family Health Climate differed between family clusters with most positive ratings in “healthy behavior families” and least positive ratings in “unhealthy behavior families.” “Divergent behavior families” rated the nutrition climate nearly as high as “healthy behavior families” while they rated the physical activity climate nearly as low as the “unhealthy behavior families.” Conclusions: The study shows that co-occurrence of multiple health behaviors occurs on the family level. Therefore, focusing the family as a whole instead of individuals and targeting aspects related to the Family Health Climate in interventions could result in benefits for both children and adults and enhance effectivity of intervention programs.
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Affiliation(s)
| | - Sarah Spengler
- Department of Sport and Health Science, Technical University of Munich, Munich, Germany
| | - Jessica S Gubbels
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Smith JD, Egan KN, Montaño Z, Dawson-McClure S, Jake-Schoffman DE, Larson M, St. George SM. A developmental cascade perspective of paediatric obesity: a conceptual model and scoping review. Health Psychol Rev 2018; 12:271-293. [PMID: 29583070 PMCID: PMC6324843 DOI: 10.1080/17437199.2018.1457450] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
Abstract
Considering the immense challenge of preventing obesity, the time has come to reconceptualise the way we study the obesity development in childhood. The developmental cascade model offers a longitudinal framework to elucidate the way cumulative consequences and spreading effects of risk and protective factors, across and within biopsychosocial spheres and phases of development, can propel individuals towards obesity. In this article, we use a theory-driven model-building approach and a scoping review that included 310 published studies to propose a developmental cascade model of paediatric obesity. The proposed model provides a basis for testing hypothesised cascades with multiple intervening variables and complex longitudinal processes. Moreover, the model informs future research by resolving seemingly contradictory findings on pathways to obesity previously thought to be distinct (low self-esteem, consuming sugary foods, and poor sleep cause obesity) that are actually processes working together over time (low self-esteem causes consumption of sugary foods which disrupts sleep quality and contributes to obesity). The findings of such inquiries can aid in identifying the timing and specific targets of preventive interventions across and within developmental phases. The implications of such a cascade model of paediatric obesity for health psychology and developmental and prevention sciences are discussed.
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Affiliation(s)
- Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, (312)503-4041.
| | - Kaitlyn N. Egan
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA, (619)733-3977.
| | - Zorash Montaño
- Children’s Hospital of Los Angeles, University of Southern California, Los Angeles, California, USA, (323)804-6666.
| | - Spring Dawson-McClure
- Center for Early Childhood Health & Development, New York University Langone Medical Center, New York, New York, USA, (919)930-7240.
| | - Danielle E. Jake-Schoffman
- Division of Preventive & Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA, (508)856-6517.
| | - Madeline Larson
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA, (253)225-0119.
| | - Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA, (305)243-0726.
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Stiles-Shields C, Doyle AC, Le Grange D, Loeb KL. Family-Based Treatment for Pediatric Obesity: Case Study of an Adaptation for a Non-Psychiatric Adolescent Population. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2018; 49:111-118. [PMID: 31186580 DOI: 10.1007/s10879-018-9399-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric overweight and obesity, a highly prevalent condition posing risks extending into adulthood, is considered a major public health concern. Findings from the pediatric obesity treatment literature support the efficacy of parental involvement across multiple formats. Family-based treatment is an outpatient intervention for adolescents with eating disorders that enlists parents as the primary agents of symptom management during the acute stages of illness, titrating down their involvement as severity of the disorder decreases. We adapted family-based treatment for pediatric obesity, modifying the original model to recognize that children and adolescents with obesity do not exhibit the developmental regression seen in eating disorders and to reflect the non-psychiatric nature of obesity. Thus, family-based treatment for pediatric obesity modulates the degree of parental involvement as a function of chronological developmental stage, not severity of the condition. To illustrate the implementation of this treatment, we present a case report of a 15-year old with an eight-year history of overweight and a greater than 30-pound weight gain prior to treatment. Through this case study, the three phases of family-based treatment for pediatric obesity and six-month post treatment follow-up results are presented through the lens of response from this adolescent and her family. We present this case report to illustrate the implementation of the intervention's adolescent module, and the potential impact of the approach in the treatment of adolescents with obesity and their families.
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Affiliation(s)
| | - Angela Celio Doyle
- Eating Disorders Center at the Evidence Based Treatment Centers of Seattle, Seattle, WA USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA USA, and Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL USA (Emeritus)
| | - Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
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Adolescents' diet quality in relation to their relatives' and peers' diet engagement and encouragement: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Public Health Nutr 2018; 21:3192-3201. [PMID: 30095062 DOI: 10.1017/s1368980018001787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine the associations between adolescents' diet quality and their perceived relatives' and peers' diet engagement and encouragement. DESIGN Cross-sectional study performed in European countries. Diet quality was scored using the Diet Quality Index for Adolescents (DQI-A) based on four components: quality, diversity, balance and meal frequency. Perceived diet quality engagement and perceived encouragement of the relatives/peers were assessed using the questions 'How healthy is each of the following persons' diet?' and 'How often does each of the following persons encourage you to eat a healthy diet?' SETTING Vienna, Ghent, Lille, Athens, Heraklion, Pecs, Rome, Dortmund, Zaragoza and Stockholm. SUBJECTS Healthy adolescents (n 2943). RESULTS The perceived engagement level of the mother, father and sister was each positively associated with the DQI-A (P<0·05). A positive association was found for the perceived engagement level of siblings, father and mother with all specific components (P<0·05). DQI-A was negatively associated with the perceived encouragement level from a best friend and positively associated with the encouragement level of the mother and father (P<0·05). Diversity, balance and quality components were positively associated with the perceived encouragement level from the mother and father (P<0·05), whereas the best friend's perceived encouragement was negatively associated with the meal frequency component (P<0·01). CONCLUSIONS These findings highlight the role of social engagement and encouragement of relatives and peers in adolescents' diet quality. Intervention or promotion programmes aimed at enhancing diet quality in adolescents should target both family and peers.
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Pratt KJ, Skelton JA. Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach. Acad Pediatr 2018; 18:620-627. [PMID: 29654905 PMCID: PMC8111666 DOI: 10.1016/j.acap.2018.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/28/2018] [Accepted: 04/04/2018] [Indexed: 01/21/2023]
Abstract
Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.
