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Hadley TS, Wild CEK, Maessen SE, Hofman PL, Derraik JGB, Anderson YC. Changes in weight status of caregivers of children and adolescents enrolled in a community-based healthy lifestyle programme: Five-year follow-up. Obes Res Clin Pract 2024; 18:154-158. [PMID: 38631969 DOI: 10.1016/j.orcp.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
Whānau Pakari is a family-centred healthy lifestyle programme for children/adolescents with overweight/obesity in New Zealand. This secondary analysis from our randomised trial within the clinical service assessed 5-year BMI changes in accompanying caregivers (n = 23), mostly mothers. Overall, baseline and 5-year caregivers' BMI were similar (32.50 vs 31.42 kg/m2, respectively; p = 0.31) but two-thirds (65%) experienced BMI reductions. Five-year BMI change was similar in High-intensity and Low-intensity randomisation groups [-1.37 kg/m2 (-4.95, 2.21); p = 0.44]. Caregiver's BMI change was not associated with child's BMI change. Despite no overall BMI reduction, our findings contrast with upward BMI trajectories predicted for NZ adults with overweight/obesity.
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Affiliation(s)
- Thomas S Hadley
- Department of Paediatrics, Health New Zealand | Te Whatu Ora Taranaki, New Plymouth, New Zealand
| | - Cervantée E K Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sarah E Maessen
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand; Curtin Medical School, Faculty of Health Sciences, Curtin University, WA, Australia; Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia; Child and Adolescent Community Health, Child and Adolescent Health Service, Perth, WA, Australia.
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Anderson YC, Wild CEK, Gilchrist CA, Hofman PL, Cave TL, Domett T, Cutfield WS, Derraik JGB, Grant CC. A Multisource Process Evaluation of a Community-Based Healthy Lifestyle Programme for Child and Adolescent Obesity. CHILDREN (BASEL, SWITZERLAND) 2024; 11:247. [PMID: 38397358 PMCID: PMC10887184 DOI: 10.3390/children11020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5-15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010-2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8-1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
- Child and Adolescent Community Health, Child and Adolescent Health Service, Perth, WA 6009, Australia
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Cervantée E K Wild
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
- Starship Children's Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Tania Domett
- Cogo Consulting, 58 Surrey Crescent, Grey Lynn, Auckland 1141, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
- Starship Children's Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Starship Children's Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 229] [Impact Index Per Article: 229.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions. Pediatrics 2023; 151:190447. [PMID: 36622110 DOI: 10.1542/peds.2022-060642] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Pitts WJ, Cave TL, Cavadino A, Shypailo RJ, Maessen SE, Hofman PL, Wong W, Anderson YC. Comparison of percentile tables and algorithm-based calculators for classification of blood pressures in children and adolescents with obesity: A secondary analysis of a clinical trial. J Paediatr Child Health 2023; 59:242-246. [PMID: 36404725 PMCID: PMC10100042 DOI: 10.1111/jpc.16270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022]
Abstract
AIM Obesity as a major risk factor for childhood hypertension necessitates careful blood pressure (BP) monitoring of those affected. This study aimed to compare BP classification in a cohort of children affected by obesity using tables versus digital calculations in two sets of guidelines. METHODS This study was a secondary analysis of data collected from a randomised clinical trial of a multidisciplinary life-style assessment and intervention program. Baseline data from 237 children with a body mass index >99th percentile or >91st percentile with weight-related comorbidities and available BP measurements were analysed. We assessed agreement between tables and algorithms in classification of elevated BP/pre-hypertension and hypertension based on the American Academy of Paediatrics (AAP) clinical practice guidelines (CPG) and the older Fourth Report using Cohen's weighted kappa. The prevalence of hypertensive diagnoses was also compared between the two guidelines. RESULTS Agreement between BP tables and algorithmic calculation of percentiles was discordant, though improved in the AAP CPG compared to the Fourth Report (Cohen's kappa = 0.70 vs. 0.57, respectively). None (0%) were missed diagnoses, and 59 (24.9%) were false positives for the Fourth Report, and 0 (0%) were missed diagnoses, and 49 (20.9%) were false positives for the AAP CPG. Under the recent guidelines, there was an increase in prevalence of 6.0% (95% confidence interval (CI) 2.5-9.4%; P = 0.0001) for BP ≥90th percentile, and of 3.0% (95% CI 0.4-5.6%; p = 0.016) for hypertension (BP ≥ 95th percentile) in the cohort (18.0% and 6.8%, respectively, increased from 12.0% and 3.8%). CONCLUSIONS Digital calculators over tables in clinical practice are recommended where possible to improve the accuracy of paediatric BP classification. Substantial rates of elevated BP/Hypertension were found in this cohort of children and adolescents with overweight and obesity.
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Affiliation(s)
- William J Pitts
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Roman J Shypailo
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah E Maessen
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - William Wong
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth Children's Hospital, Perth, Western Australia, Australia.,Community Health, Child and Adolescent Health Service, Perth, Western Australia, Australia
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Improving Obesogenic Dietary Behaviors among Adolescents: A Systematic Review of Randomized Controlled Trials. Nutrients 2022; 14:nu14214592. [PMID: 36364855 PMCID: PMC9653747 DOI: 10.3390/nu14214592] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
The overweight and obesity epidemic persists, and over 340 million children and adolescents aged 5–19 were classified as overweight or obese worldwide in 2020. Obesity intervention becomes crucial during the adolescent years due to the increased autonomy and adolescent motivation to oversee one’s own behaviors and lifestyle-related decisions. The objective of the current study was to conduct a systematic review of randomized controlled trials aimed at improving dietary intake and behaviors among adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized. The key terms used in the searches referred to the study population and the topic of interest and included words and phrases such as “obesity or overweight and adolescents”, “dietary behaviors and adolescents”, “dietary intake and adolescents”, and “dietary habits and adolescents.” A tertiary screening process was employed, and the National Heart, Lung, and Blood Institute Quality Assessment of Controlled Intervention Studies quality scoring tool was utilized to assess the quality of research articles independently by n = 2 researchers. A total of 7441 articles were identified through the database search, and 36 were included in the current systematic review. The most common outcomes explored included dietary behaviors, anthropometric or biometric outcomes, and physical activity. Approximately half of the studies demonstrated significant improvements in the primary outcomes investigated. The majority of the high-impact studies where significant improvements in primary outcomes were demonstrated were conducted in school settings or were multicomponent or multilevel in nature. Thus, interventions targeting dietary behaviors in adolescents that are delivered in the school setting and are multicomponent or multilevel in nature are the most effective in terms of impact on dietary intake, anthropometric or biometric outcomes, and physical activity.
