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Finn EB, Keller CV, Gowey MA, Savoye M, Samuels S, Fleisch AF, Rogers VW, Grey M, Damschroder LJ, Beck A, Sharifi M. Improving access to first-line treatment for pediatric obesity: Lessons from the dissemination of SmartMoves. Obesity (Silver Spring) 2024; 32:1745-1756. [PMID: 39192771 DOI: 10.1002/oby.24107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE The increasing prevalence of and inequities in childhood obesity demand improved access to effective treatment. The SmartMoves curriculum used in Bright Bodies, a proven-effective, intensive health behavior and lifestyle treatment (IHBLT), was disseminated to ≥30 US sites from 2003 to 2018. We aimed to identify barriers to and facilitators of IHBLT implementation/sustainment. METHODS We surveyed and interviewed key informants about experiences acquiring/implementing SmartMoves. In parallel, we analyzed and then integrated survey findings and themes from interviews using the constant comparative method. RESULTS Participants from 16 sites (53%) completed surveys, and 12 participants at 10 sites completed interviews. The 11 sites (63%) that implemented SmartMoves varied in both use of training opportunities/materials and fidelity to program components. In interviews, demand for obesity programming, organizational priorities, and partnerships facilitated implementation. Seven sites discontinued SmartMoves prior to the COVID-19 pandemic. Funding insecurity and insufficient staffing emerged as dominant barriers to implementation/sustainment discussed by all interviewees, and some also noted participants' competing demands and the program's fit with population as challenges. CONCLUSIONS System- and organizational-level barriers impeded sustainment of an evidence-based IHBLT program. Adequate funding could enable sufficient staffing and training to promote fidelity to the intervention's core functions and adaptation to fit local populations/context.
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Affiliation(s)
- Emily Benjamin Finn
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Caroline V Keller
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marissa A Gowey
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary Savoye
- Section of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stephanie Samuels
- Section of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Abby F Fleisch
- Center for Interdisciplinary and Population Health Research, MaineHealth Institute for Research, Westbrook, Maine, USA
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, Maine, USA
| | - Victoria W Rogers
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine, USA
| | - Margaret Grey
- Yale School of Nursing, West Haven, Connecticut, USA
| | - Laura J Damschroder
- Implementation Pathways, LLC, Ann Arbor, Michigan, USA
- VA Ann Arbor Center for Clinical Management Research (CCMR), Ann Arbor, Michigan, USA
| | - Amy Beck
- Division of General Pediatrics, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Park J, Ten Hoor G, Cho J, Won S, Ryu S, Lau ST. Obesity-related behaviors and health-related quality of life in socioeconomically vulnerable children: A cross-sectional study. J Pediatr Nurs 2024; 78:e270-e278. [PMID: 39153920 DOI: 10.1016/j.pedn.2024.07.015] [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: 11/01/2023] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study aims to explore obesity-related behaviors (ORB) and health-related quality of life (HRQoL) in socioeconomically vulnerable children, while also examining potential associations between these variables. DESIGN AND METHODS A total of 721 children enrolled in after-school care programs for socioeconomically vulnerable children participated in this study. Height (in cm) and weight (in kg) were measured directly by trained research assistants. ORB, including eating behaviors and physical activity, was assessed utilizing the Nutrition Quotient Questionnaire. HRQoL was measured utilizing the PedsQL™ 4.0. Data were analyzed using logistic regression. RESULTS The findings revealed that participants exhibited lower levels of ORB and reduced HRQoL, particularly in the physical health dimension of HRQoL. Inadequate physical activity and poor dietary habits were strongly associated with a 2.625-fold (OR = 2.625, 95% CI = 1.867-3.691) and a 4.251-fold (OR = 4.251, 95% CI = 2.466-7.328) increase, respectively, in the likelihood of having low HRQoL. Surprisingly, the study did not find a significant link between ORB levels and obesity, and obesity status did not predict a higher probability of low HRQoL. CONCLUSIONS This study underscores the need for tailored interventions designed specifically for children from socioeconomically vulnerable families to address their unique challenges. PRACTICE IMPLICATIONS This research provides valuable insights for pediatric nurses and healthcare providers, highlighting the crucial role of promoting healthy ORB in socioeconomically vulnerable children to address disparities in childhood obesity and HRQoL.