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Affiliation(s)
- Keeley J. Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Brenner FIT (Families In Training) Program, Brenner Children’s Hospital, Wake Forest Baptist Health, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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Tabak RG, Dsouza N, Schwarz CD, Quinn K, Kristen P, Haire-Joshu D. A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study. BMC Public Health 2018; 18:586. [PMID: 29720138 PMCID: PMC5932800 DOI: 10.1186/s12889-018-5466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. Methods Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. Results From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches’ flexibility and willingness to work with the family’s schedule. Acceptability themes suggest providing actionable strategies tailored to the family’s context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. Conclusions RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Nishita Dsouza
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Karyn Quinn
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Patricia Kristen
- Envolve PeopleCare, 20 Batterson Park Road, Farmington, CT, 06032, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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Campbell-Voytal KD, Hartlieb KB, Cunningham PB, Jacques-Tiura AJ, Ellis DA, Jen KLC, Naar-King S. African American Adolescent-Caregiver Relationships in a Weight Loss Trial. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:835-842. [PMID: 29610562 PMCID: PMC5877412 DOI: 10.1007/s10826-017-0920-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Kimberly D Campbell-Voytal
- Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Avenue, #321, Detroit, MI 48201
| | | | | | | | - Deborah A Ellis
- Wayne State University School of Medicine, Detroit, Michigan
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Robertson W, Fleming J, Kamal A, Hamborg T, Khan KA, Griffiths F, Stewart-Brown S, Stallard N, Petrou S, Simkiss D, Harrison E, Kim SW, Thorogood M. Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years. Health Technol Assess 2018; 21:1-180. [PMID: 28059054 DOI: 10.3310/hta21010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effective programmes to help children manage their weight are required. 'Families for Health' focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project. OBJECTIVE The aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT). DESIGN The trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families. SETTING Three sites in the West Midlands, England, UK. PARTICIPANTS Children aged 6-11 years who were overweight (≥ 91st centile BMI) or obese (≥ 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral. INTERVENTIONS Families for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality. MAIN OUTCOME MEASURES Joint primary outcome measures were change in children's BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months' follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods. RESULTS The study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the 'usual-care' control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) -0.001 to 0.229; p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (-0.118, 95% CI -0.203 to -0.034; p = 0.007), but not in the Families for Health arm (-0.005, 95% CI -0.085 to 0.078; p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care (£998 vs. £548; p < 0.001). The mean incremental cost-effectiveness of Families for Health was estimated at £552,175 per QALY gained. The probability that the Families for Health programme is cost-effective did not exceed 40% across a range of thresholds. The process evaluation demonstrated that the programme was implemented, as planned, to the intended population and any adjustments did not deviate widely from the handbook. Many families waited more than 3 months to receive the intervention. Facilitators', parents' and children's experiences of Families for Health were largely positive and there were no adverse events. Further analysis could explore why some children show a clinically significant benefit while others have a worse outcome. CONCLUSIONS Families for Health was neither effective nor cost-effective for the management of obesity in children aged 6-11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment. TRIAL REGISTRATION Current Controlled Trials ISRCTN45032201. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.
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Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth. Clin Child Fam Psychol Rev 2018; 20:64-77. [PMID: 28229248 DOI: 10.1007/s10567-017-0230-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.
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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.
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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
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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.
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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
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Webb HJ, Zimmer-Gembeck MJ, Waters AM, Farrell LJ, Nesdale D, Downey G. "Pretty Pressure" From Peers, Parents, and the Media: A Longitudinal Study of Appearance-Based Rejection Sensitivity. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2017; 27:718-735. [PMID: 29152860 DOI: 10.1111/jora.12310] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Drawing from the tripartite sociocultural model of body image, the researchers examined whether direct messages and modeling from peers, parents, and media were concurrently and prospectively associated with appearance-based rejection sensitivity (appearance-RS) in young adolescents (Mage = 12.0 years). Appearance-RS was higher among those who concurrently reported more appearance-related teasing and pressure by peers, more parent teasing, and greater acceptance of media appearance ideals. In prospective analyses, greater increases in appearance-RS over 1 year were found for adolescents who perceived higher levels of parental appearance-related teasing and negative attitudes about their own appearance. Moderation analyses indicated the positive prospective association between parental negative appearance attitudes and appearance-RS was found in younger but not older participants. Gender did not moderate associations.
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Cohen TR, Hazell TJ, Vanstone CA, Rodd C, Weiler HA. Bone Health is Maintained, While Fat Mass is Reduced in Pre-pubertal Children with Obesity Participating in a 1-Year Family-Centered Lifestyle Intervention. Calcif Tissue Int 2017; 101:612-622. [PMID: 28866763 DOI: 10.1007/s00223-017-0318-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022]
Abstract
Diet and physical activity (PA) influence bone health in children. This study tested whether increasing milk and milk products and weight-bearing types of PA favorably changed bone outcomes assessed by dual-energy X-ray absorptiometry (DXA) and bone biomarkers in children with obesity participating in a 1-year family-centered lifestyle intervention. Children were randomized to one of three groups: Control (Ctrl; no intervention), Standard treatment (StnTx: two servings milk and milk products/day; meet PA guidelines plus weight-bearing PA three times/week), or Modified treatment (ModTx: four servings milk and milk products/day; meet PA guidelines plus daily weight-bearing PA). Baseline and 12-month measurements included DXA scans for whole body (WB), lumbar spine (LS), lumbar lateral spine (LLS), and ultra-distal (UD) ulna + radius for bone mineral content (BMC), areal bone mineral density (aBMD) and BMD z-scores. Fat mass index (FMI), fat-free mass index (FFMI), and biomarkers of bone metabolism were assessed. Seventy-eight children 6-8 years old were recruited (mean body mass index for-age z-score: 3.3 ± 1.2). Compared to baseline, all groups increased BMC of WB, LS, and LLS (p < 0.001), whereas only StnTx increased UD ulna + radius BMC at 12 months (p < 0.05). At 12 months, WB-BMD z-scores were significantly lower in Ctrl (p < 0.05), whereas WB and LLS aBMD increased in StnTx and ModTx (p < 0.001) but not in Ctrl. All groups increased FFMI (p < 0.001), while only Ctrl increased FMI (p < 0.001). Bone biomarkers did not change over time. Participating in a family-centered lifestyle intervention based on Canadian diet and PA guidelines maintained bone health in obese children.
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Affiliation(s)
- Tamara R Cohen
- School of Human Nutrition, Macdonald Campus, McGill University, 21,111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada
| | - Tom J Hazell
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada
| | - Catherine A Vanstone
- School of Human Nutrition, Macdonald Campus, McGill University, 21,111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada
| | - Celia Rodd
- Children's Hospital, University of Manitoba, FW302-685 William Ave, Winnipeg, MB, R3E 0Z2, Canada
| | - Hope A Weiler
- School of Human Nutrition, Macdonald Campus, McGill University, 21,111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada.
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Uijtdewilligen L, Brown HE, Müller-Riemenschneider F, Lim YW, Brage S, van Sluijs EM. A systematic review of methods to measure family co-participation in physical activity. Obes Rev 2017; 18:1454-1472. [PMID: 28967183 PMCID: PMC6219698 DOI: 10.1111/obr.12589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 01/29/2023]
Abstract
The family environment is key in influencing children's health behaviours. Encouraging family co-participation in physical activity may therefore be an effective approach to increasing children's physical activity levels. Yet, little is known about how to best assess family co-participation in physical activity. This review summarizes methods to measure family co-participation in physical activity, which was defined as joint physical activities including at least one healthy child (0-18 years) and one other family member. Methods were identified through a systematic literature search, cross-referencing pre-selected reviews and contacting research groups. Thirty-seven measurement methods were included. Questionnaires were the most common method used, with the majority assessing frequency of co-participation and few also assessing duration and type. Reliability and internal consistency of scales were often reported, but rarely specified for the item(s) relevant to co-participation. Other methods of measuring co-participation included diaries, event history calendars, direct observations and accelerometry combined with diary, ecological momentary assessment or global positioning systems (GPS). Whilst a large number of measurement methods of family co-participation in physical activity exist, few are comprehensive and/or report acceptable psychometric properties. Future work should focus on reaching consensus in defining family co-participation in physical activity, and subsequently developing reliable and valid measures.
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Affiliation(s)
- L Uijtdewilligen
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - H E Brown
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - F Müller-Riemenschneider
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore.,Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre Berlin, Germany
| | - Y W Lim
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - S Brage
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - E M van Sluijs
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Cochrane AJ, Dick B, King NA, Hills AP, Kavanagh DJ. Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study. BMC Public Health 2017; 17:814. [PMID: 29037238 PMCID: PMC5644160 DOI: 10.1186/s12889-017-4834-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 10/06/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. METHODS We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. RESULTS The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. CONCLUSIONS A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.
