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Cuda S. Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS 2024; 11:100113. [PMID: 38953014 PMCID: PMC11216014 DOI: 10.1016/j.obpill.2024.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile. Methods The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child. Conclusions This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Hooper L, Lebow J, Gewirtz O'Brien JR, Puhl RM, Neumark-Sztainer D. Partnerships with primary care providers: Opportunities to prevent eating disorders and mitigate their progression in young people. Eat Disord 2024:1-17. [PMID: 39171418 DOI: 10.1080/10640266.2024.2394263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Epidemiologic research has identified numerous interpersonal and individual risk factors for and warning signs of emerging eating disorders in adolescents. These findings have informed public health prevention and treatment strategies, including translation of findings to clinical recommendations for primary care providers (PCPs). A next step in this translational work could include a comprehensive approach where PCPs are seen as partners in efforts to improve population health outcomes. PCPs have great potential to implement high-yield interventions that prevent or attenuate the course of adolescent eating disorders. To illustrate this potential, we present a case that highlights missed opportunities for a PCP to prevent, detect, and intervene during a patient's developing eating disorder. We then relate the case to two emerging research programs that utilize PCP partnerships: one trains PCPs in Strengths-Based Adolescent Healthcare to improve eating disorder prevention; the other adapts Family-Based Treatment for primary care to improve early access to evidence-based treatment. In addition to these promising areas of research, efforts are needed to widen requirements for eating disorder curricula in medical training programs and to address weight stigma in primary care. Together these efforts will help PCPs become effective partners in the prevention and treatment of eating disorders.
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Affiliation(s)
- Laura Hooper
- Division of Adolescent Medicine, Indiana University, Indianapolis, USA
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, USA
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, USA
| | | | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, USA
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Oshakbayev K, Durmanova A, Zhankalova Z, Idrisov A, Bedelbayeva G, Gazaliyeva M, Nabiyev A, Tordai A, Dukenbayeva B. Weight loss treatment for COVID-19 in patients with NCDs: a pilot prospective clinical trial. Sci Rep 2024; 14:10979. [PMID: 38744929 PMCID: PMC11094141 DOI: 10.1038/s41598-024-61703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
COVID-19 comorbid with noncommunicable chronic diseases (NCDs) complicates the diagnosis, treatment, and prognosis, and increases the mortality rate. The aim is to evaluate the effects of a restricted diet on clinical/laboratory inflammation and metabolic profile, reactive oxygen species (ROS), and body composition in patients with COVID-19 comorbid with NCDs. We conducted a 6-week open, pilot prospective controlled clinical trial. The study included 70 adult patients with COVID-19 comorbid with type 2 diabetes (T2D), hypertension, or nonalcoholic steatohepatitis (NASH). INTERVENTIONS a restricted diet including calorie restriction, hot water drinking, walking, and sexual self-restraint. PRIMARY ENDPOINTS COVID-19 diagnosis by detecting SARS-CoV-2 genome by RT-PCR; weight loss in Main group; body temperature; C-reactive protein. Secondary endpoints: the number of white blood cells; erythrocyte sedimentation rate; adverse effects during treatment; fasting blood glucose, glycosylated hemoglobin A1c (HbA1c), systolic/diastolic blood pressure (BP); blood lipids; ALT/AST, chest CT-scan. In Main group, patients with overweight lost weight from baseline (- 12.4%; P < 0.0001); 2.9% in Main group and 7.2% in Controls were positive for COVID-19 (RR: 0.41, CI: 0.04-4.31; P = 0.22) on the 14th day of treatment. Body temperature and C-reactive protein decreased significantly in Main group compared to Controls on day 14th of treatment (P < 0.025). Systolic/diastolic BP normalized (P < 0.025), glucose/lipids metabolism (P < 0.025); ALT/AST normalized (P < 0.025), platelets increased from baseline (P < 0.025), chest CT (P < 0.025) in Main group at 14 day of treatment. The previous antidiabetic, antihypertensive, anti-inflammatory, hepatoprotective, and other symptomatic medications were adequately decreased to completely stop during the weight loss treatment. Thus, the fast weight loss treatment may be beneficial for the COVID-19 patients with comorbid T2D, hypertension, and NASH over traditional medical treatment because, it improved clinical and laboratory/instrumental data on inflammation; glucose/lipid metabolism, systolic/diastolic BPs, and NASH biochemical outcomes, reactive oxygen species; and allowed patients to stop taking medications. TRIAL REGISTRATION ClinicalTrials.gov NCT05635539 (02/12/2022): https://clinicaltrials.gov/ct2/show/NCT05635539?term=NCT05635539&draw=2&rank=1 .
