1
|
Kay MC, Pankiewicz AR, Schildcrout JS, Wallace S, Wood CT, Shonna Yin H, Rothman RL, Sanders LM, Orr C, Delamater AM, Flower KB, Perrin EM. Early Sweet Tooth: Juice Introduction During Early Infancy is Related to Toddler Juice Intake. Acad Pediatr 2023; 23:1343-1350. [PMID: 37150479 PMCID: PMC10592660 DOI: 10.1016/j.acap.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess if 100% fruit juice intake prior to 6 months is associated with juice and sugar-sweetened beverage (SSB) intake at 24 months and whether this differs by sociodemographic factors. METHODS We used longitudinal data from infants enrolled in the control (no obesity intervention) arm of Greenlight, a cluster randomized trial to prevent childhood obesity which included parent-reported child 100% fruit juice intake at all well child checks between 2 and 24 months. We studied the relationship between the age of juice introduction (before vs after 6 months) and juice and SSB intake at 24 months using negative binomial regression while controlling for baseline sociodemographic factors. RESULTS We report results for 187 participants (43% Hispanic, 39% non-Hispanic Black), more than half (54%) of whom had reported 100% fruit juice intake before 6 months. Average 100% fruit juice intake at 24 months was greater than the recommended amount (of 4 oz) and was 8.2 oz and 5.3 oz for those who had and had not, respectively, been introduced to juice before 6 months. In adjusted models, early introduction of juice was associated with a 43% (95% confidence interval: 5%-96%) increase in juice intake at 24 months. CONCLUSIONS 100% fruit juice intake exceeding recommended levels at 6 and 24 months in this diverse cohort was prevalent. Introducing 100% fruit juice prior to 6 months may put children at greater risk for more juice intake as they age. Further research is necessary to determine if early guidance can reduce juice intake.
Collapse
Affiliation(s)
- Melissa C Kay
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Aaron R Pankiewicz
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Jonathan S Schildcrout
- Department of Biostatistics (JS Schildcrout), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Shelby Wallace
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Charles T Wood
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University Grossman School of Medicine.
| | - Russell L Rothman
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Lee M Sanders
- Department of Pediatrics (LM Sanders), Stanford University, Calif.
| | - Colin Orr
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami, Coral Gables, Fla.
| | - Kori B Flower
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Md.
| |
Collapse
|
2
|
Whooten R, Horan C, Aguirre A, Dartley AN, Taveras E. Parent and Pediatrician Perspectives on Physical Activity Promotion in Pediatric Primary Care: A Preliminary Mixed Methods Study. Am J Health Promot 2023; 37:65-76. [PMID: 35817761 DOI: 10.1177/08901171221113317] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To elicit preliminary pediatrician and parent perspectives on physical activity (PA) counseling and identify opportunities for improvement. DESIGN Mixed methods, including a cross-sectional survey and semi-structured interviews. SETTING AND PARTICIPANTS Primary care pediatricians (N = 73; 40% response rate) within a single large healthcare system and parents of students (N = 20) participating in a local school-based PA program in eastern Massachusetts. METHODS Electronic survey of pediatricians assessing opinions of American Academy of Pediatrics (AAP) PA guidelines and potential PA promotion tools; semi-structured qualitative interviews with parents assessing overall discussion, education, and recommendations relating to PA. ANALYSIS We report descriptive statistics for survey items and bivariate analyses comparing responses by physician characteristics. We performed thematic analysis of qualitative interviews and present results through an implementation science framework. RESULTS In this preliminary study, pediatricians reported adoption, appropriateness, and lower perceived effectiveness of PA counseling. School-based programs and educational materials were most often chosen as PA promotion tools. Responses varied by pediatrician characteristics. While parents reported satisfaction, opportunities for improvement included connections with community resources and continued conversations with the child about PA. CONCLUSIONS Pediatricians and parents highlighted gaps in PA counseling in primary care. While results are preliminary given small sample size, this study provides actionable targets to support PA promotion as a preventive health priority in this setting.
Collapse
Affiliation(s)
- Rachel Whooten
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
- Division of Endocrinology, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Annabelle Aguirre
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Anna Nicole Dartley
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
| | - Elsie Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, 2348Massachusetts General Hospital for Children, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Kraft Center for Community Health, 2348Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
3
|
Becker PC, Neves RO, Silva CHD, Goldani MZ, Bernardi JR. Does early fruit juice introduction influence anthropometric outcomes and food consumption at preschool age? CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023281.09992022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract The aim of this study was to evaluate the impact of fruit juice consumption before 6 months of age on Body Mass Index-for-age (BMI-for-age) and food consumption in preschoolers. We conducted a longitudinal study with mothers and their children (n=103) at 6 months and 3-6 years. Weight and height were measured and converted into BMI-for-age z-scores. Food consumption was analyzed using the Food Frequency Questionnaire for Children. Groups were compared using the chi-squared and Student’s t-tests. No differences in anthropometric measurements were found at preschool age between children who had been given fruit juice before 6 months and those who had not. Consumption of artificial juice (≥once/day) and sandwich cookies at preschool age was higher in children with early introduction of fruit juice (≤150 days of life) (63.8% versus 35.7%; p=0.028 and 21.3% versus 14.3%; p=0.001, respectively). The prevalence of the consumption of soda (1 to 4 times/week) and chocolate milk (at least once/day) was higher in children who had been given artificial juice before 6 months (69.2% versus 27.4%; p=0.014 and 38.5% versus 69.4%; p=0.027, respectively). It can be concluded that the consumption of sweet foods and sugary beverages was higher in children with early introduction of fruit juice.
Collapse
|
4
|
Becker PC, Neves RO, Silva CHD, Goldani MZ, Bernardi JR. Does early fruit juice introduction influence anthropometric outcomes and food consumption at preschool age? CIENCIA & SAUDE COLETIVA 2023; 28:269-280. [PMID: 36629571 DOI: 10.1590/1413-81232023281.09992022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/12/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to evaluate the impact of fruit juice consumption before 6 months of age on Body Mass Index-for-age (BMI-for-age) and food consumption in preschoolers. We conducted a longitudinal study with mothers and their children (n=103) at 6 months and 3-6 years. Weight and height were measured and converted into BMI-for-age z-scores. Food consumption was analyzed using the Food Frequency Questionnaire for Children. Groups were compared using the chi-squared and Student's t-tests. No differences in anthropometric measurements were found at preschool age between children who had been given fruit juice before 6 months and those who had not. Consumption of artificial juice (≥once/day) and sandwich cookies at preschool age was higher in children with early introduction of fruit juice (≤150 days of life) (63.8% versus 35.7%; p=0.028 and 21.3% versus 14.3%; p=0.001, respectively). The prevalence of the consumption of soda (1 to 4 times/week) and chocolate milk (at least once/day) was higher in children who had been given artificial juice before 6 months (69.2% versus 27.4%; p=0.014 and 38.5% versus 69.4%; p=0.027, respectively). It can be concluded that the consumption of sweet foods and sugary beverages was higher in children with early introduction of fruit juice.
Collapse
Affiliation(s)
- Patrícia Cemin Becker
- Departamento de Nutrição, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2400, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | - Renata Oliveira Neves
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, UFRGS. Porto Alegre RS Brasil
| | | | | | - Juliana Rombaldi Bernardi
- Departamento de Nutrição, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2400, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| |
Collapse
|
5
|
Smriti D, Kao TSA, Rathod R, Shin JY, Peng W, Williams J, Mujib MI, Colosimo M, Huh-Yoo J. MICA: Motivational Interviewing Conversational Agent for Parents as Proxies for their Children in Healthy Eating (Preprint). JMIR Hum Factors 2022; 9:e38908. [PMID: 36206036 PMCID: PMC9587490 DOI: 10.2196/38908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children. Objective We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children. Methods We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents’ interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents’ perceptions and suggestions for improvements in MICA. Results Findings showed participants’ perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children’s eating behaviors and provide customized support for their proxy needs and goals. Conclusions We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change.
