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de Pooter N, van den Eynde E, Raat H, Seidell JC, van den Akker EL, Halberstadt J. Perspectives of healthcare professionals on facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle. PEC INNOVATION 2022; 1:100074. [PMID: 37213756 PMCID: PMC10194305 DOI: 10.1016/j.pecinn.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore the perspectives of healthcare professionals (HCPs) within an integrated care approach on the facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle. Methods Semi-structured interviews were conducted with eighteen HCPs working within a Dutch integrated care approach. The interviews were analyzed by performing a thematic content analysis. Results Main facilitators identified by HCPs were support from parents and the social network. Main barriers were first and foremost family's lack of motivation, which was singled out as a precondition for starting the behavior change process. Other barriers were child's socio-emotional problems, parental personal problems, lack of parenting skills, parental lack of knowledge and skills regarding a healthier lifestyle, parental lack of problem awareness and HCP's negative attitude. To overcome these barriers, main needs that HCPs suggested were a tailored approach in healthcare and a supportive HCP. Conclusion The HCPs identified the breadth and complexity of underlying factors of childhood obesity, of which the family's motivation was pointed out as a critical factor to address. Innovation Understanding the patient's perspective is important for HCPs to provide the tailored care needed to address the complexity of childhood obesity.
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Affiliation(s)
- Naomi de Pooter
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
- Corresponding author at: Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Emma van den Eynde
- Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jacob C. Seidell
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Jutka Halberstadt
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Effects of metformin administration on endocrine-metabolic parameters, visceral adiposity and cardiovascular risk factors in children with obesity and risk markers for metabolic syndrome: A pilot study. PLoS One 2019; 14:e0226303. [PMID: 31821361 PMCID: PMC6903728 DOI: 10.1371/journal.pone.0226303] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Metformin treatment (1000–2000 mg/day) over 6 months in pubertal children and/or adolescents with obesity and hyperinsulinism is associated with a reduction in body mass index (BMI) and the insulin resistance index (HOMA-IR). We aimed to ascertain if long-term treatment (24 months) with lower doses of metformin (850 mg/day) normalizes the endocrine-metabolic abnormalities, improves body composition, and reduces the carotid intima-media thickness (cIMT) in pre-puberal and early pubertal children with obesity. Methods A pilot double-blind, placebo-controlled trial was conducted on 18 pre-puberal and early pubertal (Tanner stage I-II) children with obesity and risk markers for metabolic syndrome. Patients were randomly assigned (1:1) to receive metformin (850 mg/day) or placebo for 24 months. Clinical, biochemical (insulin, lipids, leptin, and high-sensitivity C-reactive protein [hsCRP]), and imaging (body composition [dual-energy X-ray absorptiometry and magnetic resonance imaging]) parameters as well as cIMT (ultrasonography) were assessed at baseline and at 6, 12, and 24 months. Results The 12-month treatment tend to cause a reduction in weight standard deviation scores (SDS), BMI-SDS, leptin, leptin–to–high-molecular-weight (HMW) adiponectin ratio, hsCRP, cIMT, fat mass, and liver fat in metformin-treated children compared with placebo. The effect of metformin on the reduction of BMI-SDS, leptin, leptin-to-HMW adiponectin ratio, hsCRP, and liver fat seemed to be maintained after completing the 24 months of treatment. No changes in insulin sensitivity (HOMA-IR) or adverse effects were detected. Conclusion In this pilot study, metformin treatment in pre-puberal and early pubertal children with obesity seemed to improve body composition and inflammation markers. Our data encourage the development of future fully powered trials using 850 mg/day metformin in young children, highlighting its excellent tolerance and potential long-term benefits.
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Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and Adolescent Obesity in the United States: A Public Health Concern. Glob Pediatr Health 2019; 6:2333794X19891305. [PMID: 31832491 PMCID: PMC6887808 DOI: 10.1177/2333794x19891305] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 10/12/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022] Open
Abstract
Childhood and adolescent obesity have reached epidemic levels in the United States. Currently, about 17% of US children are presenting with obesity. Obesity can affect all aspects of the children including their psychological as well as cardiovascular health; also, their overall physical health is affected. The association between obesity and other conditions makes it a public health concern for children and adolescents. Due to the increase in the prevalence of obesity among children, a variety of research studies have been conducted to discover what associations and risk factors increase the probability that a child will present with obesity. While a complete picture of all the risk factors associated with obesity remains elusive, the combination of diet, exercise, physiological factors, and psychological factors is important in the control and prevention of childhood obesity; thus, all researchers agree that prevention is the key strategy for controlling the current problem. Primary prevention methods are aimed at educating the child and family, as well as encouraging appropriate diet and exercise from a young age through adulthood, while secondary prevention is targeted at lessening the effect of childhood obesity to prevent the child from continuing the unhealthy habits and obesity into adulthood. A combination of both primary and secondary prevention is necessary to achieve the best results. This review article highlights the health implications including physiological and psychological factors comorbidities, as well as the epidemiology, risk factors, prevention, and control of childhood and adolescent obesity in the United States.
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Affiliation(s)
| | | | - Xiaohua Qi
- Saint James School of Medicine, Anguilla, British West Indies
| | - Jennifer Locke
- Saint James School of Medicine, Anguilla, British West Indies
| | - Saif Rehman
- Saint James School of Medicine, Anguilla, British West Indies
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Singendonk M, Kritas S, Omari T, Feinle-Bisset C, Page AJ, Frisby CL, Kentish SJ, Ferris L, McCall L, Kow L, Chisholm J, Khurana S. Upper Gastrointestinal Function in Morbidly Obese Adolescents Before and 6 Months After Gastric Banding. Obes Surg 2019; 28:1277-1288. [PMID: 29103072 DOI: 10.1007/s11695-017-3000-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effects of laparoscopic adjustable gastric band (LAGB) placement on upper gastrointestinal tract function in obese adolescents are unknown. Therefore, our aim was to determine the short-term effects of LAGB on esophageal motility, gastroesophageal reflux, gastric emptying, appetite-regulatory hormones, and perceptions of post-prandial hunger and fullness. METHODS This study was part of a prospective cohort study (March 2009-December 2015) in one tertiary referral hospital. The study included obese adolescents (14-18 years) with a body mass index (BMI) > 40 (or ≥ 35 with comorbidities). Gastric emptying was assessed by 13C-octanoic acid breath test, pharyngeal, and esophageal motor function by high-resolution manometry with impedance (HRIM), and appetite and other perceptions using 100-mm visual analogue scales. Dysphagia symptoms were scored using a Dakkak questionnaire. Data were compared pre- and post-LAGB placement and at a 6-month follow-up. RESULTS Based upon analysis of 15 adolescents, at the 6-month follow-up, LAGB placement: (i) led to a significant reduction in weight and BMI; (ii) increased fullness and decreased hunger post-meal; (iii) increased symptoms of dysphagia after solid food; and, despite these effects, (iv) caused little or no changes to appetite hormones, while (v) effects on gastric emptying, esophageal motility, esophageal bolus transport, and esophageal emptying were not significant. CONCLUSION In adolescents, LAGB improved BMI and altered the sensitivity to nutrients without significant effects on upper gastrointestinal tract physiology at the 6-month follow-up.