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Affiliation(s)
- Kuat Oshakbayev
- Internal Medicine Department, University Medical Center, Street Syganak, 46, 010000, Astana, Republic of Kazakhstan.
- ANADETO Medical Center, St. Kerey, Zhanibek Khans, 22, 010000, Astana, Republic of Kazakhstan.
| | - Aigul Durmanova
- Internal Medicine Department, University Medical Center, Street Syganak, 46, 010000, Astana, Republic of Kazakhstan
| | - Zulfiya Zhankalova
- Department of General Medical Practice, Asfendiyarov Kazakh National Medical University, #1, Street Tole Bi, 94, 050000, Almaty, Republic of Kazakhstan
| | - Alisher Idrisov
- Department of Endocrinology, Astana Medical University, Street Beibitshilik St 49/A, Astana, Republic of Kazakhstan
| | - Gulnara Bedelbayeva
- Faculty of Postgraduate Education, Asfendiyarov Kazakh National Medical University, Street Tole Bi, 94, 050000, Almaty, Republic of Kazakhstan
| | - Meruyert Gazaliyeva
- Faculty of Internal Medicine, Astana Medical University, Street Beibitshilik St 49/A, Astana, Republic of Kazakhstan
| | - Altay Nabiyev
- Internal Medicine Department, University Medical Center, Street Syganak, 46, 010000, Astana, Republic of Kazakhstan
| | - Attila Tordai
- Department of Transfusion Medicine, Semmelweis University, Vas U. 17, Budapest, 1088, Hungary
| | - Bibazhar Dukenbayeva
- Faculty of Pathology and Forensic Medicine, Astana Medical University, Astana, Republic of Kazakhstan
- ANADETO Medical Center, St. Kerey, Zhanibek Khans, 22, 010000, Astana, Republic of Kazakhstan
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Button AM, Staiano AE, Beyl RA, Stein RI, Newton RL, Baker A, Lima A, Lindros J, Conn AM, Welch RR, Cook SR, Wilfley DE. Validation of remote child weight and height measurements within a weight management trial. Obesity (Silver Spring) 2024; 32:660-666. [PMID: 38108115 PMCID: PMC10965384 DOI: 10.1002/oby.23972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of this substudy within the Treatment Efforts Addressing Child Weight Management by Unifying Patients, Parents, and Providers (TEAM UP) pragmatic clinical trial was to compare the validity of anthropometric measurements collected remotely versus in person (≤7 days apart) among youth with obesity who were 6 to 15 years of age. METHODS Child (n = 37) weight and height were measured in person by a trained data assessor. These were compared with measurements taken remotely by the child's parent with live videoconferencing observation by a study data assessor. In-person and remote measurements were compared using Bland-Altman plots, Pearson correlations, and two one-sided paired t tests. A priori bounds of acceptability were set at ±0.68 kg to allow for typical weight fluctuations within the 7-day comparison period. RESULTS Measurements were highly correlated (height: r = 0.991, p < 0.0001; weight: r = 0.999; p = 0.03). For height, two one-sided t tests for upper, t(36) = 3.95, and lower, t(36) = -2.63, bounds (-1, 1) revealed an overall p = 0.006; absolute error was 3.5 cm. For weight, two one-sided t tests for upper, t(36) = 1.93, and lower, t(36) = -7.91, bounds (-0.68, 0.68) revealed an overall p = 0.03; absolute error was 1.7 kg. CONCLUSIONS The present findings support the utility and interpretation of remotely assessed weight management outcomes for both research and clinical purposes. These procedures may offer greater accessibility to evidence-based measurement.