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Affiliation(s)
- Anita J. Cochrane
- Institute of Health and Biomedical Innovation, School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001 Australia
- LifePsyche, Box 3180, Norman Park, Brisbane, PO 4170 Australia
| | - Bob Dick
- Interchange, 37 Burbong Street, Chapel Hill, Brisbane, QLD 4069 Australia
| | - Neil A. King
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001 Australia
| | - Andrew P. Hills
- School of Health Sciences, Faculty of Health, University of Tasmania, Locked Bag 1322, Newnham Drive, Launceston, TAS 7250 Australia
| | - David J. Kavanagh
- Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, 4001 Australia
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The Team to Address Bariatric Care in Canadian Children (Team ABC3): Team Grant Research Proposal. BMC Res Notes 2017; 10:301. [PMID: 28992812 PMCID: PMC6389219 DOI: 10.1186/s13104-017-2506-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/16/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years). METHODS/DESIGN From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits. DISCUSSION Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.
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Lee HJ, Kim SH, Choi SH, Lee JS. The Association between Socioeconomic Status and Obesity in Korean Children: An Analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012). Pediatr Gastroenterol Hepatol Nutr 2017; 20:186-193. [PMID: 29026735 PMCID: PMC5636935 DOI: 10.5223/pghn.2017.20.3.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Obesity is one of the most common health problems among children and its prevalence has increased in recent decades. Socioeconomic status (SES) is a well-known risk factor for childhood obesity although the associations were different across countries. Previous studies in other countries have reported a positive association between childhood obesity and SES in developing countries, and inverse correlation has been reported in developed countries. For this reason, we wanted to investigate the relationship between SES and obesity in Korean children. METHODS Data were acquired 3,095 boys and girls who participated in the fifth Korea National Health and Nutrition Examination Survey, which was conducted from 2010 to 2012. Body mass index was calculated from measured anthropometric data using the 2007 Korean National Growth Charts. RESULTS Upon univariate analysis, we did not find any statistically significant differences in the parental employment status, monthly family income between children with and without obesity. Multiple logistic regression analysis showed childhood obesity was positively associated with maternal overweight (OR, 1.889; 95% CI, 1.079-3.309), maternal obesity (OR, 3.409; 95% CI, 2.228-5.215) and paternal obesity (OR, 2.135; 95% CI, 1.257-3.627). CONCLUSION The present study showed that socioeconomic status might not an important risk factor for obesity in Korean children. These results warrant further studies to clarify the association between SES and obesity in Korean children.
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Affiliation(s)
- Hae Jeong Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seo Heui Choi
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Ash T, Agaronov A, Young T, Aftosmes-Tobio A, Davison KK. Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. Int J Behav Nutr Phys Act 2017; 14:113. [PMID: 28836983 PMCID: PMC5571569 DOI: 10.1186/s12966-017-0571-2] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base. METHODS Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook. RESULTS More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented. CONCLUSIONS The limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.
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Affiliation(s)
- Tayla Ash
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, SPH-2 655 Huntington Avenue, Boston, 02115 USA
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Kresge Building 677 Huntington Avenue, Boston, 02115 USA
| | - Alen Agaronov
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, SPH-2 655 Huntington Avenue, Boston, 02115 USA
| | - Ta’Loria Young
- Harvard T.H. Chan School of Public Health, University of Texas at Austin, 110 Inner Campus Drive, Austin, 78705 USA
| | - Alyssa Aftosmes-Tobio
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Kresge Building 677 Huntington Avenue, Boston, 02115 USA
| | - Kirsten K. Davison
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, SPH-2 655 Huntington Avenue, Boston, 02115 USA
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Kresge Building 677 Huntington Avenue, Boston, 02115 USA
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Alulis S, Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: A qualitative meta-synthesis. Obes Res Clin Pract 2017; 11:627-639. [PMID: 28844833 DOI: 10.1016/j.orcp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child and adolescent obesity trends are rising throughout the world, revealing treatment difficulties and a lack of consensus about treatment. The family system is broadly viewed as a potential setting for facilitation of behaviour change. Therefore, family-based interventions have come into focus. However, the use of theoretical frameworks to strengthen these interventions is rare and very uneven. OBJECTIVE AND METHOD To conduct a qualitative meta-synthesis of family-based interventions for child and adolescent obesity to identify the theoretical frameworks applied, thus understanding how theory is used in practice. A literature review was conducted between January and March 2016. A total of 35 family-based interventions were selected for analysis. RESULTS Eleven interventions explicitly stated that theory guided the development and were classified as theory-inspired. The social cognitive, self-efficacy and Family Systems Theory appeared most frequently. The remaining 24 were classified as theory-related as theoretical elements of self-monitoring; stimulus control, reinforcement and modelling were used. CONCLUSION The designs of family-based interventions reveal numerous inconsistencies and a significant void between research results and health care practice. Based on the analysis, this article proposes three themes to be used as focus points when designing future interventions and when selecting theories for the development of solid, theory-based frameworks for application. The themes are: (1) age of target group, (2) intervention objective, and (3) self-efficacy and readiness for change.
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Affiliation(s)
- Sarah Alulis
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark; Lund University, Paradisgatan 2, 221 00 Lund, Sweden.
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark.
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Kumar S, Tadakamadla J, Zimmer-Gembeck M, Kroon J, Lalloo R, Johnson NW. The Effect of Parenting Practices on the Severity of Gingival Bleeding in Children. J Periodontol 2017; 88:744-751. [DOI: 10.1902/jop.2017.160817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Santhosh Kumar
- School of Dentistry and Oral Health, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jyothi Tadakamadla
- School of Dentistry and Oral Health, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | | | - Jeroen Kroon
- School of Dentistry and Oral Health, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Newell W. Johnson
- School of Dentistry and Oral Health, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Boutelle KN, Rhee KE, Liang J, Braden A, Douglas J, Strong D, Rock CL, Wilfley DE, Epstein LH, Crow SJ. Effect of Attendance of the Child on Body Weight, Energy Intake, and Physical Activity in Childhood Obesity Treatment: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:622-628. [PMID: 28558104 PMCID: PMC5710344 DOI: 10.1001/jamapediatrics.2017.0651] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/27/2017] [Indexed: 11/14/2022]
Abstract
Importance Family-based weight loss treatment (FBT) is considered the gold-standard treatment for childhood obesity and is provided to the parent and child. However, parent-based treatment (PBT), which is provided to the parent without the child, could be similarly effective and easier to disseminate. Objective To determine whether PBT is similarly effective as FBT on child weight loss over 24 months. Secondary aims evaluated the effect of these 2 treatments on parent weight loss, child and parent dietary intake, child and parent physical activity, parenting style, and parent feeding behaviors. Design, Setting, and Participants Randomized 2-arm noninferiority trial conducted at an academic medical center, University of California, San Diego, between July 2011 and July 2015. Participants included 150 overweight and obese 8- to 12-year-old children and their parents. Interventions Both PBT and FBT were delivered in 20 one-hour group meetings with 30-minute individualized behavioral coaching sessions over 6 months. Treatments were similar in content; the only difference was the attendance of the child. Main Outcomes and Measures The primary outcome measure was child weight loss (body mass index [BMI] and BMI z score) at 6, 12, and 18 months post treatment. Secondary outcomes were parent weight loss (BMI), child and parent energy intake, child and parent physical activity (moderate to vigorous physical activity minutes), parenting style, and parent feeding behaviors. Results One hundred fifty children (mean BMI, 26.4; mean BMI z score, 2.0; mean age, 10.4 years; 66.4% girls) and their parent (mean BMI, 31.9; mean age, 42.9 years; 87.3% women; and 31% Hispanic, 49% non-Hispanic white, and 20% other race/ethnicity) were randomly assigned to either FBT or PBT. Child weight loss after 6 months was -0.25 BMI z scores in both PBT and FBT. Intention-to-treat analysis using mixed linear models showed that PBT was noninferior to FBT on all outcomes at 6-, 12-, and 18-month follow-up with a mean difference in child weight loss of 0.001 (95% CI, -0.06 to 0.06). Conclusions and Relevance Parent-based treatment was as effective on child weight loss and several secondary outcomes (parent weight loss, parent and child energy intake, and parent and child physical activity). Parent-based treatment is a viable model to provide weight loss treatment to children. Trial Registration Clinicaltrials.gov Identifier: NCT01197443.