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Te’o DT, Wild CEK, Willing EJ, Wynter LE, O’Sullivan NA, Hofman PL, Maessen SE, Derraik JGB, Anderson YC. The Impact of a Family-Based Assessment and Intervention Healthy Lifestyle Programme on Health Knowledge and Beliefs of Children with Obesity and Their Families. Nutrients 2022; 14:nu14204363. [PMID: 36297048 PMCID: PMC9607640 DOI: 10.3390/nu14204363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: To determine the impact of a family-based assessment-and-intervention healthy lifestyle programme on health knowledge and beliefs of children and families affected by obesity. Second, to compare the health knowledge of the programme cohort to those of a national cohort in Aotearoa/New Zealand (NZ). Design: This mixed-methods study collected health knowledge and health belief data in a questionnaire at baseline and 12-, 24-, and 60-month follow-up assessments. Health knowledge over time was compared with baseline knowledge and with data from a nationally representative survey. A data-driven subsumption approach was used to analyse open-text responses to health belief questions across the study period. Setting: Taranaki region, a mixed urban−rural setting in NZ. Participants: Participants (caregiver/child dyads) from the Whānau Pakari randomised trial. Results: A greater proportion of the cohort correctly categorised foods and drinks as healthy or unhealthy at 12 months compared to baseline for most questionnaire items. Retention of this health knowledge was evident at 24- and 60-month follow-ups. More than twice as many participants correctly reported physical activity recommendations at follow-up compared to baseline (p < 0.001). Health knowledge of participants was similar to the national survey cohort at baseline, but surpassed it at 12 and 24 months. Participant beliefs around healthy lifestyles related to physical functioning, mental and emotional wellbeing, and enhancement of appearance, and gained greater depth and detail over time. Conclusions: This study demonstrates the important role that community-level healthy lifestyle programmes can have in knowledge-sharing and health promotion.
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Affiliation(s)
- Dayna T. Te’o
- Department of Paediatrics, Taranaki Base Hospital, Taranaki District Health Board, David Street, New Plymouth 4310, New Zealand
| | - Cervantée E. K. Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Esther J. Willing
- Kōhatu—Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Lisa E. Wynter
- Department of Paediatrics, Taranaki Base Hospital, Taranaki District Health Board, David Street, New Plymouth 4310, New Zealand
| | - Niamh A. O’Sullivan
- Department of Paediatrics, Taranaki Base Hospital, Taranaki District Health Board, David Street, New Plymouth 4310, New Zealand
| | - Paul L. Hofman
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Sarah E. Maessen
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - José G. B. Derraik
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Yvonne C. Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Enable Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
- Telethon Kids Institute, Northern Entrance, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Community Health, Child and Adolescent Health Service, 2 Mill Street, Perth, WA 6000, Australia
- Correspondence:
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Hadley TS, Cave TL, Derraik JGB, Hofman PL, Anderson YC. Associations between changes in caregiver's and child's weight status in a community-based obesity intervention programme. Int J Obes (Lond) 2022; 46:1406-1409. [PMID: 35488029 PMCID: PMC9239902 DOI: 10.1038/s41366-022-01121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We examined whether caregivers of children/adolescents enroled in a randomised controlled trial (RCT) of a family-centred intervention indirectly achieved reductions in body mass index (BMI), and if these were associated with changes in their children's BMI. METHODS RCT participants were New Zealand children/adolescents aged 4.8-16.8 years with BMI ≥ 98th percentile or >91st with weight-related comorbidities. Participants and accompanying caregivers were assessed at baseline, 12, and 24 months. RESULTS Overall, caregivers' BMI was unchanged at 12 or 24 months. Among Māori participants, reductions in caregivers' BMI at 12 months were associated with reductions in their children's BMI SDS at 12 (r = 0.30; p = 0.038) and 24 months (r = 0.39; p = 0.009). Further, children identifying as Māori whose caregivers' BMI decreased at 12 months had greater BMI SDS reductions at 12 months [-0.30 (95% CI -0.49, -0.10); p = 0.004] and 24 months [-0.39 (95% CI -0.61, -0.16); p = 0.001] than children of caregivers with increased/unchanged BMI. CONCLUSIONS This intervention programme for children/adolescents with obesity did not indirectly reduce caregiver weight status. However, reductions in caregivers' BMI were key to BMI SDS reductions among Māori participants. Given the intergenerational nature of obesity, our findings highlight the importance of culturally relevant, family-focused programmes to achieve clinically meaningful improvements in weight status across the family.
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Affiliation(s)
- Thomas S Hadley
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand. .,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. .,enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia. .,Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia. .,Community Health, Child and Adolescent Health Service, Perth, WA, Australia.