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Affiliation(s)
- Alyssa M Button
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Richard I Stein
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert L Newton
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Alison Baker
- American Academy of Pediatrics, Child and Community Health, Itasca, Illinois, USA
| | - Angela Lima
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Lindros
- American Academy of Pediatrics, Child and Community Health, Itasca, Illinois, USA
| | - Anne-Marie Conn
- University of Rochester Medical Center, Rochester, New York, USA
| | - R Robinson Welch
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen R Cook
- University of Rochester Medical Center, Rochester, New York, USA
| | - Denise E Wilfley
- Washington University School of Medicine, St. Louis, Missouri, USA
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O'Hara VM, Louder D, Johnston SV, Hastey K, Browne NT. Pediatric Obesity Care via Telemedicine: Expanding the Path Forward-A Review. Curr Obes Rep 2023; 12:546-556. [PMID: 37940835 DOI: 10.1007/s13679-023-00537-w] [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] [Accepted: 08/15/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW Review latest data regarding the intersection of pediatric obesity epidemic with telemedicine expansion to meet the need of equitable obesity care in children. RECENT FINDINGS Prevalence of pediatric obesity in the USA continues to worsen particularly in rural, underserved areas. Although there is an increasing number of obesity medicine specialists over the last decade, availability varies by geographic location. Pre-pandemic centers were limited, rarely located in rural areas, and required in-person visits for reimbursement. Telemedicine changes, responding to pandemic needs, provided increase in telemedicine utilization and acceptance with similar or improved obesity care outcomes. Given pediatric obesity prevalence and need for chronic, effective obesity care, leveraging telemedicine to expand reach and decrease access barriers provides a critical and creative remedy. Data cites similar outcomes between telemedicine and in-person care. The time to reimagine a full spectrum of care delivery for pediatric obesity is now.
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Affiliation(s)
- Valerie M O'Hara
- Maine Medical Center Weight and Wellness Clinic, 41 Donald B. Dean Drive Suite A, South Portland, ME, 04106, USA.
| | - Danielle Louder
- Northeast Telehealth Resource Center, MCD Global Health, 105 Second Street, Suite 2A, Hallowell, ME, 04347, USA
| | - Starr V Johnston
- Northern Light Acadia Hospital, 268 Stillwater Ave, Bangor, ME, 04401, USA
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Srivastava G. Diagnostic challenge: A pediatric patient with severe obesity and complications of imminent death. OBESITY PILLARS (ONLINE) 2023; 7:100077. [PMID: 37990678 PMCID: PMC10661896 DOI: 10.1016/j.obpill.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 11/23/2023]
Abstract
Background A 15-year-old patient suffering from severe obesity (400 pounds, BMI 71.6 kg/m2) with a clinical phenotype suggestive of syndromic obesity was hospitalized for severe heart failure and cardiogenic shock. The hospital admission prompted a palliative care and heart transplant consultation given end-stage-disease and poor prognosis. It further necessitated a pediatric inpatient obesity consult, which was complicated by several significant hurdles including lack of insurance coverage, FDA approvals, availability of medications, and inadequate knowledge among the medical community. Methods Innovative treatment, proactive, persistent advocacy, anti-obesity medication combination strategies modeled after diabetes and hypertension treatment algorithms, and latest evidence in obesity management were utilized to effectively and expeditiously overcome major challenges to care and the medical emergency. Results The patient was stabilized and ultimately discharged home, after -25.2% weight loss over 4 months (weight down to 299 pounds, BMI 49.9 kg/m2) through collaborative medical obesity intervention. Conclusion The typical delay in care sought by patients suffering from obesity, often due to stigma and lack of disease awareness, results in missed opportunities to prevent serious obesity-related complications. Skilled specialist expertise, fund of obesity-specific knowledge, and constant advocacy can be crucial in surmounting regulatory barriers to obesity care and in generating successful weight loss outcomes.
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Affiliation(s)
- Gitanjali Srivastava
- Vanderbilt University School of Medicine, Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Nashville, TN, USA
- Department of Surgery, Vanderbilt University School of Medicine, United States
- Department of Pediatrics, Vanderbilt University School of Medicine, United States
- Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, United States
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7
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Williams DR, Fischer AN. Pivot from Pain to Productive: Conversations about Weight Management in Youth with Obesity. Curr Sports Med Rep 2023; 22:290-296. [PMID: 37549215 DOI: 10.1249/jsr.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
ABSTRACT The prevalence of childhood obesity is almost 20% and affects 14.7 million youth. It is not a matter of if but when and how often sports medicine clinicians will care for patients with obesity. Considering the social, emotional, medical, and physical impact of obesity, we need a nuanced approach to communicate with patients and develop effective treatment plans to maintain or encourage physical activity. Neuromusculoskeletal impairments, physical complications, pain, biomechanical differences, and physical deconditioning act as potential barriers to treatment. This article introduces ways to pivot the conversation from musculoskeletal pain to a productive, well-received conversation about a holistic approach to weight management that also promotes physical activity and overall wellness in youth with obesity. Special attention is given to equipping clinicians with recommendations that incorporate the use of inclusive language, health behavior theories, and tenets of motivational interviewing to deliver equitable treatment regardless of body habitus.