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Affiliation(s)
- Kerri N. Boutelle
- Department of Pediatrics, University of California, San Diego
- Department of Psychiatry, University of California, San Diego
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego
| | - June Liang
- Department of Pediatrics, University of California, San Diego
| | - Abby Braden
- Department of Psychology, Bowling Green University, Bowling Green, Ohio
| | | | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Cheryl L. Rock
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Denise E. Wilfley
- Department of Psychology, Washington University at St Louis, St Louis, Missouri
| | | | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis
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Dooley D, Moultrie NM, Sites E, Crawford PB. Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals. J Public Health Dent 2017. [DOI: 10.1111/jphd.12229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Diane Dooley
- School of Medicine; University of California San Francisco; San Francisco CA USA
| | | | | | - Patricia B. Crawford
- Nutrition Policy Institute; Agriculture and Natural Resources, University of California; Berkeley CA USA
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Chaparro MP, de Luna X, Häggström J, Ivarsson A, Lindgren U, Nilsson K, Koupil I. Childhood family structure and women's adult overweight risk: A longitudinal study. Scand J Public Health 2017; 45:511-519. [PMID: 28482752 DOI: 10.1177/1403494817705997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. METHODS Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. RESULTS Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. CONCLUSIONS Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.
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Affiliation(s)
- M Pia Chaparro
- 1 Centre for Health Equity Studies (CHESS), Stockholm University & Karolinska Institutet, Stockholm, Sweden.,2 Present affiliation: Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Xavier de Luna
- 3 Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- 3 Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- 4 Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Urban Lindgren
- 5 Department of Geography and Economic History, Umeå University, Umeå, Sweden
| | - Karina Nilsson
- 6 Department of Sociology, Umeå University, Umeå, Sweden
| | - Ilona Koupil
- 1 Centre for Health Equity Studies (CHESS), Stockholm University & Karolinska Institutet, Stockholm, Sweden.,7 Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
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79
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Bennett EA, Kolko RP, Chia L, Elliott JP, Kalarchian MA. Treatment of Obesity Among Youth With Intellectual and Developmental Disabilities: An Emerging Role for Telenursing. West J Nurs Res 2017; 39:1008-1027. [PMID: 28349744 DOI: 10.1177/0193945917697664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Childhood obesity is a serious health issue, associated with medical comorbidity and psychosocial impairment that can persist into adulthood. In the United States, youth with intellectual and developmental disabilities are more likely to be obese than youth without disabilities. A large body of evidence supports the efficacy of family-based treatment of childhood obesity, including diet, physical activity, and behavior modification, but few interventions have been developed and evaluated specifically for this population. We highlight studies on treatment of obesity among youth with intellectual and developmental disabilities, including both residential/educational settings as well as outpatient/hospital settings. All interventions were delivered in-person, and further development of promising approaches and delivery via telenursing may increase access by youth and families. Nursing scientists can assume an important role in overcoming barriers to care for this vulnerable and underserved population.
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80
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Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:709-757. [PMID: 28359099 PMCID: PMC6283429 DOI: 10.1210/jc.2016-2573] [Citation(s) in RCA: 636] [Impact Index Per Article: 90.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
COSPONSORING ASSOCIATIONS The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSION Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
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Affiliation(s)
- Dennis M Styne
- University of California Davis, Sacramento, California 95817
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81
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Smith JD, St George SM, Prado G. Family-Centered Positive Behavior Support Interventions in Early Childhood To Prevent Obesity. Child Dev 2017; 88:427-435. [PMID: 28195411 PMCID: PMC5342923 DOI: 10.1111/cdev.12738] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Positive behavior support (PBS) strategies in early childhood, which include proactively structuring environments to support and positively reinforce healthy dietary and physical activity behaviors, are critical for preventing pediatric obesity, particularly among low-income, ethnic minority children. Existing evidence-based family-centered preventive interventions effectively impact parents' use of PBS strategies. Enhancing these programs to more directly target the key mechanisms of change specific to promoting children's healthy lifestyle behaviors could serve as the foundation for the next generation of effective protocols for preventing pediatric obesity. Two established programs that target PBS that can be feasibly implemented in a variety of service delivery systems using a multi-tiered, adaptive approach and the next steps of translation are discussed.
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82
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Grugni G, Licenziati MR, Valerio G, Crinò A, Maffeis C, Tanas R, Morino GS. The rehabilitation of children and adolescents with severe or medically complicated obesity: an ISPED expert opinion document. Eat Weight Disord 2017; 22:3-12. [PMID: 27585923 DOI: 10.1007/s40519-016-0305-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022] Open
Abstract
Severe/medically complicated obesity in childhood, and particularly in adolescence, is a real disability that requires an intensive and continuous approach which should follow the procedures and schedule of rehabilitation medicine. Given the lack of a specific document focusing on children and adolescents, the Childhood Obesity Study Group set out to explore the available evidence for the treatment of severe or medically complicated obesity and to set standards tailored to the specific context of the Italian Health Service. Through a series of meetings and electronic communications, the writing committee (selected from members of the Study Group) selected the key issues, explored the literature and produced a draft document which was submitted to the other experts until the final synthesis was approved by the group. In brief, the following issues were involved: (1) definition and epidemiology; (2) identification of common goals designed to regain functional competence and limit the progression of metabolic and psychological complications; (3) a multi-professional team approach; (4) the care setting. This paper is an expert opinion document on the rehabilitation of severe and medically complicated obesity in children and adolescents produced by experts belonging to the Childhood Obesity Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED).
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Affiliation(s)
- Graziano Grugni
- Division of Auxology, Italian Auxological Institute, Verbania, Italy
| | | | - Giuliana Valerio
- Department of Movement Sciences and Wellness, Parthenope University, Naples, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit Bambino Gesù Hospital, Research Hospital Palidoro, Rome, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Rita Tanas
- Pediatric Unit, Azienda Ospedaliera Universitaria, Ferrara, Italy
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83
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Family Functioning Predicts Body Mass Index and Biochemical Levels of Youths with Nonalcoholic Fatty Liver Disease. J Dev Behav Pediatr 2017; 38:155-160. [PMID: 27984419 DOI: 10.1097/dbp.0000000000000379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED : Family functioning is associated with obesity-related chronic illnesses and impedes effective treatment of weight-related conditions, such as nonalcoholic fatty liver disease (NAFLD). OBJECTIVES Evaluate the utility of a brief screening measure of family functioning among youth aged 8 to 18 years being treated in a specialty care clinic for NAFLD. METHODS Thirty-nine youths and their caregivers participated. Relations between family functioning and anthropometric and biochemical variables assessed 3 to 6 months later were evaluated using regression analyses, controlling for child age, gender, and ethnicity. RESULTS Family functioning was related to significantly higher body mass index (BMI) and levels of cholesterol, HbA1c, and glucose, but not serum alanine aminotransferase (ALT)-a marker of NAFLD-controlling for baseline levels. The magnitudes of effects were medium for models of BMI (Cohen's f = 0.29), cholesterol (0.32), and blood glucose (0.30) and small to medium for HbA1c (0.23) and ALT (0.10). CONCLUSION This is the first study to examine the role of family functioning in youth with NALFD. Treatment programs might consider screening for family functioning to identify families that could benefit from a family-centered behavioral intervention.