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Affiliation(s)
- M Singendonk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/AMC, Amsterdam, The Netherlands
| | - S Kritas
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - T Omari
- Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
| | - C Feinle-Bisset
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - A J Page
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - C L Frisby
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - S J Kentish
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - L Ferris
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia.,Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - L McCall
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - L Kow
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - J Chisholm
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - S Khurana
- Paediatric Surgery & Urology, Women's & Children's Hospital, Adelaide, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, Australia
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Halberstadt J, de Vet E, Nederkoorn C, Jansen A, van Weelden OH, Eekhout I, Heymans MW, Seidell JC. The association of self-regulation with weight loss maintenance after an intensive combined lifestyle intervention for children and adolescents with severe obesity. BMC OBESITY 2017; 4:13. [PMID: 28451439 PMCID: PMC5404304 DOI: 10.1186/s40608-016-0140-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knowledge is limited on the role the ability to self-regulate plays in the long-term outcome of obesity treatment in children and adolescents with severe obesity. The purpose of this study was to determine whether the ability to self-regulate after an one year intensive, partly inpatient, combined lifestyle intervention is associated with weight loss maintenance in children and adolescents with severe obesity. METHODS One hundred twenty participants (8-19 years) with an average SDS-BMI of 3.41 and their parents/caregivers were included in an intervention study. As primary determinant of weight loss maintenance, general self-regulation ability was evaluated using two behavioral computer tasks assessing inhibitory control and sensitivity to reward. RESULTS There was no association between inhibitory control at T12 and ∆SDS-BMI between T12 and T24 (β = 0.0002; CI 95% = -0.0010-0.0014; P = 0.761). There was also no relation between sensitivity to reward at T12 and ∆SDS-BMI between T12 and T24 (β = -0.0028; CI 95% = -0.0075-0.0019; P = 0.244). None of the psychosocial factors that were examined as moderators, showed a statistically significant interaction, except for parental feeding style (P = 0.023). CONCLUSIONS The ability to self-regulate after an intensive, partly inpatient, multidisciplinary one year intervention for severe obesity in children and adolescents was not associated with the ability to maintain the achieved weight loss during the following year. Factors that explain the large range of long term outcomes need to be elucidated. TRIAL REGISTRATION Netherlands Trial Register (NTR1678, registered 20-Feb-2009).
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Affiliation(s)
- Jutka Halberstadt
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Emely de Vet
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands.,Sub-department Communication, Philosophy and Technology: Centre for Integrative Development, Chairgroup Strategic Communication, Wageningen University, Wageningen, The Netherlands
| | - Chantal Nederkoorn
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Anita Jansen
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Ottelien H van Weelden
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Iris Eekhout
- Department of Epidemiology & Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology & Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
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Maternal characteristics associated with the obesogenic quality of the home environment in early childhood. Appetite 2016; 107:392-397. [DOI: 10.1016/j.appet.2016.08.108] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/22/2022]
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Axon E, Atkinson G, Richter B, Metzendorf M, Baur L, Finer N, Corpeleijn E, O'Malley C, Ells LJ. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 2016; 11:CD012436. [PMID: 27899001 PMCID: PMC6472619 DOI: 10.1002/14651858.cd012436] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Child and adolescent obesity has increased globally, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of drug interventions for the treatment of obesity in children and adolescents. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed (subsets not available on Ovid), LILACS as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to March 2016. We checked references and applied no language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of pharmacological interventions for treating obesity (licensed and unlicensed for this indication) in children and adolescents (mean age under 18 years) with or without support of family members, with a minimum of three months' pharmacological intervention and six months' follow-up from baseline. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. In addition, we excluded trials which included growth hormone therapies and pregnant participants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data following standard Cochrane methodology. Where necessary we contacted authors for additional information. MAIN RESULTS We included 21 trials and identified eight ongoing trials. The included trials evaluated metformin (11 trials), sibutramine (six trials), orlistat (four trials), and one trial arm investigated the combination of metformin and fluoxetine. The ongoing trials evaluated metformin (four trials), topiramate (two trials) and exenatide (two trials). A total of 2484 people participated in the included trials, 1478 participants were randomised to drug intervention and 904 to comparator groups (91 participants took part in two cross-over trials; 11 participants not specified). Eighteen trials used a placebo in the comparator group. Two trials had a cross-over design while the remaining 19 trials were parallel RCTs. The length of the intervention period ranged from 12 weeks to 48 weeks, and the length of follow-up from baseline ranged from six months to 100 weeks.Trials generally had a low risk of bias for random sequence generation, allocation concealment and blinding (participants, personnel and assessors) for subjective and objective outcomes. We judged approximately half of the trials as having a high risk of bias in one or more domain such as selective reporting.The primary outcomes of this review were change in body mass index (BMI), change in weight and adverse events. All 21 trials measured these outcomes. The secondary outcomes were health-related quality of life (only one trial reported results showing no marked differences; very low certainty evidence), body fat distribution (measured in 18 trials), behaviour change (measured in six trials), participants' views of the intervention (not reported), morbidity associated with the intervention (measured in one orlistat trial only reporting more new gallstones following the intervention; very low certainty evidence), all-cause mortality (one suicide in the orlistat intervention group; low certainty evidence) and socioeconomic effects (not reported).Intervention versus comparator for mean difference (MD) in BMI change was -1.3 kg/m2 (95% confidence interval (CI) -1.9 to -0.8; P < 0.00001; 16 trials; 1884 participants; low certainty evidence). When split by drug type, sibutramine, metformin and orlistat all showed reductions in BMI in favour of the intervention.Intervention versus comparator for change in weight showed a MD of -3.9 kg (95% CI -5.9 to -1.9; P < 0.00001; 11 trials; 1180 participants; low certainty evidence). As with BMI, when the trials were split by drug type, sibutramine, metformin and orlistat all showed reductions in weight in favour of the intervention.Five trials reported serious adverse events: 24/878 (2.7%) participants in the intervention groups versus 8/469 (1.7%) participants in the comparator groups (risk ratio (RR) 1.43, 95% CI 0.63 to 3.25; 1347 participants; low certainty evidence). A total 52/1043 (5.0%) participants in the intervention groups versus 17/621 (2.7%) in the comparator groups discontinued the trial because of adverse events (RR 1.45, 95% CI 0.83 to 2.52; 10 trials; 1664 participants; low certainty evidence). The most common adverse events in orlistat and metformin trials were gastrointestinal (such as diarrhoea, mild abdominal pain or discomfort, fatty stools). The most frequent adverse events in sibutramine trials included tachycardia, constipation and hypertension. The single fluoxetine trial reported dry mouth and loose stools. No trial investigated drug treatment for overweight children. AUTHORS' CONCLUSIONS This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post-intervention follow-up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long-term follow-up, to ensure the long-term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials.
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Affiliation(s)
- Emma Axon
- University of NottinghamCochrane Skin GroupNottinghamUKNG7 2NR
| | - Greg Atkinson
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Nicholas Finer
- UCL Institute of Cardiovascular ScienceNational Centre for Cardiovascular Prevention and Outcomes170 Tottenham Court RoadLondonUKW1T 7HA
- Novo Nordisk A/SGlobal Medical Affairs ManagementCopenhagenDenmark
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUKDH1 3HN
| | - Louisa J Ells
- Teesside UniversitySchool of Health and Social CareParkside West OfficesMiddlesbroughUKTS1 3BA
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Makkes S, Renders CM, Bosmans JE, van der Baan-Slootweg OH, Hoekstra T, Seidell JC. One-year effects of two intensive inpatient treatments for severely obese children and adolescents. BMC Pediatr 2016; 16:120. [PMID: 27484299 PMCID: PMC4971643 DOI: 10.1186/s12887-016-0659-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive inpatient lifestyle treatment may be a suitable alternative for severely obese children and adolescents who do not benefit from ambulatory obesity treatment. The aim was to evaluate the effectiveness of two intensive one-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to SDS-BMI and cardiometabolic risk factors. METHODS The study was designed as a randomized controlled trial with two active treatment groups. Eighty participants (8-19 years) with severe obesity received treatment at a specialized childhood obesity center in the Netherlands. Severe obesity was defined as a SDS-BMI ≥ 3.0 or a SDS-BMI ≥ 2.3 in combination with obesity-related comorbidity. Participants received an intensive one-year lifestyle treatment with an inpatient period of either two months and biweekly return visits during the next four months (short-stay group) or six months (long-stay group), both followed by six monthly return visits. Outcomes were assessed at baseline, six and 12 months and included SDS-BMI as primary outcome and cardiometabolic risk factors such as SDS-waist circumference, systolic- and diastolic blood pressure, and blood measurements as secondary outcomes. To evaluate differences in the course of the primary- and secondary outcomes over time between the two treatment groups, Generalized Estimating Equations (GEE) were performed. RESULTS No differences in the course of SDS-BMI or secondary outcomes over time were found between the two treatment groups after one year of treatment. SDS-BMI decreased statistically significantly after one year of treatment compared with baseline in both groups (0.33 (0.48) in the short-stay and 0.52 (0.49) in the long-stay group). Similar results were found for SDS-waist circumference, diastolic blood pressure and HDL-cholesterol. CONCLUSIONS Since there were no significant differences in effects between the short- and long-stay treatment and considering the burden of the long-stay treatment for children and families, we recommend implementation of the short-stay treatment. TRIAL REGISTRATION Netherlands Trial Register NTR1678 , registered 20-Feb-2009.