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Gorecki MC, Piotrowski ME, Brown CM, Teli RR, Percy Z, Lane L, Bolling CF, Siegel RM, Copeland KA. STEP IN: Supporting Together Exercise and Play and Improving Nutrition; a Feasibility Study of Parent-Led Group Sessions and Fitness Trackers to Improve Family Healthy Lifestyle Behaviors in a Low-Income, Predominantly Black Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095686. [PMID: 37174204 PMCID: PMC10178511 DOI: 10.3390/ijerph20095686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Pediatric obesity is prevalent and challenging to treat. Although family-centered behavioral management is the gold standard, many families face structural inequities to its access and efficacy. Identifying ways to manage pediatric obesity within primary care is needed. METHODS This feasibility study included three sequential trials of peer-led group sessions occurring biweekly or monthly between 3/2016 and 2/2017. Parent-child dyads were recruited from a large academic primary care clinic via mailed invitations, prioritizing patients living in local zip codes of historical disinvestment. Eligible patients were 6 to 12 years with a body mass index ≥85th percentile, with parent and child interest in making healthy lifestyle changes, and English speaking. RESULTS 27 dyads participated, 77% were non-Hispanic Black. Retention and attendance rates were highest in the initial four-session biweekly pilot (100%, 0 dropouts), high in the full six-session biweekly cohort (83%, 1 dropout), and moderate in the monthly cohort (62.7%, 4 dropouts). Families reported high satisfaction with the sessions (4.75/5). Qualitative comments suggested social connections had motivated behavior change in some families. CONCLUSION Parent-led group sessions for pediatric weight management show promise in engaging families. A future large trial is needed to assess behavior change and anthropometric outcomes.
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Affiliation(s)
- Michelle C Gorecki
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Megan E Piotrowski
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Courtney M Brown
- Department of Pediatrics, Division of Primary Care Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Radhika R Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zana Percy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Laura Lane
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Christopher F Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Robert M Siegel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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9
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van der Voorn B, Camfferman R, Seidell JC, Puhl RM, Halberstadt J. Weight-biased attitudes about pediatric patients with obesity in Dutch healthcare professionals from seven different professions. J Child Health Care 2023:13674935221133953. [PMID: 36861392 DOI: 10.1177/13674935221133953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Little is known about the prevalence of negative weight-biased attitudes among Dutch healthcare professionals (HCPs) when treating children and adolescents with obesity and whether interdisciplinary differences are present. Accordingly, we asked Dutch HCPs that treat pediatric patients with obesity to complete a validated 22-item self-report questionnaire about their weight-biased attitudes. In total, 555 HCPs participated from seven different disciplines: 41 general practitioners (GPs), 40 pediatricians, 132 youth healthcare physicians, 223 youth healthcare nurses, 40 physiotherapists, 40 dieticians, and 39 mental health professionals. HCPs from all disciplines reported to experience negative weight-biased attitudes among themselves. Pediatricians and GPs scored highest on negative weight-biased attitudes, including frustrations in treating children with obesity, and feeling less confident and prepared to treat children with obesity. Dieticians scored the least negative weight-biased attitudes. Participants from all groups perceived weight bias expressed by their colleagues, toward children with obesity. These findings are comparable to results reported by adult HCPs from other countries. Interdisciplinary differences were found and underscore the need for more research on contributing factors that impact explicit weight bias among pediatric HCPs.
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Affiliation(s)
- Bibian van der Voorn
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Roxanna Camfferman
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, Department of Human Development & Family Sciences, University of Connecticut, Hartfort, CT, USA
| | - Jutka Halberstadt
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
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Williams DR, Chaves E, Karp SM, Browne NT. Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity. OBESITY PILLARS (ONLINE) 2023; 5:100052. [PMID: 37990746 PMCID: PMC10662032 DOI: 10.1016/j.obpill.2022.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 11/23/2023]
Abstract
Background Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual. Methods This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology. Results TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience. Conclusion Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
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Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Eileen Chaves
- Neuropsychology & Pediatric Psychology, The Ohio State University, College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Sharon M. Karp
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN, 37240, USA
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Koetsier LW, van den Eynde E, van Mil EGAH, van der Velde M, de Vries R, Baan CA, Seidell JC, Halberstadt J. Scoping literature review and focus groups with healthcare professionals on psychosocial and lifestyle assessments for childhood obesity care. BMC Health Serv Res 2023; 23:125. [PMID: 36750839 PMCID: PMC9903277 DOI: 10.1186/s12913-022-08957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Childhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. This study centers on available scientific literature on psychosocial and lifestyle assessments for childhood obesity, and experiences and views of healthcare professionals with regard to assessing psychosocial and lifestyle factors within Dutch integrated care. METHODS Two methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within Dutch integrated care. Data were analysed using template analysis, complemented with open coding in MAXQDA. RESULTS The results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects. Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals. CONCLUSIONS This study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.