Collapse
Affiliation(s)
- Diva Smriti
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | - Tsui-Sui Annie Kao
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Rahil Rathod
- Tata Consultancy Services, Edison, NJ, United States
| | - Ji Youn Shin
- College of Design, University of Minnesota, Minneapolis, MN, United States
| | - Wei Peng
- College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Jake Williams
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | - Munif Ishad Mujib
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | | | - Jina Huh-Yoo
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| |
Collapse
|
6
|
Brown A, Flint SW. Preferences and emotional response to weight-related terminology used by healthcare professionals to describe body weight in people living with overweight and obesity. Clin Obes 2021; 11:e12470. [PMID: 34105886 DOI: 10.1111/cob.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
Previous studies have explored people's perceptions of weight-related terminology; however, to date, limited data has explored the emotional response to weight-related terms used by healthcare professionals (HCPs). This study explored the preferences and emotional responses of terms used by HCPs to describe body weight and of parents to describe their children's weight. A total of 2911 adults completed an online cross-sectional survey, with 1693 living with overweight or obesity (mean age 49.2 years [SD 12.5], female (96%), median body mass index (BMI) 31.4 kg/m2 [28.1, 36.5]). The survey explored preferences of 22 weight-related terms using a 5-point Likert scale and their emotional response to these terms (using 7-core emotions). Parents also indicated preferences and emotional responses to terms used to describe their children's weight. Respondents completed the modified weight bias internalization scale to examine how this may impacted preferences. 'Weight', "unhealthy weight" and "overweight" were the three preferred terms, while "super obese", "chubby", and "extra-large" were least preferred in people living with overweight and obesity. Parents preferred 'weight', "unhealthy weight" and "body mass index", and least preferred "fat", "extra-large" and "extremely obese" when describing their children's weight. All terms elicited a negative emotional response. The most commonly emotion was sadness for terms to describe adult's bodyweight, and anger for terms used to describe children's weight. All BMI categories reported disgust with terms incorporating "obese". Our results offer novel insight into the preferred terminology and emotional responses to terminology used by HCPs for both adults and parents to describe their children's weight.
Collapse
Affiliation(s)
- Adrian Brown
- Centre for Obesity Research, University College London, London, UK
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Stuart W Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| |
Collapse
|
7
|
Dinkel D, Rech JP, Snyder K. Exploring parents' provision of factors related to the establishment of physical activity between normal weight and overweight infants. J SPEC PEDIATR NURS 2021; 26:e12315. [PMID: 33118285 DOI: 10.1111/jspn.12315] [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: 08/13/2020] [Revised: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Infancy is a critical time for the prevention of obesity and establishment of healthy behaviors such as physical activity that help to control weight. A limited amount of research has examined if factors related to infant physical activity vary by infant weight status. Therefore, the purpose of this mixed methods triangulation study was to examine differences in motor development, the home environment, and infant-parent play behaviors as well as to explore how parents promote active play opportunities with normal weight infants (NWIs) and overweight infants (OWIs). DESIGN AND METHODS We used a mixed methods triangulated approach to combine quantitative and qualitative data strands to examine variables associated with active play in normal weight (n = 16) and overweight (n = 11) infants. Data were analyzed using a two-tailed Mann-Whitney U nonparametric test and a summative content analysis approach. RESULTS Although there were no differences in infants' motor development and parent play behaviors based on infant weight, several other differences were found. OWIs had less access to materials that stimulate locomotor movement. Further, parents of OWIs more often reported utilizing cognitive play strategies in comparison to parents of NWIs who more often reported using physical play strategies. Parents felt they were the greatest influence on their child's activity regardless of infant size. Importantly, all parents desired more specific guidelines on how to encourage active play and preferred this information was delivered by their healthcare provider. PRACTICE IMPLICATIONS To meet parents' desires and potentially improve infants' developmental outcomes through the establishment of healthy physical activity behaviors, pediatric nurses could provide more specific guidance on providing active opportunities for infants.
Collapse
Affiliation(s)
- Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - John P Rech
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Kailey Snyder
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| |
Collapse
|
8
|
Sah A, Hillenbrand C, Vogt J. Visible sugar : Salient sugar information impacts health perception of fruit juices but only when motivated to be responsible and not when motivated to enjoy. Appetite 2021; 164:105262. [PMID: 33862190 DOI: 10.1016/j.appet.2021.105262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/15/2022]
Abstract
The present study explores when consumers recognize the high sugar content of fruit juice and refrain from choosing it for themselves or their families. Fruit juice may be typically perceived as a healthy drink, despite its often high sugar content. We investigate the role of salience of sugar information and enjoyment and responsibility goals in perception and choice of fruit juices. We argue that sugar information needs to be salient to prevent this health halo effect, but that consumers also need to be in a motivational state that promotes processing of this information. In three experiments (N = 801), we manipulate the salience of the sugar content using a salient sugar label (or no explicit sugar label) as well as the activation of different goals (to enjoy versus to be responsible, in the context of choices for self versus significant others). Utilising a newly designed fictitious juice brand, salient sugar labels are effective in significantly raising awareness of sugar content in study 1. Consumers primed for responsibility consider fruit juice with salient sugar information unhealthier as compared to those primed for enjoyment in study 2. Further, in study 3, parents primed for responsibility perceive fruit juice with salient sugar information as unhealthier and less appealing in comparison to parents primed for enjoyment. The effects of responsibility and enjoyment primes on health perceptions are stronger when people think of responsibility or enjoyment of food in the context of their families rather than themselves. We discuss implications for theorizing, beverage marketing, and public policy.
Collapse
Affiliation(s)
- Anumeha Sah
- Henley Business School, University of Reading, Greenlands, Henley-on-Thames, RG9 3AU, UK.
| | - Carola Hillenbrand
- Henley Business School, University of Reading, Greenlands, Henley-on-Thames, RG9 3AU, UK.
| | - Julia Vogt
- University of Reading, School of Psychology and CLS, Whiteknights, Earley Gate, Reading, RG6 6AL, UK.
| |
Collapse
|
9
|
Puhl RM. What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology. Obes Rev 2020; 21:e13008. [PMID: 32048465 DOI: 10.1111/obr.13008] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight. However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patient-provider communication and public health communication are discussed.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| |
Collapse
|
10
|
Nezami BT, Lytle LA, Ward DS, Ennett ST, Tate DF. Effect of the Smart Moms intervention on targeted mediators of change in child sugar-sweetened beverage intake. Public Health 2020; 182:193-198. [PMID: 32375100 DOI: 10.1016/j.puhe.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/03/2020] [Accepted: 03/22/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Few parent-targeted interventions have examined the mechanisms of action by which the intervention changes child behavior. The purpose of this study was to test the theoretical and behavioral mediators of the Smart Moms intervention on changes in child sugar-sweetened beverage and juice (SSB/juice) consumption. STUDY DESIGN This is a secondary mediation analysis of data from a 6-month randomized controlled trial (N = 51 mother-child dyads) of a mobile phone-based program to reduce child SSB/juice intake compared with a waitlist control group. METHODS Linear mixed models compared changes in intervention targets from baseline to 3 months between treatment groups. Intervention targets that changed significantly between groups were tested in a multiple mediation model to evaluate their significance as mediators of change in child SSB/juice at 6 months. RESULTS Maternal beverage consumption but no other behavioral or theoretical intervention targets mediated the effect of the intervention on the reduction in child SSB/juice at 6 months. There were few mediators of the intervention on child SSB/juice change. CONCLUSION Greater longitudinal research is needed to understand predictors of child dietary changes to inform future intervention efforts. In addition, a greater focus on the measurement of theoretical constructs in family-based child obesity prevention research is needed.