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84
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Morgan PJ, Young MD, Lloyd AB, Wang ML, Eather N, Miller A, Murtagh EM, Barnes AT, Pagoto SL. Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review. Pediatrics 2017; 139:peds.2016-2635. [PMID: 28130430 PMCID: PMC6200318 DOI: 10.1542/peds.2016-2635] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/26/2022] Open
Abstract
CONTEXT Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. OBJECTIVE This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). DATA SOURCES A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). STUDY SELECTION Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. DATA EXTRACTION Two authors independently extracted data using a predefined template. RESULTS The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. LIMITATIONS The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. CONCLUSIONS Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers.
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Affiliation(s)
- Philip J. Morgan
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia;,Address correspondence to Philip J. Morgan, PhD, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Dr, Callaghan NSW, 2308, Australia. E-mail:
| | - Myles D. Young
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Adam B. Lloyd
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Monica L. Wang
- Department of Community Health Sciences, Boston University, Boston, Massachusetts;,Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts
| | - Narelle Eather
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Andrew Miller
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Elaine M. Murtagh
- Department of Arts Education and Physical Education, Mary Immaculate College, University of Limerick, Limerick, Ireland; and
| | - Alyce T. Barnes
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Sherry L. Pagoto
- Department of Medicine, University of Massachusetts, Worcester, Massachusetts
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Ball GDC, Mushquash AR, Keaschuk RA, Ambler KA, Newton AS. Using Intervention Mapping to develop the Parents as Agents of Change (PAC ©) intervention for managing pediatric obesity. BMC Res Notes 2017; 10:43. [PMID: 28086848 PMCID: PMC5237285 DOI: 10.1186/s13104-016-2361-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 01/01/2023] Open
Abstract
Background Pediatric obesity has become increasingly prevalent over recent decades. In view of the psychosocial and physical health risks, and the high likelihood that children with obesity will grow to become adults with obesity, there is a clear need to develop evidence-based interventions that can be delivered in the health care system to optimize the health and well-being of children with obesity and their families. The aim of this paper is to describe the development, implementation, and planned evaluation of a parent-based weight management intervention designed for parents of 8–12 year olds with obesity. Methods/results The principles of Intervention Mapping (IM) were used to develop an intervention called Parents as Agents of Change (PAC©). From 2006 to 2009, an environmental scan plus qualitative (individual interviews with parents and children), quantitative (medical record reviews), and literature review data were collected to gain broad insight into family factors related to pediatric obesity and its management. Theoretical frameworks and empirical evidence guided curriculum development, which was founded primarily on the tenets of family systems theory and cognitive behavioral theory. PAC was developed as a manualized, 16-session, group-based, health care professional-led intervention for parents to address individual, family, and environmental factors related to the management of pediatric obesity. The intervention was refined based on feedback from local and international experts, and has been implemented successfully in a multi-disciplinary weight management centre in a children’s hospital. Conclusion IM provided a practical framework to guide the systematic development of a pediatric weight management intervention for parents of children with obesity. This logical, step-by-step process blends theory and practice and is broadly applicable in the context of obesity management intervention development and evaluation. Following intervention development, the PAC intervention was evaluated within a randomized clinical trial. Trial registration NCT01267097; clinicaltrials.gov
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, University of Alberta, Room 4-515, Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Aislin R Mushquash
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada
| | - Rachel A Keaschuk
- , #780 Princeton Place, 10339-124th St, Edmonton, AB, T5N 3W1, Canada
| | - Kathryn A Ambler
- Health Technology & Service Policy, Research & Innovation Branch, Strategic Planning & Policy Development Division, Alberta Health, 18th Floor, ATB Building, 10025 Jasper Ave, Edmonton, AB, T5J 1S6, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Room 3-526, Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, AB, T6G 1C9, Canada
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Abstract
OBJECTIVE There is a need to address cultural beliefs and parenting practices regarding childhood obesity to design effective weight-control programmes for overweight/obese US Latino children. The purpose of the current study was to explore cultural beliefs about children's weight, understand parent perceptions on feeding their children, and explore barriers that interfere with a healthy lifestyle. DESIGN Four focus groups were conducted in Spanish with forty-one Latino mothers of elementary school-age children from San Diego County, California between April and May 2011. Cultural viewpoints about overweight status among children and barriers to leading a healthy lifestyle were explored. Focus group discussions were analysed based on a priori and emergent themes. RESULTS Three themes were identified: (i) mothers' cultural beliefs about health that are barriers to family health; (ii) mothers as primary caretakers of their family's health; and (iii) attitudes about targeting children's weight. Mothers acknowledged the idea that 'chubby is better' is a misperception, yet having a 'chubby' child was preferred and even accepted. Mothers described fatalistic beliefs that contradicted existing knowledge of chronic disease and daily demands of Western culture as barriers to practising healthy behaviours in the home as the family caretaker. CONCLUSIONS These findings may be used to inform more culturally appropriate research to address US Latino health. Increasing awareness of cultural beliefs and daily circumstance could help to address obesity more directly and thereby overcome some of the potential underlying barriers that might exist when involving the Latino immigrant families in obesity treatment and prevention.
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87
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Wang ML, Lemon SC, Clausen K, Whyte J, Rosal MC. Design and methods for a community-based intervention to reduce sugar-sweetened beverage consumption among youth: H 2GO! study. BMC Public Health 2016; 16:1150. [PMID: 27829397 PMCID: PMC5103444 DOI: 10.1186/s12889-016-3803-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/01/2016] [Indexed: 11/23/2022] Open
Abstract
Background Reducing sugar-sweetened beverage (SSB) intake is an important dietary target among underserved children at high risk for obesity and associated morbidities. Community-based approaches to reduce SSB intake are needed. The use of narrative-based approaches (presenting messages within the context of a story) can facilitate connection with target health messages and empower children as behavior change agents within their families. The H2GO! program is a community-based behavioral intervention that integrates narrative-based strategies to reduce SSB consumption and promote water intake among school-age youth and parents. Methods Guided by the Social Cognitive Theory and the Social Ecological Model, the H2GO! intervention consists of 6 weekly sessions that target beverage knowledge, attitudes, and behaviors through youth-produced messages and narratives to reduce SSB intake and encourage water intake and parent–child activities. To reach underserved youth and families, we identified Boys & Girls Clubs (B&GC) (youth-based community centers that serve an ethnically diverse and predominantly low socioeconomic status population) as a community partner and study setting. Participants (children ages 9–12 years and their parents) will be recruited from B&GC sites in Massachusetts, USA. Intervention efficacy will be assessed through a site-randomized trial (N = 2 youth-based community sites, pair-matched for size and racial/ethnic composition) with 54 parent–child pairs (N = 108) enrolled per site (N = 216 total). The comparison site will carry on with usual practice. Child and parental SSB and water consumption (primary outcomes) and parent and child beverage knowledge and attitudes (secondary outcomes) will be measured via self-report surveys. Additional outcomes include children’s anthropometric data, additional dietary behaviors, and physical activity. Measures will be collected at baseline, 2 and 6 months follow-up. With an estimated 20 % dropout rate, the study will have 80 % power to detect a group difference of 3.9 servings of SSBs per week. Discussion Community-based approaches hold potential for decreasing SSB consumption among youth and families, particularly among underserved populations who are at greater obesity risk. This article describes the design and methods of a community-based behavioral intervention designed to reduce SSB consumption among youth and parents/caregivers. Trial registration ClinicalTrials.gov NCT02890056. Date of Registration: August 31, 2016
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Affiliation(s)
- Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 4th floor, Boston, MA, 02118, USA.