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Affiliation(s)
- Sabine Makkes
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Carry M. Renders
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Trynke Hoekstra
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacob C. Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, Section Prevention and Public Health, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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The association of eating styles with weight change after an intensive combined lifestyle intervention for children and adolescents with severe obesity. Appetite 2016; 99:82-90. [PMID: 26752600 DOI: 10.1016/j.appet.2015.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/21/2015] [Accepted: 12/31/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED The main purpose of this prospective intervention study was to determine whether eating styles after an intensive, partly inpatient, one year combined lifestyle intervention are associated with weight change in the following year in severely obese children and adolescents. A total of 120 participants (8-19 years) with an average SDS-BMI of 3.41 (SD = 0.38) was included. Measurements were conducted at baseline (T0), at the end of treatment (T12) and at the end of follow up two years after baseline (T24). The primary outcome measurement was the ΔSDS-BMI between T12 and T24. As primary determinant of weight change after treatment, the participants eating styles were evaluated with the Dutch Eating Behavior Questionnaire - child report that measures external, emotional and restraint eating. The association between outcome and determinant was assessed in linear regression analyses. Complete data were available for 76 of the 120 participants. This study shows that for girls a higher score on restraint eating at T12 and a higher score on external eating at T12 were associated with more weight (re)gain in the year after treatment. No statistically significant association with emotional eating at T12 was found. In addition for girls a higher score on external eating at T0 was associated with more weight (re)gain in the year after treatment. Furthermore, the observed changes in eating styles suggest that on average it is possible to influence these with treatment, although the detected changes were different for girls and boys and for the different eating styles. More generally, this study indicates that for girls the levels of restraint and external eating after treatment were associated with the weight change during the following year. TRIAL REGISTRATION Netherlands Trial Register (NTR1678, registered 20-Feb-2009).
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Wiegand S, Keller KM, Lob-Corzilius T, Pott W, Reinehr T, Röbl M, Stachow R, Tuschy S, Weidanz I, Widhalm K, de Zwaan M, Holl RW. Predicting weight loss and maintenance in overweight/obese pediatric patients. Horm Res Paediatr 2015; 82:380-7. [PMID: 25531074 DOI: 10.1159/000368963] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric lifestyle interventions have positive short-term effects on obese patients. Studies on long-term effects are still scarce in Europe. We investigated long-term weight patterns and sociodemographic predictors of a weight change in a large Central European (Germany, Austria and Switzerland) overweight pediatric cohort. METHODS The APV (Adiposity Patients Verlaufsbeobachtung) database was retrospectively analyzed; 157 specialized childhood obesity centers contributed standardized data of 29,181 patients [body mass index (BMI) ≥ 90th percentile; 5-25 years old] presenting between 2000 and 2012. BMI standard deviation scores (BMI-SDS) were analyzed in a 2-year follow-up and grouped according to BMI-SDS changes. Multiple logistic regression analyses were conducted to assess associations between sociodemographic factors and weight patterns. RESULTS 2-year follow-up data were available in 3,135 patients (54.6% female). Five distinct weight trajectories 'rapid weight loss' (n = 735, 23.4%), 'delayed success' (n = 697, 22.2%), 'cycling weight' (n = 43, 1.4%), 'initial weight loss' and 'weight rebound' (n = 383, 12.2%) and 'no weight loss throughout' (n = 1,277, 40.7%) best characterized long-term BMI-SDS changes. Younger and male patients were more likely to reduce weight and maintain weight loss. CONCLUSIONS Our results suggest that an intervention before the onset of puberty seems promising for long-term weight maintenance in overweight children. Thus, new concepts are needed to improve long-term treatment success in patients with lower success rates.
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Affiliation(s)
- Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine, Berlin, Germany
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Holterman A, Gurria J, Tanpure S, DiSomma N. Nonalcoholic fatty liver disease and bariatric surgery in adolescents. Semin Pediatr Surg 2014; 23:49-57. [PMID: 24491369 DOI: 10.1053/j.sempedsurg.2013.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obesity is a multi-organ system disease with underlying insulin resistance and systemic chronic inflammation. Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of the underlying metabolic dysfunction. This review provides a highlight of the current understanding of NAFLD pathogenesis and disease characteristics, with updates on the challenges of NAFLD management in obese and severely obese (SO) patients and recommendations for the pediatric surgeons' role in the care of SO adolescents.
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Affiliation(s)
- AiXuan Holterman
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois; Pediatric Surgery, Children's Hospital of Illinois, University of Illinois College of Medicine, Peoria, Illinois.
| | - Juan Gurria
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois
| | - Smita Tanpure
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois; Pediatric Surgery, Children's Hospital of Illinois, University of Illinois College of Medicine, Peoria, Illinois
| | - Nerina DiSomma
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois; Pediatric Surgery, Children's Hospital of Illinois, University of Illinois College of Medicine, Peoria, Illinois
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Halberstadt J, Makkes S, de Vet E, Jansen A, Nederkoorn C, van der Baan-Slootweg OH, Seidell JC. The role of self-regulating abilities in long-term weight loss in severely obese children and adolescents undergoing intensive combined lifestyle interventions (HELIOS); rationale, design and methods. BMC Pediatr 2013; 13:41. [PMID: 23530979 PMCID: PMC3623620 DOI: 10.1186/1471-2431-13-41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022] Open
Abstract
Background Adequate treatment of severe childhood obesity is important given its serious social, psychological and physical consequences. Self-regulation may be a crucial determinant of treatment success. Yet, little is known about the role that self-regulation and other psychosocial factors play in the long-term outcome of obesity treatment in severely obese children and adolescents. In this paper, we describe the design of a study that aims to determine whether the ability to self-regulate predicts long-term weight loss in severely obese children and adolescents. An additional objective is to identify other psychosocial factors that may modify this relation. Methods/design The study is designed as a prospective observational study of 120 severely obese children and adolescents (8–19 years) and their parents/caregivers undergoing an intensive combined lifestyle intervention during one year. The intervention uses behavior change techniques to improve the general ability to self-regulate. Measurements will be taken at three points in time: at baseline (start of treatment), at the end of treatment (1 year after baseline) and at follow-up (2 years after baseline). The primary outcome measurement is the gender and age-specific change in SDS-BMI. The children’s general self-regulation abilities are evaluated by two behavioral computer tasks assessing two distinct aspects of self-regulation that are particularly relevant to controlling food intake: inhibitory control (Stop Signal Task) and sensitivity to reward (Balloon Analogue Risk Task). In addition to the computer tasks, a self-report measure of eating-specific self-regulation ability is used. Psychosocial factors related to competence, motivation, relatedness and outcome expectations are examined as moderating factors using several questionnaires for the patients and their parents/caregivers. Discussion This study will provide knowledge about the relation between self-regulation and long-term weight loss after intensive lifestyle interventions over a two-year period in severely obese children and adolescents, a growing but often overlooked patient group. We aim to investigate to what extent (changes in) the general ability to self-regulate predicts weight loss and weight loss maintenance. This study will also contribute to the knowledge on how this association is modified by other psychosocial factors. The results may contribute to the development of more successful interventions. Trial registration Netherlands Trial Register (NTR1678, registered 20-Feb-2009)
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Affiliation(s)
- Jutka Halberstadt
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
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McMahan S, Hampl J, Chikamoto Y. A “Fat” Tax: Knowledge and Attitudes of Snack Food Taxing among College Students. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2003.10603573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Shari McMahan
- a Division of Kinesiology and Health Promotion at California State , University , Fullerton , CA , USA
| | - Jeffrey Hampl
- b Department of Nutrition at Arizona State , University , Mesa , AZ , USA
| | - Yosuke Chikamoto
- a Division of Kinesiology and Health Promotion at California State , University , Fullerton , CA , USA
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Goldfield GS, Adamo KB, Rutherford J, Murray M. The effects of aerobic exercise on psychosocial functioning of adolescents who are overweight or obese. J Pediatr Psychol 2012; 37:1136-47. [PMID: 23027721 DOI: 10.1093/jpepsy/jss084] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate effects of stationary cycling to music versus interactive video game cycling on psychosocial functioning in obese adolescents. METHODS 30 obese adolescents aged 12-17 years were randomized to twice weekly laboratory-based sessions of stationary cycling to music or interactive video game cycling for a 10-week trial. Participant's self-reported measures of scholastic competence, social competence, athletic competence, body image, and self-esteem were obtained. Aerobic fitness and body composition were directly measured. RESULTS Although no differences emerged between exercise groups over time, when collapsed across exercise modality, significant pre-post improvements were found for body image, perceived scholastic competence and social competence. Changes in aerobic fitness, but not body composition, were positively associated with psychosocial functioning. CONCLUSIONS Aerobic exercise was associated with improvements in body image, perceived academic performance, and social competence in obese adolescents, and these psychological benefits were related to improved aerobic fitness but not changes in body composition.