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Affiliation(s)
- Jiyoung Park
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea; YEIRIN Social Cooperative, Busan, South Korea
| | - Gill Ten Hoor
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Jeonghyun Cho
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea.
| | - Seohyun Won
- College of Nursing, Inje University, Busan, South Korea
| | - Soorack Ryu
- Department of Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Serbis A, Polyzos SA, Paschou SA, Siomou E, Kiortsis DN. Diet, exercise, and supplements: what is their role in the management of the metabolic dysfunction-associated steatotic liver disease in children? Endocrine 2024; 85:988-1006. [PMID: 38519764 DOI: 10.1007/s12020-024-03783-7] [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: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), is the main cause of chronic liver disease in children and adolescents. Indeed, epidemiological studies have shown that MASLD affects up to 40% of children with obesity. Despite the recent approval of medications that target weight loss in adolescents that could have benefits on pediatric MASLD, lifestyle interventions, such as diet and exercise, remain the mainstay of our therapeutic approach. More specifically, studies on diet alone have focused on the possible role of carbohydrate or fat restriction, albeit without a definite answer on the best approach. Weight loss after dietary intervention in children with obesity and MASLD has a beneficial effect, regardless of the diet used. In relation to the role of exercise in MASLD reversal, indirect evidence comes from studies showing that a sedentary lifestyle leading to poor fitness, and low muscle mass is associated with MASLD. However, research on the direct effect of exercise on MASLD in children is scarce. A combination of diet and exercise seems to be beneficial with several studies showing improvement in surrogate markers of MASLD, such as serum alanine aminotransferase and hepatic fat fraction, the latter evaluated with imaging studies. Several dietary supplements, such as vitamin E, probiotics, and omega-3 fatty acid supplements have also been studied in children and adolescents with MASLD, but with equivocal results. This review aims to critically present available data on the effects of lifestyle interventions, including diet, exercise, and dietary supplements, on pediatric MASLD, thus suggesting a frame for future research that could enhance our knowledge on pediatric MASLD management and optimize clinicians' approach to this vexing medical condition.
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Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Stergios A Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios N Kiortsis
- Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
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Abbey BM, Heelan KA, Bartee RT, George K, Foster NL, Estabrooks PA, Hill JL. Building Healthy Families: Outcomes of an Adapted Family Healthy Weight Program Among Children in a Rural Mid-Western Community. Child Obes 2024. [PMID: 38569168 DOI: 10.1089/chi.2023.0142] [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] [Indexed: 04/05/2024]
Abstract
Background: This study aimed to evaluate the effectiveness of implementing an adapted, evidence-based 12-week Family Healthy Weight Program (FHWP), Building Healthy Families, on reducing BMI metrics and clinical health indicators in a real-world community setting. Methods: Ninety child participants with a BMI percentile greater or equal to the 95th percentile for gender and age and their parents/guardians (n = 137) enrolled in the program. Families attended 12 weekly group-based sessions of nutrition education, family lifestyle physical activity, and behavior modification. A pre-post study design with a 6-month follow-up was used. Results: Nine cohorts of families between 2009 and 2016 completed the program with 82.1% retention at 12 weeks and 53.6% at 6 months. Participants had statistically significant improvements at 12 weeks in BMI z-score, %BMIp95, body mass, body fat, fat mass, fat-free mass, and systolic blood pressure with greater improvement at 6 months in body mass, BMI metrics, body fat, fat mass, fat-free mass, and systolic blood pressure. Parents/guardians of the participants had similar statistically significant body composition and blood pressure improvements (p < 0.05). In addition, children had significant improvements in high-density lipoprotein (HDL) cholesterol and aspartate aminotransferase (AST) liver enzymes at 6 months. Conclusions: Overall, this study demonstrated that an evidence-based FHWP can result in statistically meaningful declines in BMI z-score and accompanied clinically meaningful changes in health risk. Participants lost ∼4% of their body mass in 12 weeks, while their parents/guardians lost closer to 7% of their body mass, which supports previous literature suggesting body mass changes influence health.