| | - Stephenie C Lemon
- UMass Worcester Prevention Research Center, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Julie Whyte
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 4th floor, Boston, MA, 02118, USA
| | - Milagros C Rosal
- UMass Worcester Prevention Research Center, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Davison KK, Gicevic S, Aftosmes-Tobio A, Ganter C, Simon CL, Newlan S, Manganello JA. Fathers' Representation in Observational Studies on Parenting and Childhood Obesity: A Systematic Review and Content Analysis. Am J Public Health 2016; 106:e14-e21. [PMID: 27631735 PMCID: PMC5055776 DOI: 10.2105/ajph.2016.303391] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The involvement of fathers in caregiving has increased substantially over the past 30 years. Yet in child and adolescent psychopathology, few studies include fathers as research participants and few present results for fathers separate from those for mothers. We test for the first time whether a similar pattern exists in research on parenting and childhood obesity. OBJECTIVES To conduct a systematic review and quantitative content analysis of observational studies on parenting and childhood obesity to (1) document the inclusion of fathers, relative to mothers, as research participants and (2) examine characteristics of studies that did and did not include fathers. This study presents new data on the number and gender of parent research participants. SEARCH METHODS We searched title, abstract, and Medical Subject Headings term fields in 5 research databases (PubMed, EMBASE, Academic Search Premier, PsycINFO, and CINAHL) using terms combining parents or parenting (e.g., mother, father, caregiver, parenting style, food parenting) and obesity (e.g., obesity, body weight, overweight) or obesity-related lifestyle behaviors (e.g., diet, snacking, physical activity, outdoor play, exercise, media use). SELECTION CRITERIA We identified and screened studies as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) published between January 2009 and December 2015, examining links between parenting and childhood obesity, including parents or caregivers as research participants, and written in English. We excluded interventions, nonhuman studies, dissertations, conference abstracts, and studies on youths with specific medical conditions. Of 5557 unique studies, 667 studies were eligible. DATA COLLECTION AND ANALYSIS For each of the 667 studies, 4 coders were trained to code characteristics of the study (e.g., publication year, geographic region, journal, study focus) and parent research participants (e.g., parent gender, demographic background, biological relationship with child, and residential status). We established intercoder reliability before coding the full sample of studies (mean Krippendorf's alpha = .79; average percentage agreement = 94%). MAIN RESULTS Of the studies, 1% included only fathers. By contrast, 36% included only mothers. Although slightly more than 50% of studies (n = 347) included at least 1 father, only 57 studies reported results for fathers separate from those for mothers. When we combined them with studies including only fathers, 10% of studies overall reported results for fathers. Samples sizes of fathers were small compared with mothers. Of studies with fathers, 59% included 50 or fewer fathers, whereas 22% of studies with mothers included 50 or fewer mothers. The mean sample size for fathers across all eligible studies was 139, compared with 672 for mothers. Overall, fathers represented 17% of parent participants across all eligible studies. CONCLUSIONS This study unequivocally demonstrates that fathers are underrepresented in recent observational research on parenting and childhood obesity. Public health implications. The underrepresentation of fathers in obesity research compromises the development of effective family interventions for childhood obesity prevention. Targeted opportunities and incentives are needed to support research with fathers.
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Affiliation(s)
- Kirsten K Davison
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
| | - Selma Gicevic
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
| | - Alyssa Aftosmes-Tobio
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
| | - Claudia Ganter
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
| | - Christine L Simon
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
| | - Sami Newlan
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
| | - Jennifer A Manganello
- Kirsten K. Davison, Selma Gicevic, Alyssa Aftosmes-Tobio, and Claudia Ganter are with Harvard T. H. Chan School of Public Health, Department of Nutrition, Boston, MA. Kirsten K Davison and Christine L. Simon are with Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston. Sami Newlan is with Harvard T. H. Chan School of Public Health, Department of Epidemiology, Boston. Jennifer A. Manganello is with University at Albany, Department of Health Policy, Management, and Behavior, Rensselaer, NY
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89
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Jalali MS, Sharafi-Avarzaman Z, Rahmandad H, Ammerman AS. Social influence in childhood obesity interventions: a systematic review. Obes Rev 2016; 17:820-32. [PMID: 27138986 DOI: 10.1111/obr.12420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 01/08/2023]
Abstract
The objective of this study is to understand the pathways through which social influence at the family level moderates the impact of childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviours are targeted to change children's obesity outcomes, because of the potential social and environmental influence of parents on the nutrition and physical activity behaviours of children. PubMed (1966-2013) and the Web of Science (1900-2013) were searched, and 32 studies satisfied our inclusion criteria. Results for existing mechanisms that moderate parents' influence on children's behaviour are discussed, and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations for leveraging family-based social influence mechanisms to increase the efficacy of obesity intervention programmes. © 2016 World Obesity.
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Affiliation(s)
- M S Jalali
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Z Sharafi-Avarzaman
- Faculty of Economics and Business Administration, Goethe University Frankfurt, Frankfurt, Germany
| | - H Rahmandad
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A S Ammerman
- Center for Health Promotion & Disease Prevention, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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90
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Dieris B, Reinehr T. Treatment programs in overweight and obese children: How to achieve lifestyle changes? ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.obmed.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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91
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Hammersley ML, Jones RA, Okely AD. Parent-Focused Childhood and Adolescent Overweight and Obesity eHealth Interventions: A Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e203. [PMID: 27443862 PMCID: PMC4974451 DOI: 10.2196/jmir.5893] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/18/2022] Open
Abstract
Background Effective broad-reach interventions to reduce childhood obesity are needed, but there is currently little consensus on the most effective approach. Parental involvement in interventions appears to be important. The use of eHealth modalities in interventions also seems to be promising. To our knowledge, there have been no previous reviews that have specifically investigated the effectiveness of parent-focused eHealth obesity interventions, a gap that this systematic review and meta-analysis intends to address. Objective The objective of this study was to review the evidence for body mass index (BMI)/BMI z-score improvements in eHealth overweight and obesity randomized controlled trials for children and adolescents, where parents or carers were an agent of change. Methods A systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Seven databases were searched for the period January 1995 to April 2015. Primary outcome measures were BMI and/or BMI z-score at baseline and post-intervention. Secondary outcomes included diet, physical activity, and screen time. Interventions were included if they targeted parents of children and adolescents aged 0-18 years of age and used an eHealth medium such as the Internet, interactive voice response (IVR), email, social media, telemedicine, or e-learning. Results Eight studies were included, involving 1487 parent and child or adolescent dyads. A total of 3 studies were obesity prevention trials, and 5 were obesity treatment trials. None of the studies found a statistically significant difference in BMI or BMI z-score between the intervention and control groups at post-intervention, and a meta-analysis demonstrated no significant difference in the effects of parent-focused eHealth obesity interventions compared with a control on BMI/BMI z-score (Standardized Mean Difference −0.15, 95% CI −0.45 to 0.16, Z=0.94, P=.35). Four of seven studies that reported on dietary outcomes demonstrated significant improvements in at least 1 dietary measurement, and 1 of 6 studies that reported on physical activity outcomes demonstrated significant improvements compared with the control. The quality of the interventions was generally not high; therefore, these results should be interpreted with caution. Conclusion It is recommended that larger, longer duration, high-quality parent-focused eHealth studies are conducted, which transform successful components from face-to-face interventions into an eHealth format and target younger age groups in particular. Trial Registration PROSPERO International Prospective Register of Systematic Reviews: CRD42015019837; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015019837 (Archived by WebCite at http://www.webcitation.org/6ivBHvBhq)
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Affiliation(s)
- Megan L Hammersley
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.