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Affiliation(s)
- Gary S Goldfield
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd., Ottawa, ON, Canada.
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Goldfield GS, Harvey A, Grattan K, Adamo KB. Physical activity promotion in the preschool years: a critical period to intervene. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1326-42. [PMID: 22690196 PMCID: PMC3366614 DOI: 10.3390/ijerph9041326] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/13/2012] [Accepted: 03/22/2012] [Indexed: 12/22/2022]
Abstract
The primary aim of this paper is to provide a rationale for the necessity of intervening with a physical activity intervention in the preschool years and why the daycare environment is amenable to such intervention. We also review the prevalence of physical activity, sedentary behaviour and obesity in the preschool population and the impact that these lifestyle behaviours and conditions have on the health of preschool aged children, as secondary objectives. Moreover we discuss implications for intervention and research using a "lessons learned" model based on our research team's experience of conducting a randomized controlled trial aimed at increasing physical activity, reducing sedentary behaviour and improving motor skill development and body composition in preschoolers. Lastly, we make conclusions based on the literature and highlight issues and directions that need to be addressed in future research in order to maximize health promotion and chronic disease prevention in the pediatric population.
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Affiliation(s)
- Gary S. Goldfield
- Healthy Active Living & Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (G.S.G.); (A.H.); (K.G.)
- Department of Pediatrics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Psychology, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Alysha Harvey
- Healthy Active Living & Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (G.S.G.); (A.H.); (K.G.)
| | - Kimberly Grattan
- Healthy Active Living & Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (G.S.G.); (A.H.); (K.G.)
| | - Kristi B. Adamo
- Healthy Active Living & Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (G.S.G.); (A.H.); (K.G.)
- Department of Pediatrics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Ghergherechi R, Hazhir N, Tabrizi A. Comparison of vitamin D deficiency and secondary hyperparathyroidism in obese and non-obese children and adolescents. Pak J Biol Sci 2012; 15:147-151. [PMID: 22866545 DOI: 10.3923/pjbs.2012.147.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Obesity subjects individuals into metabolic and endocrine disorders. Thus obesity may increase the risk of vitamin D deficiency. This text aims at studying the prevalence of vitamin D deficiency and secondary hyperparathyroidism in obese children. In a non-randomized case control study on 52 obese children (body mass index (BMI) >95th percentile) aged 4 to 16 years undertaken at the outpatient endocrine clinic of the Children Hospital at Tabriz University between 2009-2011. This study was conducted to compare the prevalence of vitamin D deficiency and secondary hyperparathyroidism in obese children compared with 57 non obese (BMI < 85th percentile). 109 children including 52 (50.5%) boys and 57 (49.5%) girls were studied. Most of case (76.9%) and control (42.1%) groups suffered from degrees of vitamin D deficiency. There was meaningful statistical difference between two groups considering to vitamin D deficiency and parathyroid hormone (p = 0.001). A negative relations was found between iPTH and vit D level (p < 0.001, r = -0.2), BMI and 25-OH vit D (p < 0.001, r = -0.2). A positive relation was observed between parathyroid hormone and BMI (p = 0.009, r = 0.1). Obese children are at high risk at vitamin D deficiency and secondary hyperparathyroidism. BMI appears to be an important risk factor for vitamin D deficiency.
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Affiliation(s)
- Robabeh Ghergherechi
- Department of Pediatrics Endocrinology, Tabriz University of Medical Sciences, Tabriz, Iran
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18
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Abstract
The prevalence of childhood and adolescent obesity continues to rise in the United States (US). Immediate health consequences are being observed, and long-term risks are mounting within the pediatric population, secondary to obesity. The hallmark of prevention and treatment of obesity in children and adolescents includes lifestyle modification (i.e., dietary modification, increased physical activity, and behavioral modifications). However, when intensive lifestyle modification is insufficient to reach weight loss goals, adjunctive pharmacotherapy is recommended. Among the group of weight-loss medications, orlistat is the only US Food and Drug Administration (FDA)-approved prescription drug for the treatment of overweight and obese adolescents. Other medications, including metformin, need larger studies to establish their role in treatment. No single approach to management of pediatric obesity is the answer, given the complexity of the disorder and the many reasons for failure. Evidence of weight loss medications in addition to lifestyle modification supports short-term efficacy for treatment of obese children and adolescents, although long-term results remain unclear.
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Affiliation(s)
- Kelly L. Matson
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island
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Rosnov DL, Roberts MC, Kessler ED, Pendley JS, Datto G, Hassink S. Acceptability of Weight-Loss Interventions Among Adolescents Who Are Overweight and Their Caregivers. CHILDRENS HEALTH CARE 2011. [DOI: 10.1080/02739615.2011.590386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Makkes S, Halberstadt J, Renders CM, Bosmans JE, van der Baan-Slootweg OH, Seidell JC. Cost-effectiveness of intensive inpatient treatments for severely obese children and adolescents in the Netherlands; a randomized controlled trial (HELIOS). BMC Public Health 2011; 11:518. [PMID: 21718471 PMCID: PMC3141469 DOI: 10.1186/1471-2458-11-518] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive combined lifestyle interventions are the recommended treatment for severely obese children and adolescents, but there is a lack of studies and their cost-effectiveness. The objective of this study is to compare the cost-effectiveness of two intensive one-year inpatient treatments and usual care for severely obese children and adolescents. METHODS/DESIGN Participants are 40 children aged 8-13 and 40 adolescents aged 13-18 with severe obesity (SDS-BMI ≥ 3.0 or SDS-BMI ≥ 2.3 with obesity related co-morbidity). They will be randomized into two groups that will receive a comprehensive treatment program of 12 months that focuses on nutrition, physical activity and behavior change of the participant and their parents. The two programs are the same in total duration (12 months), but differ in inpatient treatment duration. Group A will participate in a 6 month intensive inpatient treatment program during weekdays, followed by six monthly return visits of 2 days. Group B will participate in a 2 month intensive inpatient treatment program during weekdays, followed by biweekly return visits of 2 days during the next four months, followed by six monthly return visits of 2 days. Several different health care professionals are involved, such as pediatricians, dieticians, psychologists, social workers, nurses and physiotherapists. Results will also be compared to a control group that receives usual care. The primary outcome is SDS-BMI. Secondary outcomes include quality of life using the EQ-5D and cardiovascular risk factors. Data will be collected at baseline and after 6, 12 and 24 months. An economic evaluation will be conducted alongside this study. Healthcare consumption will be based on actual resource use, using prospective data collection during 2 years through cost diaries. Quality Adjusted Life Years (QALYs) will be calculated using the EQ-5D. DISCUSSION This study will provide useful information on the effectiveness and cost-effectiveness of inpatient treatment in severely obese children and adolescents. Valuable information on long term effects, after 2 years, is also included. TRIAL REGISTRATION Netherlands Trial Register (NTR): NTR1678.