Collapse
Affiliation(s)
- B T Nezami
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB #7461, Chapel Hill, NC 27599, USA.
| | - L A Lytle
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB #7461, Chapel Hill, NC 27599, USA; Department of Health Behavior, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599, USA.
| | - D S Ward
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB #7461, Chapel Hill, NC 27599, USA.
| | - S T Ennett
- Department of Health Behavior, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599, USA.
| | - D F Tate
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB #7461, Chapel Hill, NC 27599, USA; Department of Health Behavior, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599, USA.
| |
Collapse
|
11
|
Ames H, Mosdøl A, Blaasvær N, Nøkleby H, Berg RC, Langøien LJ. Communication of children's weight status: what is effective and what are the children's and parents' experiences and preferences? A mixed methods systematic review. BMC Public Health 2020; 20:574. [PMID: 32345274 PMCID: PMC7189728 DOI: 10.1186/s12889-020-08682-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/08/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Early intervention and conversation about a child's weight may offer an important chance of success in reducing weight and implementing a healthier lifestyle. This review explores the most effective ways to notify parents and children about the child's weight as well as their preferences and experiences around weight notification. METHODS We systematically searched nine databases for relevant primary research. Records were independently screened by two authors. We extracted data into a form designed for this review. Effect data was analysed using narrative synthesis and qualitative data using a best-fit framework synthesis. We assessed our confidence in the evidence using GRADE and GRADE-CERQual. RESULTS Studies of effect found that the format of feedback made little or no difference in parents attending further treatment, recognising their child as overweight or obese, reactions to the way the weight notification is given, motivation for lifestyle change, understanding how to reduce the risk of overweight, or taking any action. However, parents receiving feedback with motivational interviewing have somewhat greater satisfaction with the way the healthcare provider supports them. Qualitative studies found that parents had clear preferences for the format, timing, content and amount of information they wanted to receive in relation to both the weighing process and weight notification. They also had clear preferences for how they wanted health care providers to interact and communicate with them and their children. Both parents and children often felt that they were not receiving enough information and worried about how their results would be kept private. Many parents experienced an emotional response when told about their child's weight ranging from positive, disbelief and negative feelings. Those who reacted with disbelief or negatively were less likely to accept their child's weight status and/or act upon the notification letter. No studies reported results for children who were underweight. CONCLUSIONS Based on these qualitative results people working with weight assessment and notification programs should consider parents' preferences when developing feedback formats, considering the mode of feedback they are going to use and provide parents and children with tailored feedback and personalized follow up once a child is identified as overweight or obese.
Collapse
Affiliation(s)
- H Ames
- The Norwegian Institute of Public Health, Oslo, Norway.
| | - A Mosdøl
- The Norwegian Institute of Public Health, Oslo, Norway
| | - N Blaasvær
- The Norwegian Institute of Public Health, Oslo, Norway
| | - H Nøkleby
- The Norwegian Institute of Public Health, Oslo, Norway
| | - R C Berg
- The Norwegian Institute of Public Health, Oslo, Norway
| | - L J Langøien
- The Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
12
|
Talking About Childhood Obesity: A Survey of What Parents Want. Acad Pediatr 2019; 19:756-763. [PMID: 30867135 DOI: 10.1016/j.acap.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/17/2019] [Accepted: 03/02/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Determine parent preferences when discussing their child's weight with regard to weight-based terms, terms that are the most motivating, preferred setting, and whether or not awareness of their child's weight status impact these preferences. METHODS Parents of children ages 3 to 17 years (N = 349) presenting for health supervision visits completed a survey to assess the degree of offensiveness and motivation for change of commonly used weight-based terminology, as well as the preferred setting for discussion of weight. Parents were asked to assess their child's weight status using recommended terminology ("obese," "overweight," "healthy weight," "underweight"), and their responses were compared to the children's objective body mass index (BMI) percentile. RESULTS The children had a median age of 10.3 years; 47.3% were female, 15.8% had overweight (85th-94th percentile BMI), and 11.5% had obesity (≥95th percentile BMI). Of children with overweight/obesity, 84.2% of parents underestimated their child's weight status. The least offensive terms were "at-risk weight," "BMI is high," "BMI is above 95%," and "unhealthy weight." The more offensive terms (P < .001) were "overweight" and "obese." The parent's perception of their child's weight did not affect offensiveness ratings. "Obese" was the strongest motivator for change (P < .001), and "unhealthy weight" was next. Well visits were preferred for discussing weight (P < .001). Most parents preferred to have the child remain in the room (P < .001), especially if the child was older (P < .001). CONCLUSIONS Providers should use preferred terms when discussing excess weight regardless of a parent's perception of their child's status and should also consider the motivational value of the term. "Unhealthy weight" was both preferred and motivating, but "obese" was the most motivating.
Collapse
|
13
|
Hirschfeld-Dicker L, Samuel RD, Tiram Vakrat E, Dubnov-Raz G. Preferred weight-related terminology by parents of children with obesity. Acta Paediatr 2019; 108:712-717. [PMID: 30118160 DOI: 10.1111/apa.14538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 01/29/2023]
Abstract
AIM In order to improve weight-related discussion with patients and minimise their discomfort, the terminology used by medical staff should be carefully chosen. The aim of the study was to identify the most motivating weight-related terminology to use with children with obesity. METHODS Focus groups were used to generate a list of 12 weight-related terms in Hebrew, sent by a questionnaire to parents of children and adolescents with obesity. Terms were graded according to how desirable, stigmatising, blaming or motivating they were perceived. We identified the most positive and negative weight-based terms and conducted linear regressions to predict child motivation to lose weight when positive terms are used. RESULTS The least stigmatising and most motivating and desirable terms were 'unhealthy body weight' and 'unhealthy lifestyle'. Medical staff mostly used 'overweight', which was relatively inoffensive yet not very motivating. 'Fat/obese' ('Shamen') was the most stigmatising and blaming term and the least desired. Only 20% of parents endorsed a nonverbal graphical tool to describe body size. CONCLUSION Our findings encourage using health-based terminology over weight-based terminology to promote treatment and lifestyle changes in children with obesity. Healthcare professionals should adopt patient-centred care and improve the weight-related terms they use with children with obesity.
Collapse
Affiliation(s)
| | - Roy David Samuel
- Department of Physical Education and Movement; Kibbutzim College of Education Technology and the Arts; Tel Aviv Israel
- School of Psychology; Interdisciplinary Center (IDC); Herzliya Israel
| | - Elinor Tiram Vakrat
- Exercise, Nutrition and Lifestyle Clinic; The Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
| | - Gal Dubnov-Raz
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Exercise, Nutrition and Lifestyle Clinic; The Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Tel Hashomer Israel
| |
Collapse
|
14
|
Sastre LR, Matson S, Gruber KJ, Haldeman L. A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic. SAGE Open Med 2019; 7:2050312119834117. [PMID: 30834116 PMCID: PMC6396046 DOI: 10.1177/2050312119834117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. Methods: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. Results: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child’s weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. Conclusion: Results suggest that successful management of children’s weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.
Collapse
Affiliation(s)
- Lauren R Sastre
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Stephanie Matson
- Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
| | - Kenneth J Gruber
- Center for Youth, Family and Community Partnerships, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Lauren Haldeman
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC, USA
| |
Collapse
|
15
|
Uy MJA, Pereira MA, Berge JM, Loth KA. How Should We Approach and Discuss Children's Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians. Clin Pediatr (Phila) 2019; 58:226-237. [PMID: 30428705 PMCID: PMC6461358 DOI: 10.1177/0009922818812489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The primary objective of this study was to describe parents' preference for how physicians should approach diet and weight-related advice for their child. Semi-structured interviews were conducted with parents (n = 40) of preschoolers, transcribed verbatim, and double-coded using an inductive thematic analysis approach. Parents identified recommendations for how physicians should approach conversations about weight. Themes included (1) Tone and Approach are Important, (2) Avoid Judgment, (3) Have Regard for Parental Expertise, (4) Consider the Timing of the Discussion with Parents, and (5) Equip Parents with Concrete and Individualized Recommendations. Future research should focus on developing brief, effective communication tools to guide discussions with parents about child nutrition and weight. Opportunities to learn about and practice the use of these brief interventions should be incorporated into medical education with the goal of providing clinicians the learning opportunities, skills/tools, and resources needed to adequately and respectfully discuss weight and diet with parents and children.
