1
|
Arlinghaus KR, O'Connor DP, Ledoux TA, Hughes SO, Johnston CA. Exploratory Decision Trees to Predict Obesity Intervention Response among Hispanic American Youth. Child Obes 2022; 19:194-202. [PMID: 35696237 DOI: 10.1089/chi.2021.0296] [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: 11/12/2022]
Abstract
Introduction: Individual variability in weight-related outcomes from obesity intervention is widely acknowledged, yet infrequently addressed. This study takes a first step to address individual variation by determining characteristics that distinguish responsive (improvements in BMI) from unresponsive individuals. Methods: Classification regression tree (CRT) analysis grouped 185 low-income, Hispanic American middle school students who received a school-based obesity intervention. Predictors included baseline age, gender, standardized BMI, health-related quality of life (PedsQL), minutes of moderate-vigorous physical activity (MVPA; accelerometry), energy consumption, and dietary quality (Block Kids 2004 Food Frequency Questionnaire). Response regarding weight-related outcomes to the intervention was defined according to the American Academy of Pediatrics (AAP) guidelines. Six trees were produced, one for 3- and one for 6-month outcomes among all participants, participants with healthy weight status, and participants with overweight/obesity at baseline. Results: The AAP criteria for response were met by 57.3% and 35.1% of participants at 3 and 6 months, respectively. CRT produced six unique trees. Notably, minutes of MVPA appeared twice (the first time at the top of the tree) in most 3-month models. In addition, response at 3 months consistently appeared as the first variable in all the 6-month models. Conclusions: Overall, the number of distinct pathways and the repeated appearance of the same variable within a pathway illustrate the complex, interactive nature of factors predicting an intervention response. Initially unresponsive individuals were unlikely to respond later in the intervention. More complex modeling is needed to better understand how to best predict who will be responsive to interventions.
Collapse
Affiliation(s)
- Katherine R Arlinghaus
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Tracey A Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Sheryl O Hughes
- Children's Nutrition Research Center Baylor College of Medicine, Houston, TX, USA
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| |
Collapse
|
2
|
Zahn K, Ibrahim Q, Ball GDC, Buchholz A, Hamilton J, Ho J, Laberge AM, Legault L, Tremblay MS, Zenlea I, Thabane L, Chanoine JP, Morrison KM. Variability in How Canadian Pediatric Weight Management Clinics Deliver Care: Evidence from the CANadian Pediatric Weight Management Registry. Child Obes 2021; 17:420-426. [PMID: 33978453 DOI: 10.1089/chi.2021.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Clinical practice guidelines for pediatric weight management highlight the importance of family-based behavioral strategies to enhance health behaviors. Little is known, however, of how clinics implement these programs. The study objectives were to (1) describe how Canadian pediatric weight management clinics deliver care and (2) evaluate change in services over time. Methods: The CANadian Pediatric Weight management Registry (CANPWR) is a multisite prospective cohort study of participants enrolled in a Canadian pediatric weight management clinic. Clinical program characteristics (e.g., referral process, inclusion criteria, funding, program characteristics, patient interaction methods, and follow-up) were collected at the start and end of the CANPWR recruitment period (2015-2019). Results: Entrance into the nine clinics varied with limiting criteria based on geographic proximity, age, weight status, and presence of health conditions. The clinics varied in size (50-220 new patients/year). The planned length of intervention varied widely, from 10 weeks to open-ended (median 2 years). Behavior modification strategies were delivered with a mix of individual and group-based sessions and most were delivered in person, complemented by use of virtual care. Over time, more clinics saw patients under the age of 5 years and all clinics defined a program length. Conclusion: Although all clinics offered family-based behavioral weight management services, these varied considerably, especially in program entrance criteria, size of clinic, and the length of intervention. The influence of the variability in delivery of services on health outcomes will be addressed in future studies.
Collapse
Affiliation(s)
- Kristen Zahn
- Department of Pediatrics, Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Quazi Ibrahim
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jill Hamilton
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Laberge
- Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners and Department of Pediatrics, University of Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Pediatrics, Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jean-Pierre Chanoine
- Pediatric Endocrinology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Black WR, Borner KB, Beauchamp MT, Davis AM, Dreyer Gillette ML, Sweeney B, Hampl SE. Health-Related Quality of Life across Recent Pediatric Obesity Classification Recommendations. CHILDREN (BASEL, SWITZERLAND) 2021; 8:303. [PMID: 33921016 PMCID: PMC8071434 DOI: 10.3390/children8040303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
Extreme body mass index (BMI) values (i.e., above the 97th and below the 3rd percentiles) are inaccurately represented on the Centers for Disease Control and Prevention's growth curves, which may limit the utility of BMI percentile and BMI z-score for capturing changes in clinical outcomes for patients at extreme weights. Modeling child obesity severity based upon the percentage of BMI in excess of the 95th percentile (BMI95pct) has been proposed as an improved metric to better capture variability in weight at extreme ends of growth curves, which may improve our understanding of relationships between weight status and changes in clinical outcomes. However, few studies have evaluated whether the use of BMI95pct would refine our understanding of differences in clinical psychosocial constructs compared to previous methods for categorization. This cross-sectional study evaluated child obesity severity based on BMI95pct to examine potential group differences in a validated, obesity-specific measure of Health-Related Quality of Life (HRQoL). Four hundred and sixty-five children with obesity completed Sizing Me Up, a self-report measure of HRQoL. Children were classified into categories based on BMI95pct (i.e., class I: ≥100% and <120%; class II: ≥120% and <140%; class III: ≥140%). The results indicate that children with class III obesity reported lower HRQoL than children with class I and class II obesity; however, there were no differences between Class II and Class I. In much of the previous literature, children with class II and class III obesity are often combined under the category "Severe Obesity" based upon BMI above the 99th percentile. This study suggests that grouping children from various classes together would neglect to capture critical differences in HRQoL. Future research including children with severe obesity should consider obesity classes to best account for functioning and clinical outcomes.