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Affiliation(s)
- Sabine Makkes
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | | | - Jacob C Seidell
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
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Hillier F, Pedley C, Summerbell C. Evidence base for primary prevention of obesity in children and adolescents. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:259-64. [DOI: 10.1007/s00103-010-1227-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Sysko R, Zakarin EB, Devlin MJ, Bush J, Walsh BT. A latent class analysis of psychiatric symptoms among 125 adolescents in a bariatric surgery program. ACTA ACUST UNITED AC 2011; 6:289-97. [PMID: 21299450 DOI: 10.3109/17477166.2010.545411] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether subgroups could be identified among a sample of adolescents presenting for bariatric surgery. METHODS Participants were 125 severely obese adolescents enrolled in a bariatric surgery program referred for a psychiatric evaluation. A latent class analysis was conducted with self-report and clinician-rated measures of depressive symptoms, total problems by the Youth Self-Report Scale, anxiety severity, eating pathology, psychiatric diagnoses, quality of life, and family functioning. RESULTS A 3-class model yielded the best overall fit to the data. Adolescents in the ?eating pathology? class demonstrated high levels of both eating disordered and other psychopathology. The second class, or ?low psychopathology? class exhibited the fewest psychosocial problems, whereas adolescents in the third class were intermediate on measures of psychopathology, which is consistent with ?non-specific psychopathology.? CONCLUSIONS The latent class analysis identified homogeneous subgroups with different levels of psychopathology among a heterogeneous sample of severely obese adolescents. The identification of clinically relevant subgroups in this study offers an important initial means for examining psychopathology among adolescent bariatric surgery candidates and suggests a number of avenues for future research. CLINICAL TRIALS REGISTRY Laparoscopic Adjustable Gastric Banding (LAGB) as a Treatment for Morbid Obesity in Adolescents, NCT01045499.
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Affiliation(s)
- Robyn Sysko
- New York State Psychiatric Institute , New York, New York, NY
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A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes. J Pediatr Surg 2010; 45:74-8; discussion 78-9. [PMID: 20105583 DOI: 10.1016/j.jpedsurg.2009.10.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 10/06/2009] [Indexed: 11/22/2022]
Abstract
UNLABELLED BACKGROUND AND MATERIALS AND METHODS: The outcome of patients completing 12 months of follow-up in a prospective longitudinal trial of the safety/efficacy of laparoscopic adjustable gastric banding (LAGB) for morbidly obese adolescents aged 14 to 17 years using a Food and Drug Administration Institutional Device Exemption for the use of the LAPBAND was analyzed. Baseline and outcome data were abstracted from a prospective database. RESULTS Baseline (mean +/- SD) body mass index was 50 +/- 10 kg/m(2), and excess weight was 178 +/- 53 lb in 20 patients. Comorbidities included hypertension (45%), dyslipidemia (80%), insulin resistance (90%), metabolic syndrome (95%), and biopsy-proven nonalcoholic steatohepatitis (88%). At mean (SD) follow-up of 26 (9) months, % excess weight loss was 34% +/- 22% (n = 20) and 41% +/- 27% (n = 12), and the metabolic syndrome was resolved in 63% and 82% of the patients at 12 and 18 months, respectively. Hypertension normalized in all patients, along with improvement in lipid abnormalities and quality of life scores (P < .05). At 12 months, of the 5 patients with less than 20% excess weight loss, dyslipidemia and metabolic syndrome were resolved in 2 patients. CONCLUSION At intermediate follow-up of a LAGB-based obesity treatment program, weight loss led to resolution or improvement of major obesity-related comorbidities in most patients, supporting the efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program and its long-term evaluation.
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Abstract
Performance of bariatric surgery in pediatric patients carries profound ethical burdens for all stakeholders: morbidly obese children and adolescents, their parents and families, pediatric physicians and surgeons, pediatric health care institutions, and society. The decision to proceed with a bariatric intervention should be made only after it is established that the patient's comorbidities could not be treated with less invasive means, the patient has a favorable risk/benefit profile, the patient and her/his family have received extensive preoperative counseling and given informed consent, and the pediatric bariatric team has a comprehensive system of short- and long-term care. The patient and her/his family should be counseled about the innovative aspects of the bariatric intervention, in which sustained weight loss and potential complications are unknown. The pediatric surgeons and their respective institutions that offer bariatric surgery should be enrolled in clinical research endeavors that assess outcomes and seek optimal treatment protocols.
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Affiliation(s)
- Donna A Caniano
- Department of Pediatric Surgery, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Boyle M, Lawrence S, Schwarte L, Samuels S, McCarthy WJ. Health care providers' perceived role in changing environments to promote healthy eating and physical activity: baseline findings from health care providers participating in the healthy eating, active communities program. Pediatrics 2009; 123 Suppl 5:S293-300. [PMID: 19470606 DOI: 10.1542/peds.2008-2780h] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The California Endowment's Healthy Eating, Active Communities program was designed to reduce disparities in the incidence of obesity by improving food and physical-activity environments for low-income children. It was recognized at the outset that to succeed, the program needed support from community advocates. Health care providers can be effective advocates to mobilize community members and influence policy makers. OBJECTIVE This study was conducted to describe how health care providers address obesity prevention in clinical practice and to assess health care providers' level of readiness to advocate for policies to prevent childhood obesity. METHODS The study included two data-collection methods, (1) a self-administered survey of health care providers (physicians, dietitians, nurses, nurse practitioners, medical assistants, and community health workers) and (2) stakeholder interviews with health care facility administrators, health department staff, and health insurance organization representatives. Two-hundred and forty-eight health care providers participated in the provider survey and the health care stakeholder interviews were conducted with 56 respondents. RESULTS The majority (65%) of health care providers usually or always discussed the importance of physical-activity, reducing soda consumption, and breastfeeding (as appropriate) during clinical pediatric visits. More than 90% of the providers perceived home or neighborhood environments and parental resistance as barriers to their efforts to prevent childhood obesity in clinical practice. More than 75% of providers reported not having engaged in any policy/advocacy activities related to obesity-prevention. Most (88%) of the stakeholders surveyed thought that health care professionals should advocate for policies to reduce obesity, especially around insurance coverage for obesity-prevention. CONCLUSIONS Providers perceived that changing the food and physical-activity environments in neighborhoods and schools was likely to be the most effective way to support their clinical obesity-prevention efforts. Health care providers need time, training, resources, and institutional support to improve their ability to communicate obesity-prevention messages in both clinical practice and as community policy advocates.
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Affiliation(s)
- Maria Boyle
- Samuels & Associates, Oakland, California, USA
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Hasenboehler K, Munsch S, Meyer AH, Kappler C, Vögele C. Family structure, body mass index, and eating behavior. Int J Eat Disord 2009; 42:332-8. [PMID: 19107830 DOI: 10.1002/eat.20612] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore associations between family structure, children's body mass index (BMI), and eating behaviors of children and their mothers. METHOD Fifty-seven mothers and their children took part in an experimental study. BMI of children was measured. Mothers were asked to provide self-report data on sociodemographic background, mental health, and eating behaviors about themselves and their children. Parent-child-dyads represented their family structure using the Family System Test. RESULTS We found negative associations in typical family situations between family hierarchy and children's BMI, mothers' emotional eating and mothers' restrained eating. Family cohesion and restrained eating of the children were also negatively correlated. We obtained positive associations in typical and conflict family situations between family cohesion and external eating of the children. DISCUSSION We found indications that family structure is associated with overweight and with eating behavior in children and their mothers.