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Affiliation(s)
- L. W. Koetsier
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - E. van den Eynde
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands ,grid.5645.2000000040459992XErasmus MC, University Medical Center Rotterdam, Obesity Center CGG, Rotterdam, Netherlands
| | - E. G. A. H. van Mil
- grid.413508.b0000 0004 0501 9798Department of Paediatrics, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, s-Hertogenbosch, Netherlands ,grid.5012.60000 0001 0481 6099Maastricht University, Brightlands Campus Greenport Venlo, Maastricht, Netherlands
| | - M. van der Velde
- grid.413928.50000 0000 9418 9094Public Health Service of Amsterdam, PO Box 2200, 1000 CE, Amsterdam, Netherlands
| | - R. de Vries
- grid.12380.380000 0004 1754 9227Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - C. A. Baan
- grid.12295.3d0000 0001 0943 3265Tilburg University, Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg, Netherlands
| | - J. C. Seidell
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - J. Halberstadt
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Christison AL, Ariza AJ, Fernandez C, Kumar S, Novick MB, Santos M, Stratbucker WB, Sweeney BR, Vidmar A, Kirk S. Challenges and solutions to sustaining paediatric weight management programs in the United States. Clin Obes 2023; 13:e12577. [PMID: 36631245 DOI: 10.1111/cob.12577] [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: 09/14/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
Paediatric weight management (PWM) programs in the United States (US) face challenges in providing sustainable multidisciplinary care for patients. The aim of this study was to report PWM program approaches to sustaining program delivery. A survey of 39 PWM programs was administered to identify challenges and solutions to program sustainability. Common and useful strategies for optimizing reimbursement for services included the use of applicable reimbursable diagnostic codes and management, billing for assessments and non-medical personnel services, and the use of hospital outpatient department clinic billing. Increasing clinical breadth and capacity was achieved by offering telemedicine and other services, such as psychotherapy, pharmacotherapy, and metabolic and bariatric surgery, as well as active management of schedules. Securing institutional and extramural funding was also reported. One of the positive changes during the pandemic was the fast adoption of telemedicine services. Although delivering sustainable evidence-based multidisciplinary PWM under the current US payment models has its challenges, PWM programs implement practical operational strategies to support this work.
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Affiliation(s)
- Amy L Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Adolfo J Ariza
- Department of Pediatrics, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Cristina Fernandez
- Department of General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, United States
- Children's Center for Healthy Lifestyles & Nutrition, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marsha B Novick
- Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Melissa Santos
- Pediatric Obesity Center, Connecticut Children's, Hartford, Connecticut, USA
| | - William B Stratbucker
- Department of Pediatrics, Helen Devos Children's Hospital and Michigan State University, Grand Rapids, Michigan, USA
| | - Brooke R Sweeney
- Department of General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, United States
- Children's Center for Healthy Lifestyles & Nutrition, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Alaina Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
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13
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There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol 2022; 12:100371. [PMID: 36124049 PMCID: PMC9482082 DOI: 10.1016/j.ajpc.2022.100371] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and is etiologic for such acute cardiovascular events as myocardial infarction, ischemic stroke, unstable angina, and death. ASCVD also impacts risk for dementia, chronic kidney disease peripheral arterial disease and mobility, impaired sexual response, and a host of other visceral impairments that adversely impact the quality and rate of progression of aging. The relationship between low-density lipoprotein cholesterol (LDL-C) and risk for ASCVD is one of the most highly established and investigated issues in the entirety of modern medicine. Elevated LDL-C is a necessary condition for atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, and randomized clinical trials have all validated this association. Yet despite the enormous number of clinical trials which support the need for reducing the burden of atherogenic lipoprotein in blood, the percentage of high and very high-risk patients who achieve risk stratified LDL-C target reductions is low and has remained low for the last thirty years. Atherosclerosis is a preventable disease. As clinicians, the time has come for us to take primordial and primary prevention more serously. Despite a plethora of therapeutic approaches, the large majority of patients at risk for ASCVD are poorly or inadequately treated, leaving them vulnerable to disease progression, acute cardiovascular events, and poor aging due to loss of function in multiple visceral organs. Herein we discuss the need to greatly intensify efforts to reduce risk, decrease disease burden, and provide more comprehensive and earlier risk assessment to optimally prevent ASCVD and its complications. Evidence is presented to support that treatment should aim for far lower goals in cholesterol management, should take into account many more factors than commonly employed today and should begin significantly earlier in life.