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9
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Wild CEK, Wynter LE, Triggs CM, Derraik JGB, Hofman PL, Anderson YC. Five-year follow-up of a family-based multidisciplinary program for children with obesity. Obesity (Silver Spring) 2021; 29:1458-1468. [PMID: 34370401 DOI: 10.1002/oby.23225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to determine 5-year outcomes from a 12-month, family-based, multidisciplinary lifestyle intervention program for children. METHODS This study was the 5-year follow-up of a randomized clinical trial comparing a low-intensity control group (home-based assessments) with a high-intensity intervention group (assessments plus weekly sessions) in New Zealand. Participants were aged 5 to 16 years with BMI ≥ 98th centile or > 91st centile with weight-related comorbidities. The primary outcome was BMI standard deviation score (BMISDS). Secondary outcomes included various health markers. RESULTS Of the 199 children included in the study at baseline (47% who identified as Māori, 53% who identified as female, 28% in the most deprived quintile, mean age = 10.7 years, mean BMISDS = 3.12), 86 completed a 5-year assessment (43%). BMISDS reduction at 12 months was not retained (control = 0.00 [95% CI: -0.22 to 0.21] and intervention = 0.17 [95% CI: -0.01 to 0.34]; p = 0.221) but was greater in participants aged <10 years versus >10 years at baseline (-0.15 [95% CI: -0.33 to 0.03] vs. 0.21 [95% CI: 0.03 to 0.40]; p = 0.008). BMISDS trajectory favored participants with high attendance (p = 0.013). There were persistent improvements in water intake and health-related quality of life in both groups as well as reduced sweet drink intake in the intervention group. CONCLUSIONS This intervention, with high engagement from those most affected by obesity, did not achieve long-term efficacy of the primary outcome. Attendance and age remain important considerations for future interventions to achieve long-term BMISDS reduction.
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Affiliation(s)
- Cervantée E K Wild
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
| | - Lisa E Wynter
- Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Christopher M Triggs
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
- Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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Rohit A, McCarthy L, Mack S, Silver B, Turner S, Baur LA, Canuto K, Boffa J, Dabelea D, Sauder KA, Maple-Brown L, Kirkham R. The Adaptation of a Youth Diabetes Prevention Program for Aboriginal Children in Central Australia: Community Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179173. [PMID: 34501765 PMCID: PMC8430517 DOI: 10.3390/ijerph18179173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
This study reports on integrating community perspectives to adapt a family-focused, culturally appropriate behavioural intervention program to prevent diabetes among Aboriginal children (6–11 years) in Central Australia. A participatory action research approach was used to engage a range of service providers, cultural advisors, and family groups. Appropriateness, acceptability, content, and delivery of a prevention program within the Central Australian context were discussed through a series of workshops with twenty-five service providers and seven family groups separately. The data obtained were deductively coded for thematic analysis. Main findings included: (i) the strong need for a diabetes prevention program that is community owned, (ii) a flexible and culturally appropriate program delivered by upskilling community members as program facilitators, and (iii) consideration of social and environmental factors when implementing the program. It is recommended that a trial of the adapted prevention program for effectiveness and implementation is led by an Aboriginal community-controlled health service.
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Affiliation(s)
- Athira Rohit
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
| | - Leisa McCarthy
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
| | - Shiree Mack
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
| | - Bronwyn Silver
- Aboriginal Community-Controlled Health Organization, Central Australian Aboriginal Congress, Alice Springs 0870, Australia; (B.S.); (S.T.); (J.B.)
| | - Sabella Turner
- Aboriginal Community-Controlled Health Organization, Central Australian Aboriginal Congress, Alice Springs 0870, Australia; (B.S.); (S.T.); (J.B.)
| | - Louise A. Baur
- Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney 2006, Australia;
| | - Karla Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide 5001, Australia;
| | - John Boffa
- Aboriginal Community-Controlled Health Organization, Central Australian Aboriginal Congress, Alice Springs 0870, Australia; (B.S.); (S.T.); (J.B.)
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Centre, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.A.S.)
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Centre, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (D.D.); (K.A.S.)
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
- Department of Endocrinology, Royal Darwin Hospital, Darwin 0810, Australia
- Correspondence: (L.M.-B.); (R.K.)
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Casuarina 0810, Australia; (A.R.); (L.M.); (S.M.)
- Correspondence: (L.M.-B.); (R.K.)
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11
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Whitehead J, Smith M, Anderson Y, Zhang Y, Wu S, Maharaj S, Donnellan N. Improving spatial data in health geographics: a practical approach for testing data to measure children's physical activity and food environments using Google Street View. Int J Health Geogr 2021; 20:37. [PMID: 34407813 PMCID: PMC8375212 DOI: 10.1186/s12942-021-00288-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/04/2021] [Indexed: 03/16/2023] Open
Abstract
Background Geographic information systems (GIS) are often used to examine the association between both physical activity and nutrition environments, and children’s health. It is often assumed that geospatial datasets are accurate and complete. Furthermore, GIS datasets regularly lack metadata on the temporal specificity. Data is usually provided ‘as is’, and therefore may be unsuitable for retrospective or longitudinal studies of health outcomes. In this paper we outline a practical approach to both fill gaps in geospatial datasets, and to test their temporal validity. This approach is applied to both district council and open-source datasets in the Taranaki region of Aotearoa New Zealand.
Methods We used the ‘streetview’ python script to download historic Google Street View (GSV) images taken between 2012 and 2016 across specific locations in the Taranaki region. Images were reviewed and relevant features were incorporated into GIS datasets. Results A total of 5166 coordinates with environmental features missing from council datasets were identified. The temporal validity of 402 (49%) environmental features was able to be confirmed from council dataset considered to be ‘complete’. A total of 664 (55%) food outlets were identified and temporally validated. Conclusions Our research indicates that geospatial datasets are not always complete or temporally valid. We have outlined an approach to test the sensitivity and specificity of GIS datasets using GSV images. A substantial number of features were identified, highlighting the limitations of many GIS datasets.