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Affiliation(s)
- Kathrin Hasenboehler
- Department of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
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Son YW, Lee K, Jeon YB. The Relationship between Relative BMI Change and Height Growth among Overweight Children. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.9.688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Young Woo Son
- Department of Family Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Kayoung Lee
- Department of Family Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Young Bae Jeon
- Department of Family Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Cheng TO. Diabetes and obesity epidemics in China: A national crisis. Int J Cardiol 2007; 123:1-2. [PMID: 17395316 DOI: 10.1016/j.ijcard.2006.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 10/23/2022]
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Short-term outcome in the first 10 morbidly obese adolescent patients in the FDA-approved trial for laparoscopic adjustable gastric banding. J Pediatr Gastroenterol Nutr 2007; 45:465-73. [PMID: 18030214 DOI: 10.1097/mpg.0b013e318063eef6] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND We received the LAP-BAND Investigational Device Exemption (IDE) from the US Food and Drug Administration in December 2004 to conduct a prospective longitudinal trial examining the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in morbidly obese adolescents ages 14 to 17 years. OBJECTIVES To report the short-term results of LAGB in the first 10 adolescents with complete 9 months of follow-up. PATIENTS AND METHODS Baseline characteristics and outcome data were analyzed in 10 patients enrolled between March 2005 and February 2006. RESULTS All of the patients were girls. Their mean body mass index (+/-SD) was 50 +/- 13 kg/m, and excess weight was 171 +/- 79 pounds. Comorbidities included depression (3 patients), sleep apnea (3), hypertension (6), dyslipidemia (7), insulin resistance (9), metabolic syndrome (9), and steatohepatitis (in 4 of 5 patients with liver biopsy). Operative time was 45 +/- 9 minutes, and discharges were within 23 hours of surgery. Band-related complications were as follows: 2 dehydration, 1 pouch dilation, and 1 port revision. All of the patients lost weight, with a 9-month excess weight loss of 30% +/- 16% (range 14%-57%). Hypertension and the metabolic syndrome were resolved in 100% of patients (P = 0.04) and 80% of the patients (P = 0.01), respectively, along with significant improvement in the Pediatric Quality of Life and Beck Depression Inventory scores and a trend toward improvement in high-density lipoprotein cholesterol abnormalities (P = 0.08). CONCLUSIONS At short-term follow-up, weight loss occurred with minimal complications, leading to early resolution of major obesity-related comorbidities. Continued evaluation of the long-term safety and efficacy of LAGB as a surgical adjunct to a comprehensive obesity treatment program is warranted.
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Dillard BE, Gorodner V, Galvani C, Holterman M, Browne A, Gallo A, Horgan S, Le Holterman AX. Initial experience with the adjustable gastric band in morbidly obese US adolescents and recommendations for further investigation. J Pediatr Gastroenterol Nutr 2007; 45:240-6. [PMID: 17667722 DOI: 10.1097/mpg.0b013e31805b82fb] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The public health crisis of obesity has spread to the pediatric population. In morbidly obese (MO) adolescents, early weight loss intervention can reduce and prevent obesity-related comorbidities and mortality and improve quality of life. The present study was performed to evaluate weight loss efficacy and safety of "off-label" laparoscopic adjustable gastric banding (LAGB) procedures performed in MO adolescents by our adult bariatric program. PATIENTS AND METHODS We retrospectively reviewed data from 716 LAGB procedures performed on an off-label basis in adults and 24 adolescent patients ages 14 to 20 years by the adult bariatric program at our institution between 2001 and 2006. RESULTS There was no mortality. Average operative time was 45 minutes, length of stay for adolescents was 15 hours, and weight loss outcome and overall surgical complication rates are comparable between adolescents and adults. For adolescent subjects, baseline mean preoperative body mass index was 49 kg/m and average excess weight loss rates were 22%, 34%, 52%, 42%, and 42% at 3, 6, 12, 24, and 36 months, respectively. The overall complication rate was 29%, with a 25% incidence of pouch enlargement in adolescents (vs 18% in adult patients; P = ns). Two of 24 adolescent patients (8.4%) required laparoscopic band repositioning (vs 1.5% of adult patients; P = 0.06). CONCLUSIONS LAGB is an effective and safe surgical weight loss modality for MO adolescent subjects. Vigilant follow-up for LAGB-related complications and intensive postoperative behavioral management are important for improving long-term success. We recommend continued investigation of long-term efficacy and safety of LAGB in this population.
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Affiliation(s)
- Barney E Dillard
- Division of Pediatric Surgery, University of Illinois at Chicago, USA
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Daniels SR, Long B, Crow S, Styne D, Sothern M, Vargas-Rodriguez I, Harris L, Walch J, Jasinsky O, Cwik K, Hewkin A, Blakesley V. Cardiovascular effects of sibutramine in the treatment of obese adolescents: results of a randomized, double-blind, placebo-controlled study. Pediatrics 2007; 120:e147-57. [PMID: 17576783 DOI: 10.1542/peds.2006-2137] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescent obesity is a major public health problem. Treatment options in addition to behavioral therapy could include pharmacotherapy with sibutramine. OBJECTIVES Concerns regarding increases in blood pressure and heart rate after sibutramine treatment in some adult patients precipitated the present analysis, which evaluated the cardiovascular safety of sibutramine plus a behavioral therapy program in obese adolescents. PATIENTS AND METHODS With this 12-month, randomized, double-blind, placebo-controlled trial in 33 US clinics we studied 498 adolescents aged 12 to 16 years with multiethnic backgrounds and BMIs of 28.1 to 46.3 kg/m2. RESULTS The subjects were randomly assigned to behavioral therapy plus 10 mg of sibutramine or behavioral therapy plus placebo daily. At the end point, there was a mean treatment group difference in BMI of 2.6 kg/m2 in favor of sibutramine. Small mean decreases in blood pressure and pulse rate were seen in both sibutramine and placebo groups at the end point (systolic blood pressure: -2.1 vs -2.1 mmHg; diastolic blood pressure: -0.1 vs -1.1 mmHg; pulse rate: -0.2 vs -1.8 bpm). In both treatment groups, these reductions in vital signs were greater at the end point when BMI reduction was > or = 5% compared with < 5%. CONCLUSIONS Sibutramine may have some direct cardiovascular effects on obese adolescents. These cardiovascular effects may be balanced by a reduction in BMI, which, in adolescents, seems to be greater than that observed in adults.
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Affiliation(s)
- Stephen R Daniels
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Mamabolo RL, Alberts M, Steyn NP, Delemarre-van de Waal HA, Levitt NS. Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa. Public Health Nutr 2007; 8:501-8. [PMID: 16153331 DOI: 10.1079/phn2005786] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectivesTo determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa.DesignProspective cohort study.SettingRural villages in the Central Region of the Limpopo Province, South Africa.SubjectsOne hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded.ResultsHeight-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stuntedandoverweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96–4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17–0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46–34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24–38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7–12.10).ConclusionThe results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.