Collapse
|
16
|
Jachyra P, Anagnostou E, Knibbe TJ, Petta C, Cosgrove S, Chen L, Capano L, Moltisanti L, McPherson AC. Weighty Conversations: Caregivers', Children's, and Clinicians' Perspectives and Experiences of Discussing Weight-Related Topics in Healthcare Consultations. Autism Res 2018; 11:1500-1510. [DOI: 10.1002/aur.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Patrick Jachyra
- Bloorview Research Institute; Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
- Rehabilitation Sciences Institute; University of Toronto; Toronto Ontario
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics; University of Toronto; Toronto Ontario
| | | | - Catharine Petta
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | - Susan Cosgrove
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | - Lorry Chen
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | - Lucia Capano
- Holland Bloorview Kids Rehabilitation Hospital; Toronto Ontario
| | | | - Amy C. McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Dalla Lana School of Public Health, University of Toronto, Rehabilitation Sciences Institute, University of Toronto; Toronto Ontario
| |
Collapse
|
17
|
Jachyra P, Anagnostou E, Knibbe TJ, Petta C, Cosgrove S, Chen L, Capano L, Moltisanti L, McPherson AC. "Girls don't have big tummies": The experiences of weight-related discussions for children with autism spectrum disorders. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1096-1105. [PMID: 30244587 DOI: 10.1177/1362361318793020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Children with autism spectrum disorders appear to be at a higher risk of having obesity than their typically developing peers. Although it has been recommended that healthcare providers speak to children with autism spectrum disorders about the potential health risks of unhealthy weight, no previous research has explored how healthcare providers communicate with them about this topic. The purpose of this study was to explore children's perspectives and experiences of discussing weight-related topics in healthcare consultations. Eight children were interviewed, and an interpretive phenomenological analysis informed the research approach and analysis of the data. Results indicated that weight-related discussions with healthcare providers were often met with trepidation, anxiety, anger, and frustration. Children also expressed that they experienced weight stigma in clinical visits and everyday interactions. Weight stigma was often (unwittingly) projected by healthcare providers during appointments and had debilitating effects on children. Finally, higher weights emerged as a repetitive/restricted interest, and children reported body image challenges regarding their higher weights. Frameworks and tools that are specific to the needs and abilities of children with autism spectrum disorders are needed for healthcare providers to foster positive conversations about weight-related topics in an effort to promote lifelong wellness.
Collapse
Affiliation(s)
- Patrick Jachyra
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada.,2 Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Evdokia Anagnostou
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada.,3 Department of Paediatrics, University of Toronto, Canada
| | | | | | - Susan Cosgrove
- 5 Holland Bloorview Kids Rehabilitation Hospital, Canada
| | - Lorry Chen
- 5 Holland Bloorview Kids Rehabilitation Hospital, Canada
| | - Lucia Capano
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada
| | | | - Amy C McPherson
- 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada.,2 Rehabilitation Sciences Institute, University of Toronto, Canada.,6 Dalla Lana School of Public Health, University of Toronto, Canada
| |
Collapse
|
18
|
Puhl RM, Himmelstein MS. Adolescent preferences for weight terminology used by health care providers. Pediatr Obes 2018; 13:533-540. [PMID: 29573233 DOI: 10.1111/ijpo.12275] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In light of high rates of obesity and weight stigma in youth, the American Academy of Paediatrics recommends that paediatric health care professionals use appropriate, sensitive and non-stigmatizing language in communication about weight with youth. For these efforts to be effective, there is a need to identify weight-based language preferences among youth with overweight and obesity, as research in this area is scarce. OBJECTIVES The present study provides a systematic assessment of youth perspectives of weight-based language used by providers. METHODS Adolescents (ages 13-18 years; N = 148) enrolled in a national weight loss camp were surveyed about their preferences for words that health providers use to refer to their body weight. Adolescents completed an online survey and responded to a list of 16 words describing excess body weight, as well as questions assessing demographics, body mass index, and experienced as well as internalized weight stigma. RESULTS Adolescents assigned low ratings to words like 'fat', 'large', 'obese' and 'extremely obese', indicating that they would not want providers to use these words when discussing their body weight. In contrast, words like 'weight problem', 'BMI' and 'plus size' were rated among the most preferred words for providers to use. Word preferences varied across gender, body mass index and extent of internalized weight stigma. CONCLUSIONS These findings underscore the importance of acknowledging different word preferences among youth, and to avoid making assumptions about what words youth will feel most comfortable using in discussions about their body weight.
Collapse
Affiliation(s)
- R M Puhl
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - M S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| |
Collapse
|
19
|
Knierim SD, Newcomer S, Castillo A, Rahm AK, Raghunath S, Clarke C, Wright L, Haemer M, Hambidge SJ. Latino Parents' Perceptions of Pediatric Weight Counseling Terms. Acad Pediatr 2018; 18:342-353. [PMID: 28919572 PMCID: PMC5847465 DOI: 10.1016/j.acap.2017.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Little is known about Latino parents' perceptions of weight-related language in English or Spanish, particularly for counseling obese youth. We sought to identify English and Spanish weight counseling terms perceived by Latino parents across demographic groups as desirable for providers to use, motivating, and inoffensive. METHODS Latino parents of children treated at urban safety-net clinics completed surveys in English or Spanish. Parents rated the desirable, motivating, or offensive properties of terms for excess weight using a 5-point scale. We compared parental ratings of terms and investigated the association of parent and child characteristics with parent perceptions of terms. RESULTS A total of 525 surveys met inclusion criteria (255 English, 270 Spanish). English survey respondents rated "unhealthy weight" and "too much weight for his/her health" the most motivating and among the most desirable and least offensive terms. Spanish survey respondents found "demasiado peso para su salud" highly desirable, highly motivating, and inoffensive, and respondents valued its connection to the child's health. Commonly used clinical terms "overweight"/"sobrepeso" and "high BMI [body mass index]"/"índice de masa corporal alta" were not as desirable or as motivating. "Chubby," "fat," "gordo," and "muy gordo" were the least motivating and most offensive terms. Parents' ratings of commonly used clinical terms varied widely across demographic groups, but more desirable terms had less variability. CONCLUSIONS "Unhealthy weight," "too much weight for his/her health," and its Spanish equivalent, "demasiado peso para su salud," were the most desirable and motivating, and the least offensive terms. Latino parents' positive perceptions of these terms occurred across parent and child characteristics, supporting their use in weight counseling.
Collapse
Affiliation(s)
- Shanna Doucette Knierim
- Ambulatory Care Services, Denver Health, Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | - Sophia Newcomer
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Alyssa Castillo
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Mass
| | - Alanna Kulchak Rahm
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo; Genomic Medicine Institute Geisinger Health System, Danville, Pa
| | | | - Christina Clarke
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Matthew Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Simon J Hambidge
- Ambulatory Care Services, Denver Health, Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| |
Collapse
|
20
|
Stark LJ, Filigno SS, Bolling C, Ratcliff MB, Kichler JC, Robson SM, Simon SL, McCullough MB, Clifford LM, Stough CO, Zion C, Ittenbach RF. Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial. J Pediatr 2018; 192:115-121.e1. [PMID: 29150147 PMCID: PMC5732872 DOI: 10.1016/j.jpeds.2017.09.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/07/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To test the hypotheses that an innovative skills-based behavioral family clinic and home-based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool-aged children with obesity. STUDY DESIGN Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18-session clinic and home-based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression-based analysis of covariance models. RESULTS A total of 151 of the 167 children randomized met intent-to-treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = -0.32, SD = ±0.33) compared with motivational interviewing (mean = -0.05, SD = ±0.27), P < .001, ω2 = 0.74 and compared with standard care (mean = -0.13, SD = ±0.31), P < .004, ω2 = 0.75. CONCLUSIONS In preschool-age children, an intensive 6-month behavioral skills-based intervention is necessary to reduce obesity. TRIAL REGISTRATION Clinicaltrials.gov NCT01546727.