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14
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Puhl RM, Lessard LM, Foster GD, Cardel MI. Patient and Family Perspectives on Terms for Obesity. Pediatrics 2022; 150:190093. [PMID: 36404759 DOI: 10.1542/peds.2022-058204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Parent communication about body weight is a sensitive topic, but limited research has studied youth preferences for words used to talk about their weight with parents. We assessed perspectives of weight-based terminology in 2 racially/ethnically diverse samples of youth and parents. METHODS We collected online survey data from 2 panel survey samples between September and December 2021: youth aged 10 to 17 years (n = 2032) and parents of youth aged 10 to 17 years (n = 1936). Participants rated 27 different terms and phrases to describe body weight; parents reported on their usage of this terminology and youth reported their preferences for and emotional responses to terminology. Patterns were examined across sex, race/ethnicity, sexual orientation, and weight status. RESULTS Youth reported preferences for words such as "healthy weight" and dislike of terms such as "obese," "fat," and "large," which induced feelings of sadness, shame, and embarrassment. Differences in youth preferences and emotional reactions were present across sex, sexual orientation, race/ethnicity, and weight status. This included a general pattern of lower preference ratings among girls (versus boys) and sexual minority (versus heterosexual) youth, and stronger preferences for words such as "thick" or "curvy" among racial/ethnic minority, sexual minority, and higher-weight youth. Use of most weight terms was higher among fathers compared with mothers, and by Hispanic/Latinx parents compared with white and Black/African American parents. CONCLUSIONS Our findings underscore diversity of youth preferences and the need for individualized approaches that support effective parent and youth communication by using their preferred terms when discussing weight-related health.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut.,Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Leah M Lessard
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,WW International, Inc, New York, New York
| | - Michelle I Cardel
- WW International, Inc, New York, New York.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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15
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Williams DR, Braddock A, Houser M, Blair G, Browne N. Review of upstream social factors contributing to childhood obesity. OBESITY PILLARS 2022; 4:100040. [PMID: 37990668 PMCID: PMC10662005 DOI: 10.1016/j.obpill.2022.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/23/2023]
Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
| | - Amy Braddock
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Marcella Houser
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Giselle Blair
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Nancy Browne
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
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16
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Cuda S, Censani M, Kharofa R, O'Hara V, Conroy R, Williams DR, Paisley J, Browne AF, Karjoo S, Browne NT. Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 4:100048. [PMID: 37990664 PMCID: PMC10662101 DOI: 10.1016/j.obpill.2022.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details medication-induced weight gain and advanced therapies for the child with overweight or obesity. Methods The scientific information and clinical guidance in this CPS are based on scientific evidence, supported by the medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement addresses medication-induced weight gain and advanced therapies for the child with overweight or obesity. Conclusions This OMA Clinical Practice Statement on medication induced-weight gain and advanced therapies for the child with overweight or obesity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications. This CPS also addresses treatment recommendations. This section is designed to help the provider with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | | | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason AvenueSpringfield, MA, 01107, USA
| | - Dominique R Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology 501 6th Ave S St. Petersburg, FL, 33701, USA
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17
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van der Voorn B, Camfferman R, Seidell JC, Halberstadt J. Talking with pediatric patients with overweight or obesity and their parents: self-rated self-efficacy and perceived barriers of Dutch healthcare professionals from seven disciplines. BMC Health Serv Res 2022; 22:1236. [PMID: 36203179 PMCID: PMC9541008 DOI: 10.1186/s12913-022-08520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many healthcare professionals (HCPs) feel uncomfortable and incompetent talking about weight with children with overweight and obesity and their parents. To optimally target interventions that can improve obesity care for children, we assessed the self-efficacy (SE) and perceived barriers (PBs) of Dutch HCPs with regard to talking about weight and lifestyle when treating children with overweight or obesity. We also analyzed interdisciplinary differences. METHODS A newly developed, practice- and literature-based questionnaire was completed by 578 HCPs from seven disciplines. ANOVA and chi-square tests were used to analyze interdisciplinary differences on SE, PBs, and the effort to discuss weight and lifestyle despite barriers. Regression analyses were used to check whether age, sex or work experience influenced interdisciplinary differences. RESULTS On average, the reported score on SE was 7.2 (SD 1.2; scale 1-10) and the mean number of PBs was 4.0 (SD 2.3). The majority of HCPs (94.6%) reported perceiving one or more barriers (range 0-12 out of 17). HCPs who in most cases perceived too many barriers to discuss weight and lifestyle of the child (9.6%, n = 55) reported a lower SE (mean 6.3) than professionals who were likely to discuss these topics (mean SE 7.3, p < 0.01), despite having a similar number of PBs (mean 4.5 vs 4.0, p > 0.05). In total, 14.2% (n = 82) of HCPs either felt incapable (SE ≤ 5) or reported that in most cases they did not address weight and lifestyle due to PBs. CONCLUSIONS Although on average Dutch HCPs rated their self-efficacy as fairly good, for a subgroup major improvements are necessary to lower perceived barriers and improve self-efficacy, in order to improve the quality of care for Dutch children with obesity.