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Xanthakos SA, Inge TH. Extreme pediatric obesity: weighing the health dangers. J Pediatr 2007; 150:3-5. [PMID: 17188602 DOI: 10.1016/j.jpeds.2006.11.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 11/07/2006] [Indexed: 10/23/2022]
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Cooper C, Sarvey S, Collier D, Willson C, Green I, Pories ML, Rose MA, Escott-Stump S, Pories W. For comparison: experience with a children’s obesity camp. Surg Obes Relat Dis 2006; 2:622-6. [PMID: 17020822 DOI: 10.1016/j.soard.2006.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 07/17/2006] [Accepted: 07/27/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND The alarming rise in childhood obesity has resulted in a number of bariatric surgical initiatives. To interpret the outcomes, a comparison with a nonoperative approach is prudent. METHODS In 2003, 2004, and 2005, we measured the outcomes produced by an isolated summer camp in North Carolina for 74, 99, and 89 obese children and adolescents with a mean age of 12.7 +/- 2.3, 13.0 +/- 1.9, and 13.2 +/- 1.8 years and initial body mass index (BMI) of 33.1 +/- 5.7, 33.4 +/- 6.4, and 32.9 +/- 7.0 kg/m2, respectively. The camp featured a 1700/d caloric diet, daily aerobic and resistance weight training exercise, nutrition classes, and weekly sessions with a psychologist. The changes in weight, BMI, body shape measurements, and fitness level were assessed. The average length of stay was 4.3, 4.2, and 4.4 weeks, respectively, in 2003, 2004, and 2005. RESULTS The BMI, body shape, and weight change measures significantly improved during each of the summers. The campers lost 1.6, 2.0, and 1.8 kg/wk during each of the 3 years. Their waist measurements decreased by 9.1 +/- 5.12 cm, 9.9 +/- 5.6 cm, and 8.1 +/- 5.8 cm. Significant improvements occurred in the timed sprints, .5-mile (0.8-km) run, and vertical jump. Of those campers staying for two summers, 4.4% continued to reduce their BMI despite growth, 56.5% maintained their BMI at less than the initial baseline measurement, and 39.1% increased their BMI to greater than the baseline. The co-morbidities also improved. One camper, aged 15 years, weighing 211 kg, progressed from being able to walk 3 steps to managing the 100-yard (91-m) dash in 42 seconds after losing 35 kg in 8 weeks. CONCLUSION Diets, exercise, and behavioral modification are useful approaches in severely obese children that can, in some, produce significant albeit expensive long-term results. Recidivism is a problem. Surgical outcomes must compare favorably with these outcomes.
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Affiliation(s)
- Christopher Cooper
- East Carolina University Brody School of Medicine, Greenville, North Carolina 27834, USA
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Inge TH, Lawson L. Treatment considerations for severe adolescent obesity. Surg Obes Relat Dis 2006; 1:133-9. [PMID: 16925229 DOI: 10.1016/j.soard.2005.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Revised: 02/03/2005] [Accepted: 02/04/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas H Inge
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA.
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Klein JD, Postle CK, Kreipe RE, Smith SM, McIntosh S, Spada J, Ossip-Klein D. Do physicians discuss needed diet and nutrition health topics with adolescents? J Adolesc Health 2006; 38:608.e1-6. [PMID: 16635776 DOI: 10.1016/j.jadohealth.2005.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 03/24/2005] [Accepted: 06/07/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE Preventive services guidelines recommend screening all adolescents for diet habits, physical activity and growth, counseling underweight teens about body image and dieting patterns, and counseling overweight or obese teens about dietary habits and exercise. In this study, we assess whether adolescents at risk for overweight or for eating disorders have discussed recommended diet and nutrition topics with their physicians. METHODS We surveyed 14-18-year-old adolescents who had been seen for well care in primary care pediatric and family medicine practices. Adolescents self-reported their weight, height, body image, dieting habits, and issues they had discussed with their clinicians. Body mass index (BMI) was used to define those "at risk for an eating disorder" (< 5% BMI), "at risk of becoming overweight" (85%-95% BMI), and "overweight" (> 95% BMI). RESULTS A total of 8384 adolescents completed surveys (72% completion rate). Nearly one-third of adolescents were "at risk" or overweight. Females were less likely to be overweight than males (9.4% vs. 15.7%; p < .001). Although 26.4% were attempting to lose weight, only 12.2% of all teens were actually overweight. Exercise and restricting intake were the preferred methods of weight loss. Physicians routinely discussed adolescents' weight during visits, and were more likely to discuss it with those "at risk" (p < .001). Body image was more often discussed with girls than with boys (52% vs. 44.6%, p < .001) and with those at risk (51.6% vs. 45.5%; p < .001). Discussion of healthy eating and weight loss occurred more often with adolescents "at risk" for becoming overweight (p < .001). CONCLUSIONS Many adolescents are at risk for being overweight or are currently overweight, confirming the importance of clinicians discussing diet and nutrition health topics with all teens. Many adolescents also misclassify their body image, and hence perceive their body image to be different from their actual BMI; clinicians should discuss body image with all adolescents, not just those at risk for eating disorders. Better interventions are needed to promote healthy nutrition and physical activity to all adolescents.
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Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA.
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Bastarrachea RA, López-Alvarenga J, Calzada-León R, Arellano-Montaño S, Gonzalez-Barranco J. Valuable lessons from research on drugs for adolescent obesity in Mexico. Adv Ther 2006; 23:506-7; author reply 507-9. [PMID: 16989042 DOI: 10.1007/bf02850173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fennig S, Fennig S. Intensive therapy for severe paediatric morbid obesity. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Williamson DA, Martin PD, White MA, Newton R, Walden H, York-Crowe E, Alfonso A, Gordon S, Ryan D. Efficacy of an internet-based behavioral weight loss program for overweight adolescent African-American girls. Eat Weight Disord 2005; 10:193-203. [PMID: 16277142 DOI: 10.1007/bf03327547] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This randomized controlled trial tested the efficacy of an internet-based lifestyle behavior modification program for weight management in African-American girls. DESIGN African-American girls were randomly assigned to an interactive behavioral internet program or an internet health education program, the control condition. The behavioral intervention included internet counseling and was highly interactive. The control intervention was a passive (non-interactive) educational program. Parents were also participants in the study. Participants in both treatment groups met in face-to-face sessions on four occasions over the first 12 weeks of a 6-month intervention. SUBJECTS The study enrolled 57 African-American adolescent girls (ages 11 to 15 years) who were overweight or obese and had at least one biological parent who was obese [body mass index (BMI) >30 kg/m2]. Of the 57 participants, 50 (88%) completed the 6-month trial. MEASUREMENTS Outcome data, including BMI, body weight, body composition, dietary intake, and weight loss behaviors were collected at baseline and 6-months later. A computer server tracked utilization of the websites. Participation in the program was measured by number of "hits" on the website. RESULTS Compared to the control condition, adolescents in the behavioral treatment lost more body fat (group difference =1.6% body fat) and parents lost significantly more body weight (group difference =2.1 kg). Utilization of the behavioral website by adolescents and parents was associated with positive outcome. Dietary fat intake was lowered for adolescents and parents in the behavioral treatment group. CONCLUSION An internet-based behavioral intervention was superior to internet-based health education and yielded decreased body fat for adolescent girls and decreased body weight for parents.
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Affiliation(s)
- D A Williamson
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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Steyn NP, Labadarios D, Maunder E, Nel J, Lombard C. Secondary anthropometric data analysis of the National Food Consumption Survey in South Africa: the double burden. Nutrition 2005; 21:4-13. [PMID: 15661473 DOI: 10.1016/j.nut.2004.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 07/25/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is an increase in the prevalence of overweight and obesity in children worldwide, including South Africa. We investigated the prevalences of overweight, obesity, and stunting in a current generation of children (ages 12 to 108 mo), which has a high prevalence of stunting, and evaluated the determinants of both nutritional disorders. METHODS Secondary data analysis of the weight and height measurements of 12- to 108-mo-old children (weighted n = 2200, non-weighted n = 2894) during the 1999 National Food Consumption Survey in South Africa is reported. The body mass index reference percentiles recommended for use in children by the International Obesity Task Force were used to determine the prevalence of overweight and obesity, and the National Center for Health Statistics (NCHS) percentiles were used to determine the prevalence of stunting. RESULTS Nationally, the prevalence of stunting (height-for-age < or = -2 standard deviations, NCHS 50th percentile) in these children was 19.3% (95% confidence interval [CI] = 17.49 to 21.16) and was highest in 1- to 3-y-old children (24.4%) and in children of farm workers on commercial farms (25.6%). The prevalence of combined overweight and obesity (body mass index > or = 25 kg/m(2) in 17.1%, 95% CI = 15.00 to 19.23) at the national level was nearly as high as that for stunting. Further, the types of determinants for stunting and overweight were generally similar (although directionally opposite in degree of risk conferred) and included type of housing, type of toilet in the home, fuel used in cooking, presence of a refrigerator or stove, presence of a television in the house, educational level of the caregiver, and maternal education level. An example of the directionally opposite degree of risk is exemplified by the use of paraffin as a fuel being protective against being overweight (odds ratio = 0.78, 95% CI = 0.63 to 0.97) but predictive of an increased risk for stunting (odds ratio = 1.24, 95% CI = 1.04 to 1.48). Stunting itself conferred an increased risk (odds ratio = 1.80, 95% CI = 1.48 to 2.20) of being overweight. CONCLUSION Certain defined determinants appear to play important roles in children's nutritional outcomes in relation to stunting and to overweight and obesity.