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Affiliation(s)
- Jesse Whitehead
- School of Nursing, University of Auckland, Private Bag 920019, Auckland, 1142, New Zealand.
| | - Melody Smith
- School of Nursing, University of Auckland, Private Bag 920019, Auckland, 1142, New Zealand
| | - Yvonne Anderson
- Department of Paediatrics, Child and Youth Health, University of Auckland, Level 1, Building 507, Grafton Campus, Private Bag 92019, Auckland, 1142, New Zealand.,Department of Paediatrics, Taranaki Base Hospital, Taranaki District Health Board, David Street, New Plymouth, 4310, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
| | - Yijun Zhang
- School of Nursing, University of Auckland, Private Bag 920019, Auckland, 1142, New Zealand
| | - Stephanie Wu
- Faculty of Health and Medical Sciences, University of Auckland, Private Bag 920019, Auckland, 1142, New Zealand
| | - Shreya Maharaj
- Faculty of Health and Medical Sciences, University of Auckland, Private Bag 920019, Auckland, 1142, New Zealand
| | - Niamh Donnellan
- School of Nursing, University of Auckland, Private Bag 920019, Auckland, 1142, New Zealand
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12
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Wild CEK, Rawiri NT, Cormack DM, Willing EJ, Hofman PL, Anderson YC. A Collaborative Indigenous-non-Indigenous Partnership Approach to Understanding Participant Experiences of a Community-Based Healthy Lifestyles Program. QUALITATIVE HEALTH RESEARCH 2021; 31:1404-1411. [PMID: 33703952 PMCID: PMC8278546 DOI: 10.1177/1049732321998640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We describe the approach of an Indigenous-non-Indigenous research partnership in the context of a qualitative study which aimed to understand barriers and facilitators to engagement in a community-based healthy lifestyles program in Aotearoa/New Zealand. Informed by Kaupapa Māori research principles and by "Community-Up" research values, this collaborative approach between the mixed Māori-non-Māori research team effectively engaged with Māori and non-Māori families for in-depth interviews on participant experience, including with non-service users. "Community-Up" research principles allowed for a respectful process which upheld the mana (status, dignity) of the interview participants and the research team. Challenges included maintaining flexibility in our conceptions of ethnicity to reflect the complexity of modern family life in Aotearoa/New Zealand. We were committed to ongoing communication, awareness, and attention to the relationships that formed the basis of our research partnership, which allowed effective navigation of challenges and was critical to the study's success.
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Affiliation(s)
- Cervantée E. K. Wild
- The University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
| | | | | | | | - Paul L. Hofman
- The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C. Anderson
- The University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
- Taranaki District Health Board, New Plymouth, New Zealand
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13
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Anderson YC, Wild CEK, Hofman PL, Cave TL, Taiapa KJ, Domett T, Derraik JGB, Cutfield WS, Grant CC, Willing EJ. Participants' and caregivers' experiences of a multidisciplinary programme for healthy lifestyle change in Aotearoa/New Zealand: a qualitative, focus group study. BMJ Open 2021; 11:e043516. [PMID: 33980517 PMCID: PMC8118004 DOI: 10.1136/bmjopen-2020-043516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Child and adolescent obesity continues to be a major health issue internationally. This study aims to understand the views and experiences of caregivers and participants in a child and adolescent multidisciplinary programme for healthy lifestyle change. DESIGN Qualitative focus group study. SETTING Community-based healthy lifestyle intervention programme in a mixed urban-rural region of Aotearoa/New Zealand. PARTICIPANTS Parents/caregivers (n=6) and children/adolescents (n=8) who participated in at least 6 months of an assessment and weekly session, family-based community intervention programme for children and adolescents affected by obesity. RESULTS Findings covered participant experiences, healthy lifestyle changes due to participating in the programme, the delivery team, barriers to engagement and improvements. Across these domains, four key themes emerged from the focus groups for participants and their caregivers relating to their experience: knowledge-sharing, enabling a family to become self-determining in their process to achieve healthy lifestyle change; the importance of connectedness and a family-based programme; the sense of a collective journey and the importance of a nonjudgemental, respectful welcoming environment. Logistical challenges and recommendations for improvement were also identified. CONCLUSIONS Policymakers need to consider the experiences of participants alongside quantitative outcomes when informing multidisciplinary intervention programmes for children and adolescents affected by obesity.Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTR):12611000862943; Post-results.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Cervantée E K Wild
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu-Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
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14
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Cave TL, Derraik JG, Willing EJ, Hofman PL, Anderson YC. Caregiver perceptions of weight in preschool children, and determinants of engagement in a multidisciplinary intervention service for weight issues. Obes Res Clin Pract 2021; 15:262-267. [DOI: 10.1016/j.orcp.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
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15
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Wild CEK, Rawiri NT, Willing EJ, Hofman PL, Anderson YC. What affects programme engagement for Māori families? A qualitative study of a family-based, multidisciplinary healthy lifestyle programme for children and adolescents. J Paediatr Child Health 2021; 57:670-676. [PMID: 33354861 PMCID: PMC8247020 DOI: 10.1111/jpc.15309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
AIM It is important that intervention programmes are accessible and acceptable for groups most affected by excess weight. This study aimed to understand the barriers to and facilitators of engagement for Māori in a community-based, assessment-and-intervention healthy lifestyle programme (Whānau Pakari). METHODS Sixty-four in-depth, home-based interviews were conducted with past service users. Half of these were with families with Māori children and half with non-Māori families. The interviews were thematically analysed with peer debriefing for validity. RESULTS Māori families experienced barriers due to racism throughout the health system and society, which then affected their ability to engage with the programme. Key barriers included the institutionalised racism evident through substantial structural barriers and socio-economic challenges, the experience of interpersonal racism and its cumulative impact with weight stigma, and internalised racism and beliefs of biological determinism. Responses to these barriers were distrust of health services, followed by renewed engagement or complete disengagement. Participants identified culturally appropriate care as that which was compassionate, respectful, and focused on relationship building. CONCLUSIONS While Whānau Pakari is considered appropriate due to the approach of the delivery team, this is insufficient to retain some Māori families who face increased socio-economic and structural barriers. Past instances of weight stigma and racism have enduring effects when re-engaging with future health services, and inequities are likely to persist until these issues are addressed within the health system and wider society.