Collapse
Affiliation(s)
- William R. Black
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kelsey B. Borner
- Department of Psychology and Behavioral Health, Children’s National Hospital, Washington, DC 20010, USA;
| | - Marshall T. Beauchamp
- Department of Psychology, University of Missouri–Kansas City, Kansas City, MO 6110, USA;
| | - Ann M. Davis
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Meredith L. Dreyer Gillette
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Brooke Sweeney
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Sarah E. Hampl
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| |
Collapse
|
4
|
Abstract
Zusammenfassung
Hintergrund
Adipositas ist im Kindes- und Jugendalter stark verbreitet. Medizinische Rehabilitationsmaßnahmen mit ihrem umfassenden Behandlungsangebot stellen eine wesentliche Säule der Versorgung dar. Da Adipositas mit vielfältigen psychosozialen Belastungen verbunden ist, stellt sich die Frage, ob psychotherapeutische Angebote noch stärker berücksichtigt werden sollten.
Fragestellung
Untersucht wurde, wie verbreitet psychische Auffälligkeiten bei Kindern und Jugendlichen mit Adipositas sind und in welchem Zusammenhang sie zum Gewichtsverlauf stehen.
Material und Methoden
Die Stichprobe bestand aus 220 Kindern und Jugendlichen mit Adipositas (8 bis 16 Jahre, M = 13,11 Jahre; SD ± 1,88 Jahre; 54,5 % weiblich), die an einer stationären Rehabilitationsmaßnahme teilnahmen. Emotionale- und Verhaltensauffälligkeiten (Strengths and Difficulties Questionnaire, SDQ) wurden zu Rehabilitationsbeginn sowie 6 und 12 Monate nach Rehabilitationsende im Elternbericht erfasst. Zudem wurden Daten zur Bestimmung des Gewichtstatus durch das medizinische Personal der Kliniken bzw. in der Katamnese von Hausärzten erhoben.
Ergebnisse
Fast die Hälfte der Kinder und Jugendlichen (48,6 %) wies auffällige Werte auf; v. a. Mädchen waren signifikant häufiger betroffen. Die deskriptive Betrachtung nach Rehabilitationsende zeigte einen vergleichbar hohen Anteil. Zudem wirkte sich das Vorliegen psychosozialer Auffälligkeiten signifikant negativ auf den Gewichtsverlauf aus.
Schlussfolgerung
Psychische Probleme sollten im Rahmen der Adipositastherapie stärker berücksichtigt werden. Zum einen sollten evtl. belastete Kinder durch Screenings identifiziert werden, zum anderen psychotherapeutische Maßnahmen zur Reduktion psychosozialer Belastungen integraler Bestandteil der Behandlung sein.
Collapse
|
5
|
Breinker JL, Schmidt R, Hübner C, Cämmerer J, Körner A, Sergeyev E, Kiess W, Hilbert A. [Psychological Parameters of Adolescent Patients Prior to Obesity Treatment]. Psychother Psychosom Med Psychol 2020; 71:35-41. [PMID: 32823357 DOI: 10.1055/a-1197-3155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Overweight and obesity in children and adolescents are highly prevalent and persistent. Current weight loss treatments are rarely individualized and show only small to moderate efficacy. Only rarely, psychopathological parameters are considered. The present study evaluated the psychopathology of adolescents with overweight and obesity (N=201, ages 12-17 years) prior to obesity treatment. The data were analyzed for age and sex effects. Self-report questionnaires assessed general symptom burden, eating disorder and general psychopathology, weight-related self-stigmatization, and physical and mental quality of life. Girls showed higher rates of weight-related self-stigmatization and higher disordered eating behavior compared to boys. Older adolescents reported a lower quality of life compared to younger adolescents. In normative comparisons with population-based samples and norms, adolescents with overweight and obesity showed significantly adverse outcomes in all parameters. Thus, this study identified psychopathology as an important factor in adolescents with high weight status that may affect obesity treatment. Future studies should examine psychopathology more differentially and determine therapeutic resources in adolescent overweight and obesity.
Collapse
Affiliation(s)
- Julius Lars Breinker
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig
| | - Ricarda Schmidt
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig
| | - Claudia Hübner
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig
| | - Jana Cämmerer
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Zentrum für Pädiatrische Forschung, Universitätsmedizin Leipzig
| | - Antje Körner
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig
| | - Elena Sergeyev
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig
| | - Wieland Kiess
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Zentrum für Pädiatrische Forschung, Universitätsmedizin Leipzig.,LIFE Forschungszentrum für Zivilisationskrankheiten, Universität Leipzig
| | - Anja Hilbert
- Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig
| |
Collapse
|
6
|
Fang H, He J, Ran T, Chen H, Jin W, Tang B, Hong Z, Fang M. Synthesis, biological activities, and docking studies of d-pantolactone derivatives as novel FAS inhibitors. Bioorg Med Chem 2019; 27:115069. [DOI: 10.1016/j.bmc.2019.115069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 12/31/2022]
|