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Affiliation(s)
- N P Steyn
- Chronic Diseases of Lifestyle Unit, Tygerberg, South Africa.
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Lee K, Sohn H, Lee S, Lee J. Weight and BMI over 6 years in Korean children: relationships to body image and weight loss efforts. ACTA ACUST UNITED AC 2005; 12:1959-66. [PMID: 15687397 DOI: 10.1038/oby.2004.246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the relationships among longitudinal weight status, body dissatisfaction, and attitude to weight loss among Korean children from the age of 7-8 to 13-14 years old. RESEARCH METHODS AND PROCEDURES 351 Korean school children's heights and weights were measured at the ages of 7-8 and 13-14 years old; at the age of 13-14, they completed a questionnaire about body dissatisfaction and weight loss efforts. RESULTS At the age of 7-8, 15.7% of children were overweight by International Obesity Task Force standards, as compared with 26.2% at the age of 13-14. Of the 55 7- to 8-year-old overweight children, 85.5% were still overweight at the age of 13-14 years old. Greater concerns about body image and stronger desires to be thinner were observed among stable overweight children and among those in whom there had been a rapid increase in BMI over the 6-year study period. Girls favored thinner shapes than did boys, regardless of their weight status or BMI changes. In girls, the level of body dissatisfaction was related only to weight loss desire, regardless of weight status or changes in BMI. In boys, however, weight loss desire was related only to weight loss attempts and was independent of weight status, BMI changes, and level of body dissatisfaction. DISCUSSION Regardless of weight status, changes in BMI should be considered when dealing with body dissatisfaction and attitudes to weight loss in children.
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Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, Inje University, Busan, Republic of Korea.
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Munsch S, Biedert E, Roth B, Speck V, Roth S. Ambulante Behandlung der Adipositas im Kindes- und Jugendalter. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2005; 33:89-103. [PMID: 15900803 DOI: 10.1024/1422-4917.33.2.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Adipositas im Kindesalter ist ein zunehmendes Problem in Industrie- und immer mehr auch in Entwicklungsländern. Die Prävalenzraten steigen bis zu 15% in den USA und bis zu 10% in Europa. Der vorliegende Artikel gibt einen Überblick über die aktuelle Forschungslage sowie über medizinische und psychosoziale Probleme, die mit kindlicher Adipositas verbunden sind. Es folgt eine umfassende Zusammenstellung und Beurteilung verschiedener Behandlungsmöglichkeiten, wobei detailliert auf die Behandlungsmerkmale und die Wirksamkeit von ambulanten Behandlungsansätzen bei kindlicher Adipositas eingegangen wird. Methode: Medline- und PsycINFO-Suche von 1966 bis 2003. Schlussfolgerungen: Die Aussagekraft und Generalisierbarkeit der Untersuchungsergebnisse wird insbesondere durch die begrenzte Vergleichbarkeit der Studien eingeschränkt. Implikationen zur Behandlung kindlicher und jugendlicher Adipositas und weiterer Forschung werden diskutiert.
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Affiliation(s)
- Simone Munsch
- Institut für Psychologie, Universität Basel, Abteilung Klinische Psychologie und Psychotherapie
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Horgan S, Holterman MJ, Jacobsen GR, Browne AF, Berger RA, Moser F, Holterman AXL. Laparoscopic adjustable gastric banding for the treatment of adolescent morbid obesity in the United States: a safe alternative to gastric bypass. J Pediatr Surg 2005; 40:86-90; discussion 90-1. [PMID: 15868564 DOI: 10.1016/j.jpedsurg.2004.09.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Morbid obesity (MO) has reached epidemic proportions and is a major health problem in developed nations. In the adolescent with MO, early intervention can minimize obesity-related comorbidities, avoid premature mortality, improve quality of life, and prevent obesity-related diseases as these patients mature into adulthood. The primary surgical treatment of adolescent patients meeting National Institutes of Health criteria for bariatric surgery has been the gastric bypass (GB). Although GB has led to weight loss and improvement of comorbid conditions, concerns remain over the high incidence of postoperative complications and life-style-altering long-term sequelae of gastrointestinal tract reconstruction. Based on the excellent results from international adult series as well as the authors' own experience of more than 300 adult patients, laparoscopic adjustable gastric banding (LAGB) as an alternative to GB to eligible adolescents was offered. METHODS After medical, psychologic, and nutritional screening, 4 patients (ages 17-19 years) with a body mass index of 40 or more (range, 40-61) who failed medical attempts at weight loss were selected for LAGB. RESULTS The operative time was 40 to 90 minutes. All patients were discharged on the day of surgery. There were no early complications. One patient had cholecystitis 6 months after surgery requiring laparoscopic cholecystectomy. For the 4 patients, the amount of excess weight loss was 57% at 30 months, 34% at 12 months, 87% at 7 months, and 15% at 4 months, respectively. CONCLUSIONS In this preliminary series of the US experience in the use of LAGB for the management of adolescents with MO, the lack of operative morbidity, short operative time/hospital stay, and encouraging initial weight loss mirror the adult experience and illustrate that the LAGB is a safe and effective alternative to GB. These encouraging results support further evaluation of LAGB as a surgical option in a comprehensive adolescent weight loss program.
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Affiliation(s)
- Santiago Horgan
- Division of General Surgery and Minimally Invasive Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Abstract
Cardiology in China has shown significant changes in the last decade or so. Interventional cardiology, in particular, has shown remarkable advances, especially in the management of coronary artery disease, which, unfortunately, has shown a disconcerting increase in incidence in a country traditionally known for very low incidence of coronary artery disease. Important contributing factors include increasing affluence, westernization of dietary habit and lifestyle, and rampant cigarette smoking. At present, the Chinese population has an annual coronary mortality of one sixth of that reported in the West, an incidence of acute myocardial infarction of one tenth to one eighth, and a mortality of acute myocardial infarction of one eighth. The prevalence of coronary artery disease among the general Chinese population (3-7%) is roughly one quarter of that among the Caucasians in the West, but this will get worse for sure. China still has a lot of catching up to do to reach full modernization. There is a price that every developing country must pay for modernization. However, let the price the Chinese pay not exceed the benefits derived from modernization. Can we achieve a utopian stage in the 21st century in which the modern Chinese retain their ancestral low rates of coronary artery disease while adapting the positive aspects of a modern western lifestyle?
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Affiliation(s)
- Tsung O Cheng
- The George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, Washington, DC 20037, USA.
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Hampl JS, Wharton CM, Taylor CA, Winham DM, Block JL, Hall R. Primetime television impacts on adolescents' impressions of bodyweight, sex appeal, and food and beverage consumption. NUTR BULL 2004. [DOI: 10.1111/j.1467-3010.2004.00419.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- T Lobstein
- IASO International Obesity TaskForce, 231 North Gower Street, London NW1 2NS, UK.
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Hurst S, Blanco K, Boyle D, Douglass L, Wikas A. Bariatric Implications of Critical Care Nursing. Dimens Crit Care Nurs 2004; 23:76-83. [PMID: 15192368 DOI: 10.1097/00003465-200403000-00006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The delivery of optimum nursing care to morbidly obese patients in critical care presents unique challenges in critical thinking, planning, and teamwork. The purpose of this article is to review the special needs of this patient population and to provide a template to guide proactive nursing care planning in critical care settings.
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Affiliation(s)
- Sue Hurst
- Banner Good Samaritan Medical Center in Phoenix, Arizona 85006, USA
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