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Affiliation(s)
- Cervantée EK Wild
- Liggins InstituteUniversity of AucklandAucklandNew Zealand,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Kōhatu – Centre for Hauora MāoriUniversity of OtagoDunedinNew Zealand
| | | | - Esther J Willing
- Starship Children's HospitalAuckland District Health BoardAucklandNew Zealand
| | - Paul L Hofman
- Liggins InstituteUniversity of AucklandAucklandNew Zealand,Tamariki Pakari Child Health and Wellbeing TrustNew PlymouthNew Zealand
| | - Yvonne C Anderson
- Liggins InstituteUniversity of AucklandAucklandNew Zealand,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Tamariki Pakari Child Health and Wellbeing TrustNew PlymouthNew Zealand,Department of PaediatricsTaranaki District Health BoardNew PlymouthNew Zealand
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16
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Littlewood R, Canfell OJ, Walker JL. Response to 'Systematic reviews do not always capture context of real-world intervention programmes for childhood obesity' by Wild et al., 2021 in BMC Public Health. BMC Public Health 2021; 21:500. [PMID: 33715618 PMCID: PMC7958423 DOI: 10.1186/s12889-021-10487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
In a correspondence to BMC Public Health, Wild et al. respond to our systematic review that synthesised results of interventions to prevent or treat childhood obesity in Māori and Pacific Islanders. Our review included the Whānau Pakari study as one of six included studies – a multidisciplinary intervention for Māori children and adolescents living with obesity led by their research team. Our review suggested that future research can incorporate stronger co-design principles when designing culturally-tailored interventions to maximise cultural specificity, enhance engagement, facilitate program ownership and contribute to improved health and weight-related outcomes. We commend Whānau Pakari and the team of Wild et al. on their sustained commitment to addressing obesity in priority populations and agree that systematic reviews struggle to capture real-world context of interventions for complex diseases such as obesity. In this article, we respond sequentially to the comments made by Wild et al. and (1) clarify the scope of our review article (2) reiterate our commendation of mixed-methods approaches that capture real-world context (3) explain a referencing error that caused a misinterpretation of our results (4) clarify our interpretation of some Whānau Pakari characteristics (5) welcome partnership to facilitate shared learning with Wild et al.
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Affiliation(s)
- Robyn Littlewood
- Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton, QLD, Australia.,Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia. .,UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD, Australia. .,Digital Health Cooperative Research Centre, Australian Government, Sydney, NSW, Australia.
| | - Jacqueline L Walker
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia
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Wild CEK, Cave TL, Willing EJ, Derraik JGB, Grant CC, Hofman PL, Anderson YC. Correspondence: systematic reviews do not always capture context of real-world intervention programmes for childhood obesity (response to Littlewood, et al., 2020 in BMC Public Health). BMC Public Health 2021; 21:501. [PMID: 33715630 PMCID: PMC7958484 DOI: 10.1186/s12889-021-10486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
In a recent issue of the BMC Public Health journal, Littlewood et al. described the results of a systematic review of interventions to prevent or treat childhood obesity in Māori or Pacific Island peoples. They found that studies to date have had limited impact on improving health outcomes for Māori and Pacific Island peoples, and suggest this may be due to a lack of co-design principles in the conception of the various studies. Ensuring that interventions are appropriate for groups most affected by obesity is critical; however, some inaccuracies should be noted in the explanation of these findings. There is a risk with systematic reviews that the context of intervention trials is lost without acknowledging the associated body of literature for programmes that refer to the ongoing commitment to communities and groups most affected by obesity.
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Affiliation(s)
- Cervantée E K Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. .,Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand. .,Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu - Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand.,Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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18
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Pearce A, Longhurst G. The Role of the Clinical Exercise Physiologist in Reducing the Burden of Chronic Disease in New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030859. [PMID: 33498267 PMCID: PMC7908570 DOI: 10.3390/ijerph18030859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022]
Abstract
Clinical exercise physiologists (CEPs) specialize in managing long-term, non-communicable health conditions using scientific rehabilitative exercise prescription, which alleviates the burden of these conditions on health care systems. This is evident, particularly in Australia (AUS), where they are registered as health care workers. CEPs have been shown to reduce the physical burden of long-term conditions on populations and the economic load that these place on national health departments. This article aims to evidence the effectiveness of CEPs in Noncommunicable Disease (NCD) rehabilitation, the cost-effectiveness of supervised exercise prescription for various NCDs by CEPs in AUS, and related cost-effectiveness New Zealand (NZ) burden of disease. This article highlights the important role NZ. CEPs can play in reducing chronic disease cost if given the same opportunities as Australian CEPs within NZ's health care system.