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Affiliation(s)
- B van der Voorn
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Section Youth and Lifestyle, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - R Camfferman
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Section Youth and Lifestyle, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - J C Seidell
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Section Youth and Lifestyle, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - J Halberstadt
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Section Youth and Lifestyle, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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18
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Calcaterra V, Rossi V, Mari A, Casini F, Bergamaschi F, Zuccotti GV, Fabiano V. Medical treatment of weight loss in children and adolescents with obesity. Pharmacol Res 2022; 185:106471. [PMID: 36174963 DOI: 10.1016/j.phrs.2022.106471] [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: 07/19/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.
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Affiliation(s)
- Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Alessandra Mari
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Francesca Casini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy.
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19
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Tucker JM, Stratbucker W, King EC, Cuda S, Negrete S, Sweeney B, Kumar S, Borzutzky C, Binns HJ, Kirk S. Characteristics of paediatric weight management in the United States: Associations with program retention and BMI outcomes in the paediatric obesity weight evaluation registry (POWER). Pediatr Obes 2022; 17:e12848. [PMID: 34498814 DOI: 10.1111/ijpo.12848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe characteristics of paediatric weight management (PWM) programs across the United States and evaluate associations with program-specific retention rates and body mass index (BMI) outcomes at 6 months. METHODS A program profile survey was administered to 33 programs within the Paediatric Obesity Weight Evaluation Registry (POWER) to assess program staffing, services, and treatment format. Patient retention and percent of the 95th BMI percentile (%BMIp95) changes were assessed for each program. RESULTS At 6 months program retention rates ranged from 15% to 74% (median: 41%), and program %BMIp95 changes ranged from -9.0 to +0.5 percentage points (median: -1.7). Percent of patients with ≥5 percentage-point decrease in %BMIp95 ranged from 17% to 71% across programs (median: 29%). No associations were detected between program characteristics and retention or %BMIp95 changes. CONCLUSIONS Six-month patient retention and BMI outcomes vary substantially in PWM programs across the United States. Yet, no associations were found between PWM treatment factors and these program-level patient outcomes.
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Affiliation(s)
- Jared M Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - William Stratbucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Suzanne Cuda
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Sylvia Negrete
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Brooke Sweeney
- General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Children's Center for Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Helen J Binns
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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20
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Abstract
Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider. Within the health care setting, it is important that health care providers strategically focus on reducing obesity bias and provide high-quality obesity management. People-first language should be used and waiting rooms and examination rooms should be accommodating to people of all sizes.
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Affiliation(s)
- Sharon M Fruh
- College of Nursing, University of South Alabama, 5721 USA Drive North, Mobile, AL 36688, USA.
| | - Rebecca J Graves
- College of Nursing, University of South Alabama, 5721 USA Drive North, HAHN 2037 F, Mobile, AL 36688, USA
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, HKS 1020, 171 Student Services Drive, Mobile, AL 36688, USA
| | - Susan G Williams
- College of Nursing, University of South Alabama, 161 North Section Street Suite C, Fairhope, AL 36532, USA
| | - Heather R Hall
- College of Nursing, University of South Alabama, 5721 USA Drive North, Room 3068, Mobile, AL 36688, USA
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21
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Abstract
Pediatric obesity is a heterogeneous, chronic, relapsing disease associated with metabolic and psychosocial complications. Weight-based victimization, including unrelenting microaggressions, negatively impacts child mental and physical health. Evidence-based guidelines offer individualized, stepwise approaches to obesity treatment. Pediatric nurses positively impact children with obesity by providing affirmation, clinical management, and psychosocial support. Pediatric nurses are respected and positioned to present evidence-based obesity education, correct common obesity myths, sensitively address obesity-related bias and discrimination, and model person-first language and actions. This article shares how nurses in multiple practice areas can make a meaningful impact on the lives of children and adolescents with obesity.