Collapse
Affiliation(s)
- Lori J. Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stephanie Spear Filigno
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Jessica C. Kichler
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shannon M. Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
| | - Stacey L. Simon
- Department of Pediatrics, Division of Pulmonary Medicine, Children’s Hospital Colorado, Aurora, CO
| | - Mary Beth McCullough
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lisa M. Clifford
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Cynthia Zion
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Richard F. Ittenbach
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
21
|
Hennink-Kaminski H, Vaughn AE, Hales D, Moore RH, Luecking CT, Ward DS. Parent and child care provider partnerships: Protocol for the Healthy Me, Healthy We (HMHW) cluster randomized control trial. Contemp Clin Trials 2017; 64:49-57. [PMID: 29128650 DOI: 10.1016/j.cct.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Formation of diet and physical activity habits begins during early childhood. However, many preschool-aged children in the United States do not achieve recommendations for a nutritious diet or active lifestyle. Two important spheres of influence, home and child care, could ensure that children receive consistent health messages. Innovative approaches that engage both parents and child care providers in a substantial way are needed. Social marketing, a promising approach for health promotion targeting children, uses principles that recognize the need to engage multiple stakeholders and to emphasize benefits and overcome barriers associated with behavior change. Yet, application of social marketing principles in interventions for preschool-age children is limited. METHODS Healthy Me, Healthy We (HMHW) is 2-arm, cluster randomized controlled trial to evaluate the effect of a 8-month social marketing campaign on the diet and physical activity behaviors of preschool children (3-4years old), their parents, and child care providers. The campaign is delivered by the child care center and includes branded classroom and at-home activities and materials. Primary outcomes are children's diet quality (assessed with Healthy Eating Index scores) and minutes of non-sedentary activity (measured via accelerometers). Secondary outcomes assess children's body mass index, nutrition and physical activity practices at the child care center and at home, and health behaviors of child care providers and parents. CONCLUSION HMHW is an innovative approach to promoting healthy eating and physical activity in preschool children. The campaign targets children during a key developmental period and leverages a partnership between providers and parents to affect behavior change.
Collapse
Affiliation(s)
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, USA
| | - Courtney T Luecking
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| |
Collapse
|
22
|
Curtis K, Atkins L, Brown K. Big hearts, small hands: a focus group study exploring parental food portion behaviours. BMC Public Health 2017; 17:716. [PMID: 28923032 PMCID: PMC5604285 DOI: 10.1186/s12889-017-4711-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The development of healthy food portion sizes among families is deemed critical to childhood weight management; yet little is known about the interacting factors influencing parents' portion control behaviours. This study aimed to use two synergistic theoretical models of behaviour: the COM-B model (Capability, Opportunity, Motivation - Behaviour) and Theoretical Domains Framework (TDF) to identify a broad spectrum of theoretically derived influences on parents' portion control behaviours including examination of affective and habitual influences often excluded from prevailing theories of behaviour change. METHODS Six focus groups exploring family weight management comprised of one with caseworkers (n = 4), four with parents of overweight children (n = 14) and one with parents of healthy weight children (n = 8). A thematic analysis was performed across the dataset where the TDF/COM-B were used as coding frameworks. RESULTS To achieve the target behaviour, the behavioural analysis revealed the need for eliciting change in all three COM-B domains and nine associated TDF domains. Findings suggest parents' internal processes such as their emotional responses, habits and beliefs, along with social influences from partners and grandparents, and environmental influences relating to items such as household objects, interact to influence portion size behaviours within the home environment. CONCLUSION This is the first study underpinned by COM-B/TDF frameworks applied to childhood weight management and provides new targets for intervention development and the opportunity for future research to explore the mediating and moderating effects of these variables on one another.
Collapse
Affiliation(s)
- Kristina Curtis
- Behaviour & Interventions Research, Faculty of Health & Life Sciences, Coventry University (Joint with Public Health Warwickshire), Mile Lane, Coventry, CV1 2NL UK
| | - Louise Atkins
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Katherine Brown
- Behaviour & Interventions Research, Faculty of Health & Life Sciences, Coventry University (Joint with Public Health Warwickshire), Mile Lane, Coventry, CV1 2NL UK
| |
Collapse
|
23
|
Hesketh KR, Lakshman R, van Sluijs EMF. Barriers and facilitators to young children's physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature. Obes Rev 2017; 18:987-1017. [PMID: 28589678 PMCID: PMC5575514 DOI: 10.1111/obr.12562] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
Abstract
Positive activity behaviours (i.e. higher physical activity [PA]/lower sedentary behaviour [SB]) are beneficial from infancy, yet evidence suggests that young children (0- to 6-year-olds) are relatively inactive. To better understand the perceived influences on these behaviours and to aid intervention development, this paper systematically synthesizes the extensive qualitative literature regarding perceived barriers and facilitators to PA and SB in young children (0-6 years old). A search of eight electronic databases (July 2016) identified 43 papers for inclusion. Data extraction and evidence synthesis were conducted using thematic content analysis, underpinned by the socio-ecological model (i.e. individual, interpersonal, community, organizational and policy levels). Parents, childcare providers and children perceived seven broad themes to be important for PA and SB, including the child; the home; out-of-home childcare; parent-childcare provider interactions; environmental factors; safety; and weather. Each theme mapped onto between one and five levels of the socio-ecological model; barriers and facilitators at the interpersonal level (e.g. parents, care providers and family) were most frequently cited, reflecting the important (perceived) role adults/peers play in shaping young children's behaviours. We provide an overarching framework to explain PA and SB in early childhood. We also highlight where gaps in the current literature exist (e.g. from male carers; in developing countries; and barriers and facilitators in the environmental and policy domains) and where future quantitative work may focus to provide novel insights about children's activity behaviours (e.g. safety and weather).
Collapse
Affiliation(s)
- K. R. Hesketh
- MRC Epidemiology Unit and Centre for Diet and Activity ResearchUniversity of CambridgeCambridgeUK
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - R. Lakshman
- MRC Epidemiology Unit and Centre for Diet and Activity ResearchUniversity of CambridgeCambridgeUK
- Public Health Directorate, Cambridgeshire County CouncilCambridgeUK
| | - E. M. F. van Sluijs
- MRC Epidemiology Unit and Centre for Diet and Activity ResearchUniversity of CambridgeCambridgeUK
| |
Collapse
|
24
|
Kaakinen P, Kyngäs H, Kääriäinen M. Technology-based counseling in the management of weight and lifestyles of obese or overweight children and adolescents: A descriptive systematic literature review. Inform Health Soc Care 2017; 43:126-141. [DOI: 10.1080/17538157.2017.1353997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Pirjo Kaakinen
- Faculty of Medicine, Research unit of Nursing Science and Health management, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Helvi Kyngäs
- Faculty of Medicine, Research unit of Nursing Science and Health management, Oulu, Finland
| | - Maria Kääriäinen
- Faculty of Medicine, Research unit of Nursing Science and Health management, Oulu, Finland
| |
Collapse
|
25
|
Heyman MB, Abrams SA, Heitlinger LA, Cabana MD, Gilger MA, Gugig R, Hill ID, Lightdale JR, Daniels SR, Corkins MR, de Ferranti SD, Golden NH, Magge SN, Schwarzenberg SJ. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics 2017; 139:peds.2017-0967. [PMID: 28562300 DOI: 10.1542/peds.2017-0967] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an extra source of water for healthy infants and young children as their diets expanded to include solid foods with higher renal solute load. It was also sometimes recommended for children with constipation. Fruit juice is marketed as a healthy, natural source of vitamins and, in some instances, calcium. Because juice tastes good, children readily accept it. Although juice consumption has some benefits, it also has potential detrimental effects. High sugar content in juice contributes to increased calorie consumption and the risk of dental caries. In addition, the lack of protein and fiber in juice can predispose to inappropriate weight gain (too much or too little). Pediatricians need to be knowledgeable about juice to inform parents and patients on its appropriate uses.