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92
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Fenner AA, Howie EK, Davis MC, Straker LM. Relationships between psychosocial outcomes in adolescents who are obese and their parents during a multi-disciplinary family-based healthy lifestyle intervention: One-year follow-up of a waitlist controlled trial (Curtin University's Activity, Food and Attitudes Program). Health Qual Life Outcomes 2016; 14:100. [PMID: 27389034 PMCID: PMC4936224 DOI: 10.1186/s12955-016-0501-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Limited studies have investigated relationships in psychosocial outcomes between adolescents who are obese and their parents and how psychosocial outcomes change during participation in a physical activity and healthy eating intervention. This study examined both adolescent and parent psychosocial outcomes while participating in a one - year multi-disciplinary family-based intervention: Curtin University's Activity, Food, and Attitudes Program (CAFAP). METHODS Following a waitlist control period, the intervention was delivered to adolescent (n = 56, ages 11-16) and parent participants over 8 weeks, with one-year maintenance follow-up. Adolescent depression and quality of life, family functioning, and parent depression, anxiety, and stress were assessed at six time points: baseline and prior to intervention (e.g., waitlist control period), immediately following intervention, and at 3, 6, and 12 months post-intervention. Relationships between adolescent and parent psychosocial outcomes were assessed using Spearman correlations and changes in both adolescent and parent outcomes were assessed using linear mixed models. Changes in adolescent psychosocial outcomes were compared to changes in behavioural (physical activity and healthy eating) and physical (weight) outcomes using independent samples t-tests. RESULTS The majority of psychosocial outcomes were significantly correlated between adolescents and parents across the one-year follow-up. Adolescent depression, psychosocial and physical quality of life outcomes significantly improved before or following intervention and were maintained at 6-months or one-year follow-up. Parent symptoms of depression, anxiety, and stress were reduced during waitlist and primarily remained improved. Changes in adolescent psychosocial outcomes were shown to be partially associated with behavioural changes and independent of physical changes. CONCLUSIONS Adolescents in CAFAP improved psychosocial and physical quality of life and reversed the typical trajectory of depressive symptoms in adolescents who are obese during a one-year maintenance period. CAFAP was also effective at maintaining reductions in parent symptoms of depression, anxiety, and stress demonstrated during the waitlist period. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry (No. 12611001187932 ).
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Affiliation(s)
- Ashley A. Fenner
- />School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Erin K. Howie
- />School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Melissa C. Davis
- />School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Leon M. Straker
- />School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
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93
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Naar-King S, Ellis DA, Carcone AI, Templin T, Jacques-Tiura AJ, Brogan Hartlieb K, Cunningham P, Jen KLC. Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 45:428-41. [PMID: 25668386 PMCID: PMC4658314 DOI: 10.1080/15374416.2014.971459] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to develop an adaptive behavioral treatment for African American adolescents with obesity. In a sequential multiple assignment randomized trial, 181 youth ages 12-16 years with primary obesity and their caregiver were first randomized to 3 months of home-based versus office-based delivery of motivational interviewing plus skills building. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based skills or contingency management. Primary outcome was percent overweight and hypothesized moderators were adolescent executive functioning and depression. There were no significant differences in primary outcome between home-based or office-based delivery or between continued home-based skills or contingency management for nonresponders to first-phase treatment. However, families receiving home-based treatment initially attended significantly more sessions in both phases of the trial, and families receiving contingency management attended more sessions in the second phase. Overall, participants demonstrated decreases in percent overweight over the course of the trial (3%), and adolescent executive functioning moderated this effect such that those with higher functioning lost more weight. More potent behavioral treatments to address the obesity epidemic are necessary, targeting new areas such as executive functioning. Delivering treatment in the home with contingency management may increase session attendance for this population.
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94
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Granich J, Lin A, Hunt A, Wray J, Dass A, Whitehouse AJ. Obesity and associated factors in youth with an autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:916-926. [PMID: 26893400 DOI: 10.1177/1362361315616345] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Weight status on children and youth with autism spectrum disorder is limited. We examined the prevalence of overweight/obesity in children and youth with autism spectrum disorder, and associations between weight status and range of factors. Children and youth with autism spectrum disorder aged 2-16 years (n = 208) and their parents participated in this study. Body mass index was calculated using the Centers for Disease Control and Prevention growth charts and the International Obesity Task Force body mass index cut-offs. The Autism Diagnostic Observation Schedule was administered. Parents completed questionnaires about socio-demographics, diagnosed comorbidities, sleep disturbances, social functioning and medication of youth with autism spectrum disorder. The prevalence of overweight/obesity in participants with autism spectrum disorder was 35%. One quarter of obese children and youth (25.6%) had obese parents. There was a significant association between children and youth's body mass index and maternal body mass index (r = 0.25, n = 199, p < 0.001). The gender and age, parental education, family income, ethnicity, autism spectrum disorder severity, social functioning, psychotropic and complementary medication use of children and youth with autism spectrum disorder were not statistically associated with their weight status. Findings suggest the need for clinical settings to monitor weight status of children and youth with autism spectrum disorder in a bid to manage or prevent overweight/obesity in this population. Incorporating a family system approach to influence health behaviours among children and youth with autism spectrum disorder especially for specific weight interventions is warranted and should be further explored.
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Affiliation(s)
| | | | | | - John Wray
- Child and Adolescent Health Service, Australia
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95
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Fulkerson JA, Friend S, Flattum C, Horning M, Draxten M, Neumark-Sztainer D, Gurvich O, Story M, Garwick A, Kubik MY. Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial. Int J Behav Nutr Phys Act 2015; 12:154. [PMID: 26667110 PMCID: PMC4678662 DOI: 10.1186/s12966-015-0320-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
Background Family meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth. Methods Families (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011–2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score. Results General linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts. Conclusions The study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding. Trial registration This study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.
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Affiliation(s)
- Jayne A Fulkerson
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - Sarah Friend
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - Colleen Flattum
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - Melissa Horning
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - Michelle Draxten
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Dianne Neumark-Sztainer
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Olga Gurvich
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - Mary Story
- Community & Family Medicine and Global Health, Duke University, Durham, North Carolina, USA.
| | - Ann Garwick
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - Martha Y Kubik
- School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
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Hartlieb KB, Naar S, Ledgerwood DM, Templin TN, Ellis DA, Donohue B, Cunningham PB. Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study. Int J Adolesc Med Health 2015; 29:/j/ijamh.2017.29.issue-3/ijamh-2015-0091/ijamh-2015-0091.xml. [PMID: 26641960 DOI: 10.1515/ijamh-2015-0091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. OBJECTIVE To examine the effects of CM in improving adolescent weight loss when added to BST. DESIGN The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. PARTICIPANTS/SETTING Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. INTERVENTION Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. MAIN OUTCOME MEASURES Youth weight. STATISTICAL ANALYSIS PERFORMED Linear mixed effects modeling was used in the analysis. RESULTS CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. CONCLUSION This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.
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Henneman L, McBride CM, Cornel MC, Duquette D, Qureshi N. Screening for Familial Hypercholesterolemia in Children: What Can We Learn From Adult Screening Programs? Healthcare (Basel) 2015; 3:1018-30. [PMID: 27417810 PMCID: PMC4934628 DOI: 10.3390/healthcare3041018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 12/30/2022] Open
Abstract
Familial hypercholesterolemia (FH), an autosomal dominant atherosclerotic disease, is a common monogenic subtype of cardiovascular disease. Patients with FH suffer an increased risk of early onset heart disease. Early identification of abnormally elevated cholesterol signpost clinicians to interventions that will significantly decrease risk of related morbidity and mortality. Cascade genetic testing can subsequently identify at-risk relatives. Accordingly, a number of screening approaches have been implemented for FH in countries including the UK and the Netherlands. However, incomplete identification of cases remains a challenge. Moreover, the potential for early intervention is now raising questions about the value of implementing universal cholesterol screening approaches that focus on children. In this report, we briefly discuss the potential benefit of such screening. Additionally, we submit that ever increasing genome technological capability will force a discussion of including genetic tests in these screening programs. We discuss the opportunities and challenges presented by such an approach. We close with recommendations that the success of such screening endeavors will rely on a better integrated practice model in public health genomics that bridges stakeholders including practitioners in primary care, clinical genetics and public health.