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19
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Anderson YC, Wynter LE, O'Sullivan NA, Wild CEK, Grant CC, Cave TL, Derraik JGB, Hofman PL. Two-year outcomes of Whānau Pakari, a multi-disciplinary assessment and intervention for children and adolescents with weight issues: A randomized clinical trial. Pediatr Obes 2021; 16:e12693. [PMID: 32959996 DOI: 10.1111/ijpo.12693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether 12-month BMI SDS reductions persisted at 24 months in a multi-disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved. METHODS This was a community-based 12-month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. The low-intensity control received comprehensive home-based baseline assessments and advice, and 6-monthly follow-up. The high-intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers. RESULTS 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention-to-treat analysis [Control -0.03 (95%CI -0.14, 0.09) and Intervention -0.02 (-0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high-intensity intervention. ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95%CI -0.38, -0.06). CONCLUSIONS This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lisa E Wynter
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Niamh A O'Sullivan
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | | | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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20
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Abstract
Objective: The objective of the current study was to identify challenges of making and sustaining healthy lifestyle changes for families with children/adolescents affected by obesity, who were referred to a multicomponent healthy lifestyle assessment and intervention programme in Aotearoa/New Zealand (NZ). Design: Secondary qualitative analysis of semi-structured interviews. Setting: Taranaki region of Aotearoa/NZ. Participants: Thirty-eight interviews with parents/caregivers (n 42) of children/adolescents who had previously been referred to a family-focused multidisciplinary programme for childhood obesity intervention, who identified challenges of making healthy lifestyle changes. Participants had varying levels of engagement, including those who declined contact after their referral. Results: Participant-identified challenges included financial cost, impact of the food environment, time pressures, stress, maintaining consistency across households, independence in adolescence, concern for mental health and frustration when not seeing changes in weight status. Conclusions: Participants recognised a range of factors that contributed towards their ability to make and sustain change, including factors at the wider socio-environmental level beyond their immediate control. Even with the support of a multidisciplinary healthy lifestyle programme, participants found it difficult to make sustained changes within an obesogenic environment. Healthy lifestyle intervention programmes and families’ abilities to make and sustain changes require alignment of prevention efforts, focusing on policy changes to improve the food environment and eliminate structural inequities.
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21
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Wild CE, Rawiri NT, Willing EJ, Hofman PL, Anderson YC. Determining barriers and facilitators to engagement for families in a family-based, multicomponent healthy lifestyles intervention for children and adolescents: a qualitative study. BMJ Open 2020; 10:e037152. [PMID: 32895279 PMCID: PMC7478027 DOI: 10.1136/bmjopen-2020-037152] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Recruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community. DESIGN Qualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban-rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity. PARTICIPANTS Families were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families. RESULTS Three interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences. CONCLUSIONS While participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.
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Affiliation(s)
| | - Ngauru T Rawiri
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu - Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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22
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McGavock J, Chauhan BF, Rabbani R, Dias S, Klaprat N, Boissoneault S, Lys J, Wierzbowski AK, Sakib MN, Zarychanski R, Abou-Setta AM. Layperson-Led vs Professional-Led Behavioral Interventions for Weight Loss in Pediatric Obesity: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2010364. [PMID: 32658289 PMCID: PMC7358915 DOI: 10.1001/jamanetworkopen.2020.10364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE The appropriate approach for weight loss among children and adolescents with overweight and obesity remains unclear. OBJECTIVE To evaluate the difference in the treatment outcomes associated with behavioral weight loss interventions led by laypersons and professionals in comparison with unsupervised control arms among children and adolescents with overweight and obesity. DATA SOURCES For this systematic review and meta-analysis, the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, the Cochrane Library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 1996, to June 1, 2019. STUDY SELECTION Included in this study were randomized clinical trials (RCTs) of behavioral interventions lasting at least 12 weeks for children and adolescents (aged 5-18 years) with overweight and obesity. Exclusion criteria included non-RCT studies, interventions lasting less than 12 weeks, adult enrollment, participants with other medical diagnoses, pharmacological treatment use, and articles not written in English. Two of 6 reviewers independently screened all citations. Of 25 586 citations, after duplicate removal, 78 RCTs (5780 participants) met eligibility criteria. DATA EXTRACTION AND SYNTHESIS A bayesian framework and Markov chain Monte Carlo simulation methods were used to combine direct and indirect associations. Random-effects and fixed-effect network meta-analysis models were used with the preferred model chosen by comparing the deviance information criteria. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES The immediate and sustained changes in weight and body mass index (BMI) standardized mean difference (SMD) were primary outcomes planned before data collection began, whereas waist circumference and percent body fat were secondary outcomes. The hypothesis being tested was formulated before the data collection. RESULTS Of 25 586 citations retrieved, we included 78 RCTs (5780 participants), with a follow-up of 12 to 104 weeks. Compared with the control condition, random-effects models revealed that professional-led weight loss interventions were associated with reductions in weight (mean difference [MD], -1.60 kg [95% CI, -2.30 to -0.99 kg]; 68 trials; P < .001) and BMI (SMD, -0.30 [95% CI, -0.39 to -0.20]; 59 trials; P < .001) that were not sustained long term (weight MD, -1.02 kg [95% CI, -2.20 to 0.34 kg]; 21 trials; P = .06; BMI SMD, -0.12 [95% CI, -0.46 to 0.21]; 20 trials; P < .001). There was no association between layperson-led interventions and weight loss in the short-term (MD, -1.40 kg [95% CI, -3.00 to 0.26 kg]; 5 trials; P = .05) or long-term (MD, -0.98 kg [95% CI, -3.60 to 1.80 kg]; 1 trial; P = .23) compared with standard care. No difference was found in head-to-head trials (professional vs layperson MD, -0.25 kg [95% CI -1.90 to 1.30 kg]; 5 trials; P = .38). CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found that professional-led weight loss interventions were associated with short-term but not sustained weight reduction among children and adolescents with overweight or obesity, and the evidence for layperson-led approaches was insufficient to draw firm conclusions.