Collapse
Affiliation(s)
- Melvin B. Heyman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of California, San Francisco, California
- UCSF Benioff Children’s Hospital, San Francisco, California; and
| | - Steven A. Abrams
- Department of Pediatrics, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
McPherson AC, Hamilton J, Kingsnorth S, Knibbe TJ, Peters M, Swift JA, Krog K, Chen L, Steinberg A, Ball GDC. Communicating with children and families about obesity and weight-related topics: a scoping review of best practices. Obes Rev 2017; 18:164-182. [PMID: 27888564 DOI: 10.1111/obr.12485] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/07/2016] [Accepted: 10/18/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Healthcare professionals have called for direction on how best to communicate about weight-related topics with children and families. Established scoping review methodology was used to answer the question: 'How can healthcare professionals best communicate with children and their families about obesity and weight-related topics?' METHODS We searched four scientific databases, two grey literature repositories and 14 key journals (2005-2016). Inclusion criteria were (i) children up to and including 18 years of age and/or their parents; (ii) communication about healthy weight, overweight, obesity or healthy/active living; and (iii) healthcare setting. RESULTS Thirty-two articles were included. Evidence-based best practices were largely absent from the literature, although the following guiding principles were identified: (i) include all stakeholders in discussions; (ii) raise the topic of weight and health early and regularly; (iii) use strengths-based language emphasizing health over weight; (iv) use collaborative goal-setting to engage children and parents and (v) augment discussions with appropriate tools and resources. Guidance on how to implement these principles and how to negotiate relevant contextual factors (e.g. age, culture and disability) is still needed. CONCLUSION Despite agreement on a number of guiding principles, evidence-based weight-related communication best practices are lacking. Rigorous, empirical evaluations of communication approaches are urgently required, especially those that include children's perspectives.
Collapse
Affiliation(s)
- A C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - J Hamilton
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - S Kingsnorth
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - T J Knibbe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - M Peters
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - J A Swift
- School of Biosciences, University of Nottingham, Nottingham, UK
| | - K Krog
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - L Chen
- Nutrition Services, Rehabilitation and Complex Continuing Care, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - A Steinberg
- Department of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | - G D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
27
|
Stark LJ, Filigno SS, Bolling C, Ratcliff MB, Kichler JC, Robson SL, Simon SL, McCullough MB, Clifford LM, Stough CO, Zion C, Ittenbach RF. Learning about Activity and Understanding Nutrition for Child Health (LAUNCH): Rationale, design, and implementation of a randomized clinical trial of a family-based pediatric weight management program for preschoolers. Contemp Clin Trials 2017; 52:10-19. [PMID: 27777128 PMCID: PMC6309338 DOI: 10.1016/j.cct.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
Abstract
Obesity affects nearly 2 million preschool age children in the United States and is not abating. However, research on interventions for already obese preschoolers is limited. To address this significant gap in the literature, we developed an intervention targeting obesity reduction in 2 to 5year olds, Learning about Activity and Understanding Nutrition for Child Health (LAUNCH). This paper describes the rationale, design, participant enrollment, and implementation of a 3-arm randomized, parallel-group clinical trial comparing LAUNCH to a motivational-interviewing intervention (MI) and standard care (STC), respectively. Whereas LAUNCH was designed as a skills based intervention, MI focused on addressing the guardian's motivation to make changes in diet and activity and providing tools to do so at the guardian's level of readiness to implement changes. Child body mass index z-score was the primary outcome, assessed at pretreatment, posttreatment (Month 6), and 6 and 12month follow-ups (Months 12 and 18). Mechanisms of weight change (e.g., dietary intake, physical activity) and environmental factors associated with weight (e.g., foods available in the home, caregiver diet) were also assessed. This study is unique because it is one of the few randomized controlled trials to examine a developmentally informed, clinic and home skills based behavioral family intervention for preschoolers who are already obese. Being obese during the preschool years increases the likelihood of remaining obese as an adult and is associated with serious health conditions; if this intervention is successful, it has the potential to change the health trajectories for young children with obesity.
Collapse
Affiliation(s)
- Lori J Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Stephanie Spear Filigno
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | | | - Jessica C Kichler
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Shannon L Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, United States
| | - Stacey L Simon
- Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital Colorado, Aurora, CO, United States
| | - Mary Beth McCullough
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lisa M Clifford
- Department of Clinical and Health Psychology, University of Florida, United States
| | - Cathleen O Stough
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Cynthia Zion
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Richard F Ittenbach
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| |
Collapse
|
28
|
Robson SM, Bolling C, McCullough MB, Stough CO, Stark LJ. A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals. J Pediatr 2016; 177:262-266.e1. [PMID: 27453375 PMCID: PMC5037027 DOI: 10.1016/j.jpeds.2016.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine referral by primary care providers (PCPs) of preschool children with obesity (≥95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT), and identify reasons for not referring children. STUDY DESIGN In phase I, 3 experts in obesity, psychology, and nutrition completed an open card sort and classified PCPs' reasons for declining referral into groups based on similarity of reasons. Categories were then defined and labeled. In phase II, 2 independent sorters placed each decline into 1 of the categories defined in phase I. RESULTS PCPs referred 78% of eligible children to the RCT. Compared with children declined for referral, referred children had a significantly higher weight (48.4 lb vs 46.1 lb; P < .001) and BMI percentile (97.6 vs 97.0; P < .001). Eleven categories for decline were identified in phase I. In phase II, excellent reliability was obtained between each independent sorter and the phase I categories, and also between the 2 independent sorters (κ values, 0.72-1.0). The most common reason for declining was "family not a good fit" (23.6%), followed by "doesn't believe weight is a problem" (13.9%), "family would not be interested" (12%), and "doesn't believe measurement is accurate" (11.5%). Appropriately, exclusionary criteria of the RCT was a reason as well (11.8%). CONCLUSION The availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in previous studies. However, concerns about the family's response or interest in a weight management program remained barriers, as did PCPs' perceptions about obesity in young children. TRIAL REGISTRATION ClinicalTrials.gov:NCT01546727.
Collapse
Affiliation(s)
- Shannon M. Robson
- University of Delaware, Newark, Delaware, USA,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Lori J. Stark
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
29
|
Towner EK, Clifford LM, McCullough MB, Stough CO, Stark LJ. Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps. Pediatr Clin North Am 2016; 63:481-510. [PMID: 27261546 PMCID: PMC6246919 DOI: 10.1016/j.pcl.2016.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.
Collapse
Affiliation(s)
- Elizabeth K Towner
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Wayne State University, IBio 6135 Woodward Avenue, H206, Detroit, MI 48202, USA.
| | - Lisa M Clifford
- Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA
| | - Mary Beth McCullough
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Cathleen Odar Stough
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Lori J Stark
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 3015, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| |
Collapse
|
30
|
Shefferly A, Scharf RJ, DeBoer MD. Longitudinal evaluation of 100% fruit juice consumption on BMI status in 2-5-year-old children. Pediatr Obes 2016; 11:221-7. [PMID: 26110996 PMCID: PMC4734899 DOI: 10.1111/ijpo.12048] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/28/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity in childhood is related to multiple lifestyle factors. Our objective was to evaluate the relationship between consumption of 100% fruit juice and weight status over time among pre-school children. METHODS We used linear and logistic multivariable regression to evaluate body mass index (BMI) z-score and overweight/obese status as a function of 100% fruit juice intake for 8950 children examined at ages 2, 4 and 5 years as part of the Early Childhood Longitudinal Study-Birth Cohort, a representative sample of the United States. RESULTS Cross-sectional analysis at ages 4 and 5 years showed no difference in the prevalence of overweight and obesity between consistent juice drinkers and inconsistent/non-drinkers. Longitudinal analysis found that children who drank 100% juice consistently at age 2 years had greater increases in BMI z-score by age 4 years than infrequent/non-drinkers (P < 0.0001), a difference driven by lesser increases in height z-score (P = 0.0003) and slightly greater increases in weight z-score (P = 0.0550) among consistent juice drinkers over the 2 to 4 year time period. Additionally, consistent juice drinkers at age 2 had higher odds of becoming overweight by age 4 (adjusted odds ratio 1.30; CI 1.06-1.60). These differences in growth parameters were not noted between ages 4 and 5 years. CONCLUSIONS Drinking 100% fruit juice regularly at age 2 is associated with higher odds of becoming overweight between 2 and 4 years. Paediatricians and parents can discourage excessive fruit juice consumption as part of a larger effort to avoid unhealthy gain in BMI in young children.