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Affiliation(s)
- Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.
| | - Colleen M McBride
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Martina C Cornel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.
| | - Debra Duquette
- Genomics and Genetic Disorders Section, Michigan Department of Health and Human Services, Lansing, MI 48909, USA.
| | - Nadeem Qureshi
- Division of Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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Maximova K, Ambler KA, Rudko JN, Chui N, Ball GDC. Ready, set, go! Motivation and lifestyle habits in parents of children referred for obesity management. Pediatr Obes 2015; 10:353-60. [PMID: 25394883 DOI: 10.1111/ijpo.272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 07/29/2014] [Accepted: 09/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parents play a fundamental role in helping children with obesity to make and maintain healthy lifestyle changes. OBJECTIVE This study aimed to characterize stages of engagement to change nutrition and physical activity habits among parents whose children with obesity were enrolled in obesity management and examine differences in parents' own nutrition and physical activity habits according to their stage of engagement. METHODS Medical records of 113 children (body mass index [BMI] ≥95th percentile) enrolled in an outpatient weight management clinic were reviewed for baseline (cross-sectional) data. Parents completed the Weight Loss Behavior-Stage of Change Scale to assess the degree of engagement in making healthy changes to their lifestyle behaviours. Latent class analysis was used to classify parents into distinct clusters by grouping individuals with similar ratings of stages of engagement regarding nutrition- and physical activity-related behaviours. RESULTS Parents' engagement in healthy lifestyle behaviours varied (more engaged [n = 43]; less engaged [n = 70]). A greater proportion of parents in the more engaged group was in action and/or maintenance stages of changing their lifestyle habits. The more engaged group was less overweight than the less engaged group (BMI = 28.5 vs. 33.3 kg m(-2); P < 0.05). Further, the more engaged group consumed fewer total calories, calories from fat, trans fat and carbohydrates vs. their less engaged peers (P < 0.05). Compared with the less engaged group, the more engaged group consumed more daily servings of vegetables and fruits (4.9 vs. 3.9, P < 0.05) and accumulated more steps per day (9130 vs. 7225; P < 0.05). The more engaged group was also more likely to meet daily recommendations for vegetable and fruit intake (48.8 vs. 24.3%; P < 0.05) and physical activity (42.9 vs. 22.9%, P < 0.05). CONCLUSIONS Parents of children with obesity varied in their degree of engagement in making healthy changes to their lifestyle behaviours, and those categorized as more engaged already demonstrated positive lifestyle behaviours. Information regarding parents' degree of engagement in healthy behaviours can inform clinical recommendations, especially when parents represent the primary agents of change in families trying to manage paediatric obesity.
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Affiliation(s)
- K Maximova
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - K A Ambler
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J N Rudko
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - N Chui
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - G D C Ball
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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99
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Boutelle KN, Braden A, Douglas JM, Rhee KE, Strong D, Rock CL, Wilfley DE, Epstein L, Crow S. Design of the FRESH study: A randomized controlled trial of a parent-only and parent-child family-based treatment for childhood obesity. Contemp Clin Trials 2015; 45:364-370. [PMID: 26358536 DOI: 10.1016/j.cct.2015.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
Approximately 1 out of 3 children in the United States is overweight or obese. Family-based treatment (FBT) is considered the gold-standard treatment for childhood obesity, but FBT is both staff and cost intensive. Therefore, we developed the FRESH (Family, Responsibility, Education, Support, & Health) study to evaluate the effectiveness of intervening with parents, without child involvement, to facilitate and improve the child's weight status. Targeting parents directly in the treatment of childhood obesity could be a promising approach that is developmentally appropriate for grade-school age children, highly scalable, and may be more cost effective to administer. The current paper describes the FRESH study which was designed to compare the effectiveness of parent-based therapy for pediatric obesity (PBT) to a parent and child (FBT) program for childhood obesity. We assessed weight, diet, physical activity, and parenting, as well as cost-effectiveness, at baseline, post-treatment, and at 6- and 18-month follow-ups. Currently, all participants have been recruited and completed assessment visits, and the initial stages of data analysis are underway. Ultimately, by evaluating a PBT model, we hope to optimize available child obesity treatments and improve their translation into clinical settings.
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Affiliation(s)
- Kerri N Boutelle
- University of California San Diego, Department of Pediatrics, United States; University of California San Diego, Department of Psychiatry, United States.
| | - Abby Braden
- University of California San Diego, Department of Pediatrics, United States
| | - Jennifer M Douglas
- University of California San Diego, Department of Pediatrics, United States
| | - Kyung E Rhee
- University of California San Diego, Department of Pediatrics, United States
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Cheryl L Rock
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Denise E Wilfley
- Washington University in St. Louis School of Medicine, Department of Psychiatry, United States
| | - Leonard Epstein
- University at Buffalo, Department of Pediatrics, United States
| | - Scott Crow
- University of Minnesota, Department of Psychiatry, United States; The Emily Program, United States
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100
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Falbe J, Cadiz AA, Tantoco NK, Thompson HR, Madsen KA. Active and Healthy Families: A Randomized Controlled Trial of a Culturally Tailored Obesity Intervention for Latino Children. Acad Pediatr 2015; 15:386-95. [PMID: 25937516 DOI: 10.1016/j.acap.2015.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a critical need for culturally relevant interventions to address obesity among Latino children, who have a greater risk of obesity and diabetes than non-Hispanic white children. To test the impact of a family-centered, culturally tailored obesity intervention delivered through group medical appointments on body mass index (BMI) and other measures of cardiovascular risk among Latino children. METHODS In a randomized controlled trial, 55 parent-child dyads were assigned to Active and Healthy Families (AHF) or a usual care wait-list control condition. Dyads were eligible if they spoke Spanish and if the child received care in a federally qualified health center, was aged 5 to 12 years, had a BMI in the 85th percentile or higher, and had not participated in AHF. The 10-week AHF intervention included biweekly group sessions delivered by a registered dietitian, physician, and promotora triad. Sessions covered topics such as parenting, screen time, healthy beverages, physical activity, and stress due to immigration. RESULTS Child BMI (kg/m(2)) decreased (-0.50) in the AHF group and increased (+0.32) in the control group, yielding an adjusted difference in change of -0.78 (95% confidence interval [CI] -1.28, -0.27). Children assigned to AHF also exhibited relative improvements over controls in BMI z score (-0.10; 95% CI -0.19, -0.02) and triglycerides (-26.8 mg/dL; 95% CI -50.1, -3.6), but no significant between-group differences were observed for blood pressure or other fasting blood measures. CONCLUSIONS AHF resulted in reductions in child BMI, BMI z score, and triglycerides. AHF, which was designed for low-income Latino families, has potential to reduce health disparities, but future studies are needed to determine long-term impact.
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Affiliation(s)
- Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif.
| | - Annabelle A Cadiz
- Contra Costa Public Health, Contra Costa Health Services, Martinez, Calif
| | - Nicole K Tantoco
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif
| | - Hannah R Thompson
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif
| | - Kristine A Madsen
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Calif
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