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Affiliation(s)
- Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Bhupendrasinh F. Chauhan
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- I. H. Asper Clinical Research Institute, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Nika Klaprat
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Sara Boissoneault
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | | | - Mohammad Nazmus Sakib
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
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Littlewood R, Canfell OJ, Walker JL. Interventions to prevent or treat childhood obesity in Māori & Pacific Islanders: a systematic review. BMC Public Health 2020; 20:725. [PMID: 32429872 PMCID: PMC7236934 DOI: 10.1186/s12889-020-08848-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background Māori and Pacific Islander people are a priority population originating from Australasia. Māori and Pacific Islander children exhibit greater risk of obesity and associated morbidities compared to children of other descent, secondary to unique cultural practices and socioeconomic disadvantage. Despite these known risk factors, there is limited synthesised evidence for preventing and treating childhood obesity in this unique population. The objective of this systematic review was to identify and evaluate global prevention or treatment interventions for overweight or obesity that targeted Māori and Pacific Islander children and adolescents (aged 2–17 years). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The databases PubMed, EMBASE, Scopus, Web of Science and CINAHL were searched from inception to August 2018. Study quality and risk of bias was assessed using a modified Downs and Black Quality Checklist for Health Care Intervention Studies. Studies were included if RCT/intervention/case control/ or prevention study designs. The study group was defined under the search term ‘Oceanic Ancestry Group’. Results Of the initial 94 articles identified, six were included describing two prevention and three treatment interventions. Interventions were heterogenous in setting, design, length and outcomes. Four interventions were implemented in New Zealand. Most studies were of ‘fair’ quality. One study recruited an exclusive population of Māori and Pacific Islander participants. In the five studies that recruited mixed populations, one performed sub-group analysis on Māori and Pacific Islander participants. No study reported an improvement in anthropometric outcomes post-intervention in complete or sub-group analysis. Improvements in cardiometabolic or psychological secondary outcomes were inconsistent across all studies. Conclusions There is a lack of evidence to recommend specific intervention characteristics to optimise obesity prevention or treatment outcomes for Māori and Pacific Islander children. Future research requires greater consideration of cultural values and beliefs, community engagement, exclusive targeting of Māori and Pacific Islander children and families, and sub-group analyses for mixed-population studies. Incorporating co-design principles during study design and implementation can maximise the cultural specificity of interventions and may contribute to improved health and weight-related outcomes for this at-risk, priority population. Trial registration PROSPERO CRD42019121790 (26 March 2019).
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Affiliation(s)
- Robyn Littlewood
- Health and Wellbeing Queensland, Queensland Government, The State of Queensland, 139 Coronation Drive, Milton Green, Milton, QLD, 4064, Australia.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4067, Australia
| | - Oliver J Canfell
- Health and Wellbeing Queensland, Queensland Government, The State of Queensland, 139 Coronation Drive, Milton Green, Milton, QLD, 4064, Australia. .,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4067, Australia. .,Children's Health Queensland Hospital and Health Service, Department of Health, Queensland Government, South Brisbane, QLD, 4101, Australia.
| | - Jacqueline L Walker
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, 4067, Australia
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Wild CEK, O'Sullivan NA, Lee AC, Cave TL, Willing EJ, Cormack DM, Hofman PL, Anderson YC. Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:528-534. [PMID: 31780274 DOI: 10.1016/j.jneb.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand. METHODS Whānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance. RESULTS Self-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program. CONCLUSIONS AND IMPLICATIONS Program convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.
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Affiliation(s)
| | - Niamh A O'Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Arier C Lee
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu-Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - Donna M Cormack
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand; Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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Anderson Y, Wynter L, Grant C, Wild C, O'Sullivan N, Cave T, Derraik J, Cutfield W, Hofman P. Two-year outcomes of Whānau Pakari: a novel home-based intervention for child and adolescent obesity. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2018.11.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Anderson YC, Dolan GMS, Wynter LE, Treves KF, Wouldes TA, Grant CC, Cave TL, Smiley AJ, Derraik JGB, Cutfield WS, Hofman PL. Caregiver's readiness for change as a predictor of outcome and attendance in an intervention programme for children and adolescents with obesity: a secondary data analysis. BMJ Open 2019; 9:e023195. [PMID: 30918030 PMCID: PMC6475337 DOI: 10.1136/bmjopen-2018-023195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE/DESIGN It remains unclear as to the efficacy of readiness for change measurements in child and adolescent obesity intervention programmes. This observational study aimed to determine whether the caregiver's stage of change could predict outcome and adherence to treatment in an intensive intervention programme for children and adolescents with obesity. SETTING Participants were from the Whānau Pakari randomised clinical trial, a community based multi-disciplinary intervention programme for obesity in Taranaki, New Zealand. PARTICIPANTS Eligible participants (recruited January 2012 to August 2014) were aged 5-16 years and had a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities. INTERVENTIONS This study only assessed participants randomised to the high-intensity intervention programme (6-month assessments with weekly group sessions for 12 months) given attendance data were required (n=96). PRIMARY AND SECONDARY OUTCOME MEASURES Primary trial outcome was BMI SD score (SDS). Secondary outcome measures included indices such as fruit and vegetable intake, 550-m run/walk time and quality of life scores. At baseline assessment, participants (if >11 years old) and their accompanying adult were assessed for readiness to make healthy lifestyle change. RESULTS A quantitative measure of stage of change in caregivers was not a predictor of primary or secondary outcomes (change in BMI SDS pre-contemplation/contemplation -0.08, 95% CI -0.18 to 0.03, action -0.16, 95% CI -0.27 to -0.05, p=0.27), or overall attendance in the weekly activity sessions (40.0% vs 37.1%, respectively, p=0.54) in the child or adolescent. CONCLUSIONS Caregiver's stage of change was not a predictor of success in this multi-disciplinary assessment and intervention programme for children and adolescents with obesity. Future research needs to determine participants' factors for success. TRIAL REGISTRATION NUMBER ANZCTR12611000862943; Post-results.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - Lisa E Wynter
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Katharine F Treves