Collapse
Affiliation(s)
- Ann Shefferly
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Rebecca J. Scharf
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Mark D. DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, VA,Author to whom correspondence should be addressed: Division of Pediatric Endocrinology, University of Virginia School of Medicine, P.O. Box 800386, Charlottesville, VA 22908, Phone: 434-924-9833, Fax: 434-924-9181,
| |
Collapse
|
31
|
Affiliation(s)
| | - Mark D. DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908; ,
| |
Collapse
|
32
|
Upperman C, Palmieri P, Lin H, Flores G, Turer CB. What do parents want for their children who are overweight when visiting the paediatrician? Obes Sci Pract 2015; 1:33-40. [PMID: 28580163 PMCID: PMC5450825 DOI: 10.1002/osp4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to determine whether parental preferences regarding primary care weight‐management strategies differ by child age, gender, overweight severity, race/ethnicity or parental agreement that their child is overweight. Methods A survey was administered to parents of 2‐ to 18‐year‐old children who are overweight at an academic primary‐care clinic regarding perception of child overweight, helpful/harmfulness of having the child present during weight discussions, and dietary‐advice preferences. Multivariable analyses examined factors associated with preferred weight‐management strategies, after adjustment for parent/child characteristics. Results Eighty‐three per cent of parents agreed that a child's presence during weight discussions is helpful/very helpful, 74% that paediatricians should prescribe specific diets, and 55% preferred specific vs. general dietary advice only (N = 219). In multivariable analyses, characteristics associated with helpfulness of child presence included older child age (vs. 2–5 year olds, 6–11 year olds: odds ratio [OR], 4.6; 95% CI, 1.3–16; 12‐ to 18‐year‐olds: OR, 23; 95% CI, 4–136), male gender (OR, 5.0; 95% CI, 1.7–10) and obesity (vs. overweight: OR, 2.8; 95% CI, 1.7–12). Characteristics associated with preferring specific diets included Latino race/ethnicity (OR, 5.3; 95% CI, 3–12), older age (vs. 2–5 year olds, 6–11 year olds: OR, 2.8; 95% CI, 1.1–7; 12–18 year olds: OR, 3.7; 95% CI, 1.5–10) and agreement that the child is overweight (OR, 2.3; 95% CI, 1.1–5) and, for specific dietary advice, older age (vs. 2–5 year olds: OR, 2.3; 95% CI, 1.1–5) and agreement that the child is overweight (OR, 2.1; 95% CI, 1.2–4). Conclusions Findings suggest that weight‐management strategies tailored to child age, gender, overweight severity, race/ethnicity and parental agreement that their child is overweight may prove useful in improving child weight status.
Collapse
Affiliation(s)
- C. Upperman
- School of Medicine; UT Southwestern Medical Center; Dallas TX USA
| | - P. Palmieri
- Department of Pediatrics; UT Southwestern and Children's Medical Center; Dallas TX USA
| | - H. Lin
- Department of Pediatrics; UT Southwestern Medical Center; Dallas TX USA
| | - G. Flores
- Department of Pediatrics; UT Southwestern and Children's Medical Center; Dallas TX USA
| | - C. B. Turer
- Department of Pediatrics; UT Southwestern and Children's Medical Center; Dallas TX USA
| |
Collapse
|
33
|
Mazarello Paes V, Ong KK, Lakshman R. Factors influencing obesogenic dietary intake in young children (0-6 years): systematic review of qualitative evidence. BMJ Open 2015; 5:e007396. [PMID: 26377503 PMCID: PMC4577937 DOI: 10.1136/bmjopen-2014-007396] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesogenic dietary intake is prevalent in young children and is associated with obesity and other adverse health outcomes in childhood and later in life. OBJECTIVE To describe the barriers to and facilitators of obesogenic dietary intake in early childhood, in order to inform interventions and public health policies to prevent obesity. DESIGN Systematic review of qualitative literature on factors influencing obesogenic diets in children aged 0-6 years. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, ASSIA and Sociological Abstracts. REVIEW METHODS Qualitative studies meeting the inclusion criteria were synthesised. Data were analysed by creating a thematic framework, underpinned by the socioecological model, which included familiarisation of data across the studies, indexing, charting, mapping and interpretation. RESULTS 20 studies from the USA (10), Europe (6) and Australia (4) included the views of 1067 participants (901 parents/caregivers, 37 children, 87 teachers, 15 dieticians and 27 nursery staff). Study designs included focus groups (n=16), individual interviews (n=6) and ethnography (n=1) with some studies using more than one design. Despite wide differences in the study context and focus, several consistent themes emerged. Parental factors increasing young children's obesogenic diets were: negative parent/family/peer modelling, lack of knowledge, time constraints, using food as reward, affordability and concerns about child's health. Child preferences also increased intake. Environmental factors increasing intake include: availability, advertising, societal, cultural and preschool/childcare influences. CONCLUSIONS Future intervention strategies should aim to promote modelling of positive behaviours, create home and preschool environments that promote healthy diets, and simultaneously target factors at the family and preschool/childcare levels. TRIAL REGISTRATION NUMBER This review is one of a series of systematic reviews on the determinants of obesogenic behaviours in young children, registered with the International Prospective Register for Systematic Reviews (PROSPERO), CRD42012002881.
Collapse
Affiliation(s)
- Veena Mazarello Paes
- Institute of Public Health, University of Cambridge, Cambridge, UK
- Institute of Child Health, University College London, London, UK
| | - Ken K Ong
- MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Rajalakshmi Lakshman
- MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| |
Collapse
|
34
|
Knierim SD, Rahm AK, Haemer M, Raghunath S, Martin C, Yang A, Clarke C, Hambidge SJ. Latino parents' perceptions of weight terminology used in pediatric weight counseling. Acad Pediatr 2015; 15:210-7. [PMID: 25536907 DOI: 10.1016/j.acap.2014.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/16/2014] [Accepted: 11/14/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify which English and Spanish terms Latino parents consider motivating, as well as culturally and linguistically appropriate, for provider use during weight counseling of overweight and obese Latino youth. METHODS Latino parent perceptions of common Spanish and English terms for overweight were discussed with 54 parents in 6 focus groups (3 English, 3 Spanish). Atlas.ti software was used for qualitative analysis. An initial codebook was used to code passages for English and Spanish terminology separately. Subsequent changes to the coded passages and creation of new codes were made by team consensus. RESULTS "Demasiado peso para su salud" (too much weight for his/her health) was the only phrase for excess weight that was consistently identified as motivating and inoffensive by Spanish-speaking parents. "Sobrepeso" (overweight), a commonly used term among health care providers, was motivating to some parents but offensive to others. English-speaking parents had mixed reactions to "unhealthy weight," "weight problem," and "overweight," finding them motivating, confusing, or insulting. Parents found "fat" "gordo" and "obese" "obeso" consistently offensive. Most participants found growth charts and the term "BMI" confusing. Parents consistently reported that providers could enhance motivation and avoid offending families by linking a child's weight to health risks, particularly diabetes. CONCLUSIONS "Demasiado peso para su salud" (too much weight for his/her health) was motivating to many Spanish-speaking Latino parents. Among English-speaking Latino parents, no single English term emerged as motivating, well-understood, and inoffensive. Linking a child's excess weight with increased health risks was motivating and valuable to many parents regardless of language spoken.