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22
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Martos-Moreno GÁ, Martínez-Villanueva Fernández J, Frías-Herrero A, Martín-Rivada Á, Argente J. Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients. Nutrients 2021; 13:nu13113847. [PMID: 34836102 PMCID: PMC8624087 DOI: 10.3390/nu13113847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Limited therapeutic tools and an overwhelming clinical demand are the major limiting factors in pediatric obesity management. The optimal protocol, environment, body mass index (BMI) change targets and duration of obesity-oriented interventions remain to be elucidated. Aims: We aimed to characterize the singularities of follow-up, anthropometric and metabolic evolution of a large cohort of pediatric patients with obesity in a specialized university hospital outpatient obesity unit. Patients and methods: Follow-up duration (up to seven years), attrition rate and anthropometric and metabolic evolution of 1300 children and adolescents with obesity were studied. An individualized analysis was conducted in patients attaining a high level of weight loss (over 1.5 BMI-SDS (standard deviation score) and/or 10% of initial weight; n = 252; 19.4%) as well as in "metabolically healthy" patients (n = 505; 38.8%). Results: Attrition rate was high during the early stages (11.2% prior to and 32.5% right after their initial metabolic evaluation). Mean follow-up time was 1.59 ± 1.60 years (7% of patients fulfilled 7 years). The highest BMI reduction occurred in the first year (-1.11 ± 0.89 SDS, p < 0.001 in 72.5% of patients). At the end of the follow-up, improvements in glucose and lipid metabolism parameters were observed (both p < 0.05), that were highest in patients with the greatest weight reduction (all p < 0.01), independent of the time spent to achieve weight loss. The pubertal growth spurt negatively correlated with obesity severity (r = -0.38; p < 0.01) but patients attaining adult height exceeded their predicted adult height (n = 308, +1.6 ± 5.4 cm; p < 0.001). "Metabolically healthy" patients, but with insulin resistance, had higher blood pressure, glucose, uric acid and triglyceride levels than those without insulin resistance (all p < 0.05). Preservation of the "metabolically healthy" status was associated with BMI improvement. Conclusions: Behavioral management of children with obesity can be effective and does not impair growth but is highly conditioned by high attrition. The best results regarding BMI reduction and metabolic improvement are achieved in the first year of intervention and can be preserved if follow-up is retained.
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Affiliation(s)
- Gabriel Á. Martos-Moreno
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
- La Princesa Research Institute, E-28009 Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28029 Madrid, Spain
| | - Julián Martínez-Villanueva Fernández
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
| | - Alicia Frías-Herrero
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
| | - Álvaro Martín-Rivada
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
| | - Jesús Argente
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
- La Princesa Research Institute, E-28009 Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28029 Madrid, Spain
- IMDEA Food Institute, CEI UAM & CSIC, E-28049 Madrid, Spain
- Correspondence:
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23
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Lister NB, Baur LA, Paxton SJ, Jebeile H. Contextualising Eating Disorder Concerns for Paediatric Obesity Treatment. Curr Obes Rep 2021; 10:322-331. [PMID: 33970441 DOI: 10.1007/s13679-021-00440-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Eating disorders are complex mental health conditions that share risk factors with obesity. This review outlines the context for concerns that paediatric obesity treatment presents a risk for eating disorder development. RECENT FINDINGS Most children and adolescents undergoing professionally supervised obesity treatment will have improvements or no change to eating disorder risk profiles. However, some may subsequently develop a clinical eating disorder, and this is proposed to relate to weight-focussed dietary interventions that are standard in paediatric obesity treatment. Nevertheless, dietary restraint may not be a strong predictor of eating disorder risk in the context of paediatric obesity treatment. Most international guidelines recommend weight maintenance or weight loss as a treatment goal, and weight loss is related to improvements in cardiometabolic health but not eating disorder risk in the short term. The risk of inducing or exacerbating an eating disorder during paediatric weight management is likely to be low; however, the serious consequences combined with increasing scale of obesity treatment, and lack of empirical evidence, are of concern. There is a need for further research to identify long-term predictors of eating disorder development for children and adolescents who seek treatment for their obesity.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia.
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
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