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Affiliation(s)
- Bryce M Abbey
- Department of Kinesiology and Sport Sciences and University of Nebraska at Kearney, Kearney, NE, USA
| | - Kate A Heelan
- Department of Kinesiology and Sport Sciences and University of Nebraska at Kearney, Kearney, NE, USA
| | - R Todd Bartee
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA
| | - Kaiti George
- Department of Kinesiology and Sport Sciences and University of Nebraska at Kearney, Kearney, NE, USA
| | - Nancy L Foster
- Psychology Department, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, College of Health and School of Medicine; University of Utah, Salt Lake City, UT, USA
| | - Jennie L Hill
- Department of Population Health Sciences, School of Medicine; University of Utah, Salt Lake City, UT, USA
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Pike JM, Haberlin-Pittz KM, Alharbi BS, Perkins SM, Hannon TS. A co-designed, community-based intensive health behavior intervention promotes participation and engagement in youth with risk factors for type 2 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1264312. [PMID: 38108040 PMCID: PMC10722280 DOI: 10.3389/fcdhc.2023.1264312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023]
Abstract
Background Obesity among youth (children and adolescents) is associated with increased risk for youth-onset type 2 diabetes. Lifestyle change can delay or prevent the development of type 2 diabetes, yet real-world implementation of health behavior recommendations is challenging. We previously engaged youth with risk factors for type 2 diabetes, their caregivers, and professionals in a human-centered design study to co-design a lifestyle change program. Here we report the outcomes for this 16-week co-designed lifestyle change program for youth at risk for T2D and their caregivers. Research design and methods This single-arm family-based cohort study included youth aged 7-18 years, with BMI ≥85th percentile (overweight or obese) and at least one additional risk factor for type 2 diabetes, and their caregivers. Clinical (BMI, HbA1c), self-reported physical activity, and quality of life outcomes were evaluated at baseline (B), post-intervention (M4), and 1 year (M12) following the intervention. Results Seventy-eight youth (mean age 12.4 ± 2.7y, 67% female, 37.8% white) and 65 caregivers were included in the data analysis. Youth baseline BMI z-scores (2.26 ± 0.47) and HbA1c (5.3 ± 0.3) were unchanged at follow up time points [BMI z-scores M4 (2.25 ± 0.52), M12 (2.16 ± 0.58), p-value 0.46], [HbA1c M4 (5.3 ± 0.3), M12 (5.2 ± 0.3), p-value (0.04)]. Youth reported increased physical activity at M4 (p = 0.004), but not at M12. Youth quality of life scores increased at M12 (p=0.01). Families who attended at least one session (n=41) attended an average of 9 out of 16 sessions, and 37 percent of families attended 13 or more sessions. Conclusion A co-designed, community-based lifestyle intervention promotes increased physical activity, improved quality of life, maintenance of BMI z-scores and HbA1c, and engagement in youth with risk factors for T2D.
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Affiliation(s)
- Julie M. Pike
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
| | - Kathryn M. Haberlin-Pittz
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
| | - Basmah S. Alharbi
- Department of Biostatistics and Health Data Science, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Susan M. Perkins
- Department of Biostatistics and Health Data Science, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tamara S. Hannon
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
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Pryor S, Savoye M, Nowicka P, Price G, Sharifi M, Yaesoubi R. Cost-Effectiveness and Long-Term Savings of the Bright Bodies Intervention for Childhood Obesity. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1183-1191. [PMID: 36967028 PMCID: PMC10518029 DOI: 10.1016/j.jval.2023.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/16/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To estimate the cost and cost-effectiveness of Bright Bodies, a high-intensity, family-based intervention that has been demonstrated to improve body mass index (BMI) among children with obesity in a randomized controlled trial. METHODS We developed a microsimulation model to project 10-year BMI trajectories of 8 to 16-year-old children with obesity, using data from the National Longitudinal Surveys and Centers for Disease Control and Prevention growth charts, and we validated the model using data from the Bright Bodies trial and a follow-up study. We used the trial data to estimate the average reduction in BMI per person-year over 10 years and the incremental costs of Bright Bodies, compared with the traditional clinical weight management (control), from a health system's perspective in 2020 US dollars. Using results from studies of Medical Expenditure Panel Survey data, we projected the long-term obesity-related medical expenditure. RESULTS In the primary analysis, assuming depreciating effects postintervention, Bright Bodies is expected to reduce a participant's BMI by 1.67 kg/m2 (95% uncertainty interval 1.43-1.94) per year over 10 years as compared with control. The incremental intervention cost of Bright Bodies was $360 ($292-$421) per person compared with the clinical control. Nevertheless, savings in obesity-related healthcare expenditure offset these costs and the expected cost-savings of Bright Bodies is $1126 ($689-$1693) per person over 10-years. The projected time to achieve cost-savings compared with clinical control was 3.58 (2.63-5.17) years. CONCLUSIONS Although resource-intensive, our findings suggest that Bright Bodies is cost-saving compared to the clinical control by averting future obesity-related healthcare costs among children with obesity.
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Affiliation(s)
- Sydney Pryor
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Mary Savoye
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Gary Price
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
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