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Trecia A Wouldes
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Anna J Smiley
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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27
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Anderson YC, Kirkpatrick K, Dolan GMS, Wouldes TA, Grant CC, Cave TL, Wild CEK, Derraik JGB, Cutfield WS, Hofman PL. Do changes in weight status affect cognitive function in children and adolescents with obesity? A secondary analysis of a clinical trial. BMJ Open 2019; 9:e021586. [PMID: 30782863 PMCID: PMC6367974 DOI: 10.1136/bmjopen-2018-021586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES It is unclear whether an association exists between obesity in children/adolescents and cognitive function, and whether the latter can be altered by body mass index (BMI) standard deviation score (SDS) reductions. We aimed to determine whether an association exists between BMI SDS and cognitive function in children/adolescents with obesity engaged in an obesity intervention. Second, we sought to determine if BMI SDS reduction at 12 months was associated with improved cognitive function. DESIGN Secondary analysis of a clinical trial. PARTICIPANTS Participants (n=69) were recruited from an obesity intervention. Eligible participants (recruited June 2013 to June 2015) were aged 6-16 years, with a BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. OUTCOME MEASURES Primary outcome measure was change in BMI SDS from baseline at 12 months. Dependent variables of cognitive functioning and school achievement were assessed at baseline and 12 months, using dependent variables of cognitive functioning (elements of Ravens Standard Progressive Matrices, Wide Range Achievement Test-fourth edition and Wechsler Intelligence Scale for Children-fourth edition). RESULTS At baseline, BMI SDS was not associated with all aspects of cognitive function tested (n=69). Reductions in BMI SDS over time did not alter cognitive function overall. However, there was a greater reduction in comprehension standard scores in participants who increased their BMI SDS (adjusted estimated difference -6.1, 95% CI -11.6 to -0.6; p=0.03). CONCLUSIONS There were no observed associations between BMI SDS and cognitive function in participants, apart from comprehension in the exploratory analyses, which may have been a random finding. Further studies need to include larger longitudinal cohorts incorporating a wider BMI range at entry to determine whether our findings persist. TRIAL REGISTRATION NUMBER ANZCTR12611000862943; Pre-results.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kaye Kirkpatrick
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | | | - Trecia A Wouldes
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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Seo YG, Lim H, Kim Y, Ju YS, Lee HJ, Jang HB, Park SI, Park KH. The Effect of a Multidisciplinary Lifestyle Intervention on Obesity Status, Body Composition, Physical Fitness, and Cardiometabolic Risk Markers in Children and Adolescents with Obesity. Nutrients 2019; 11:nu11010137. [PMID: 30634657 PMCID: PMC6356576 DOI: 10.3390/nu11010137] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 12/02/2022] Open
Abstract
This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were ≥85th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI z-score of the overall completers decreased by about 0.05 after the 16-week intervention (p = 0.02). After the intervention, only the exercise group had a significantly lower BMI z-score than the baseline score by about 0.1 (p = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (β = −1.52, 95%CI = −2.58–−0.45), lean body mass (LM) (β = 1.20, 95%CI = 0.12–2.29), diastolic blood pressure (β = −5.24, 95%CI = −9.66–−0.83), high-sensitivity C-reactive protein (β = −1.67, 95%CI = −2.77–−1.01), and wall sit test score (β = 50.74, 95%CI = 32.30–69.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.
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Affiliation(s)
- Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea.
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin, Gyeonggi-do 17104, Korea.
| | - YoonMyung Kim
- University College, Yonsei University International Campus, Incheon 21983, Korea.
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea.
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea.
| | - Han Byul Jang
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea.
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea.
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea.
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29
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Home Visitations for Delivering an Early Childhood Obesity Intervention in Denver: Parent and Patient Navigator Perspectives. Matern Child Health J 2018; 22:1589-1597. [DOI: 10.1007/s10995-018-2553-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Anderson YC, Leung W, Grant CC, Cave TL, Derraik JGB, Cutfield WS, Pereira NM, Hofman PL, Sullivan TA. Economic evaluation of a multi-disciplinary community-based intervention programme for New Zealand children and adolescents with obesity. Obes Res Clin Pract 2018; 12:293-298. [PMID: 29779834 DOI: 10.1016/j.orcp.2018.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/25/2018] [Accepted: 04/27/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether Whānau Pakari, a home-based, 12-month multi-disciplinary child obesity intervention programme was cost-effective when compared with the prior conventional hospital-based model of care. METHODS Whānau Pakari trial participants were recruited January 2012-August 2014, and randomised to either a high-intensity intervention (weekly sessions for 12 months with home-based assessments and advice, n=100) or low-intensity control (home-based assessments and advice only, n=99). Trial participants were aged 5-16 years, resided in Taranaki, Aotearoa/New Zealand (NZ), with a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities. Conventional group participants (receiving paediatrician assessment with dietitian input and physical activity/nutrition support, n=44) were aged 4-15 years, and resided in the same or another NZ centre. The change in BMI standard deviation score (SDS) at 12 months from baseline and programme intervention costs, both at the participant level, were used for the economic evaluation. A limited health funder perspective with costs in 2016 NZ$ was taken. RESULTS The per child 12-month Whānau Pakari programme costs were significantly lower than in the conventional group. In the low-intensity group, costs were NZ$939 (95% CI: 872, 1007) (US$648) lower than the conventional group. In the high-intensity intervention group, costs were NZ$155 (95% CI: 89, 219) (US$107) lower than in the conventional group. BMI SDS reductions were similar in the three groups. CONCLUSIONS A home-based, multi-disciplinary child obesity intervention had lower programme costs per child, greater reach, with similar BMI SDS outcomes at 12 months when compared with the previous hospital-based conventional model.
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Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - William Leung
- Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand; Starship Children's Health, Auckland District Health Board, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand; A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; Starship Children's Health, Auckland District Health Board, Auckland, New Zealand; A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Nicola M Pereira
- Child Health Service, Midcentral District Health Board, Palmerston North, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand; Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Trudy A Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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