Collapse
Affiliation(s)
- Shanna Doucette Knierim
- Ambulatory Care Services, Denver Health, Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | - Alanna Kulchak Rahm
- Geisinger Health System, Danville, Pa; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Matthew Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | | | - Carmen Martin
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Alyssa Yang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Christina Clarke
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Simon J Hambidge
- Ambulatory Care Services, Denver Health, Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Colorado School of Public Health, Aurora, Colo
| |
Collapse
|
35
|
Rodríguez-Ventura AL, Pelaez-Ballestas I, Sámano-Sámano R, Jimenez-Gutierrez C, Aguilar-Salinas C. Barriers to lose weight from the perspective of children with overweight/obesity and their parents: a sociocultural approach. J Obes 2014; 2014:575184. [PMID: 25371816 PMCID: PMC4202246 DOI: 10.1155/2014/575184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/22/2014] [Accepted: 09/15/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION There are not enough studies about the barriers to lose weight from the perspective of children and their parents. METHODS Children and adolescents diagnosed with overweight/obesity in the Department of Endocrinology and their parents were invited to participate in a series of focus group discussions (FGD). Twenty-nine children 10-16 years old and 22 parents participated in 7 focus groups; 2 mothers and 2 adolescents participated in depth interviews. All interviews were recorded, transcribed, and analyzed through grounded theory. RESULTS Parents went to the hospital only when their children presented any obesity complication; for them, overweight was not a health problem. Parents referred to lack of time to supervise about a healthy diet and exercise; besides, the same parents, relatives, friends, and the mass media encourage the consumption of junk food. Children accepted eating a lot, not doing exercise, skipping meals, and not understanding overweight consequences. Both, parents and children, demanded support to do the time recommended for exercise inside the schools. They also suggested getting information from schools and mass media (TV) about overweight consequences, exercise, and healthy food by health workers; they recommended prohibiting announcements about junk food and its sale. CONCLUSIONS The barriers detected were lack of perception of being overweight, its identification as a disease and its consequences, lack of time to supervise a healthy lifestyle, and a big social influence to eat junk food.
Collapse
Affiliation(s)
- Ana Lilia Rodríguez-Ventura
- Departamento de Investigación en Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Piso 2, Torre de Investigación, Montes Urales 800, Colonia Lomas de Virreyes, 11000 Miguel Hidalgo, Mexico City, DF, Mexico
- Departamento de Endocrinología, Hospital Infantil de México Federico Gómez, Mexico City, DF, Mexico
| | - Ingris Pelaez-Ballestas
- Departamento de Reumatología, Antropología, Médica Hospital General de México, Mexico City, DF, Mexico
| | - Reyna Sámano-Sámano
- Departamento de Investigación en Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Piso 2, Torre de Investigación, Montes Urales 800, Colonia Lomas de Virreyes, 11000 Miguel Hidalgo, Mexico City, DF, Mexico
| | - Carlos Jimenez-Gutierrez
- Departamento de Investigación en Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Piso 2, Torre de Investigación, Montes Urales 800, Colonia Lomas de Virreyes, 11000 Miguel Hidalgo, Mexico City, DF, Mexico
| | - Carlos Aguilar-Salinas
- Departamento de Endocrinología, Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Mexico City, DF, Mexico
| |
Collapse
|
36
|
Lupi JL, Haddad MB, Gazmararian JA, Rask KJ. Parental perceptions of family and pediatrician roles in childhood weight management. J Pediatr 2014; 165:99-103.e2. [PMID: 24721470 DOI: 10.1016/j.jpeds.2014.02.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/15/2014] [Accepted: 02/19/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterize parental perceptions of the respective roles of families and the pediatrician in childhood weight management. STUDY DESIGN Structured in-person interviews (n = 69) were conducted with parents of children ages 3-12 years visiting a pediatric clinic. Interview topics included perceptions of weight and associated problems, child weight status and concerns, and the pediatrician's role in weight management. Interviews were coded qualitatively and analyzed thematically. RESULTS Nine major themes were developed from the findings. Parents were clear about the health consequences of excess weight but were not clear about the concept of body mass index, often relying on visual cues or symptoms to identify excess weight. Parents relied on pediatricians to identify weight problems and suggest diet and exercise plans, but few recognized them as a link to additional weight-management resources. Parents were divided on the role of the pediatrician in managing child weight and were most interested in receiving tailored nutrition information. Parents preferred family behavioral change strategies over singling out an overweight child. Although parents did not always define their child as overweight, many parents of overweight children did express concerns about their child's weight. CONCLUSIONS Parents believe that pediatricians have a central role in identifying childhood weight problems by completing screening tests such as body mass index assessments, interpreting the health implications, and communicating those implications to parents. Ensuring that parents understand the health implications of excess weight is critical given gaps in parental knowledge and confidence with healthy lifestyle changes as well as parental ambivalence toward child-directed interventions.
Collapse
Affiliation(s)
- Jenna L Lupi
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA
| | - Maryam B Haddad
- Laney Graduate School, Emory University, Atlanta, GA; Department of Epidemiology, Emory University, Atlanta, GA
| | | | - Kimberly J Rask
- Department of Health Policy and Management, Emory University, Atlanta, GA.
| |
Collapse
|
37
|
Carson V, Tremblay MS, Spence JC, Timmons BW, Janssen I. The Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and screen time among children from Kingston, Ontario. Paediatr Child Health 2014; 18:25-8. [PMID: 24381488 DOI: 10.1093/pch/18.1.25] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the proportion of children meeting the new Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and to describe parental attitudes toward and barriers to reducing screen time. METHODS Participants included 657 children zero to four years of age from the Kingston, Ontario, area. From May to September 2011, parents completed a questionnaire regarding their child's screen time and their attitudes toward and barriers to reducing their child's screen time. RESULTS AND CONCLUSIONS Approximately 32% of children younger than two years of age engaged in no screen time and approximately 46% of children two to four years of age engaged in <1 h per day; thereby, meeting the recommendations of the new guidelines. Most parents believed that their child did not engage in excessive screen time. Physicians and other health professionals should inform parents of these new guidelines and provide strategies to help their children meet targets.
Collapse
Affiliation(s)
- Valerie Carson
- School of Kinesiology and Health Studies, Queen's University, Kingston
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, University of Ottawa, Ottawa, Ontario; ; Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - John C Spence
- Sedentary Living Lab, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta
| | - Brian W Timmons
- Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston; ; Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario
| |
Collapse
|
38
|
He L, Zhai Y, Engelgau M, Li W, Qian H, Si X, Gao X, Sereny M, Liang J, Zhu X, Shi X. Association of children's eating behaviors with parental education, and teachers' health awareness, attitudes and behaviors: a national school-based survey in China. Eur J Public Health 2013; 24:880-7. [PMID: 24287031 DOI: 10.1093/eurpub/ckt177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In China, childhood obesity is a growing health issue. Eating behaviors among children can be influenced by both the family and school environment. We examine the association between these environments and eating habits among children. METHODS A total of 11 270 fourth to sixth grade school children, 11 270 of their fathers or mothers, and 1348 teachers from 48 schools were sampled using a multistage cluster random sampling method. Questionnaires collected information on eating behaviors among children, non-communicable chronic disease (NCD)-related health knowledge and behaviors among teachers, and education levels among parents. Mixed effect logistic regression models were used to describe the key associations between eating behaviors among children and teacher and parental characteristics. RESULTS Health awareness, positive health attitudes, never-smoking and regular-exercise among teachers was positively associated with healthy eating behaviors among their students (having breakfast, vegetables and dairy products every day; P < 0.05), and negatively associated with the unhealthy behaviors (daily intake of fried foods and desserts and sugary beverages; P < 0.05). More than one parent having a high school level or above was positively related to healthy eating behaviors among their children (P < 0.05), but its associations with high-calorie eating habits were negative in urban and positive in rural areas (P < 0.05). CONCLUSIONS School-based interventions which target health-related awareness, attitude and behaviors among school teachers may help improve school-aged children's eating behaviors. Parental education levels may help guide efforts to target children at higher risk of unhealthy eating habits.
Collapse
Affiliation(s)
- Liu He
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yi Zhai
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | | | - Weirong Li
- 3 Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hanzhu Qian
- 4 Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Xiang Si
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xin Gao
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Melanie Sereny
- 5 Department of Sociology, Duke University, Durham, NC, USA
| | - Jing Liang
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaolei Zhu
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaoming Shi
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| |
Collapse
|
39
|
Batal M, Makvandi E, Imbeault P, Gagnon-Arpin I, Grenier J, Chomienne MH, Bouchard L. Comparison of dietary intake between Francophones and Anglophones in Canada: data from CCHS 2.2. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2013; 104:S31-8. [PMID: 24300318 PMCID: PMC6973893 DOI: 10.17269/cjph.104.3501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 06/12/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the dietary intake and food choices between Francophone Canadians in a state of linguistic minority (outside of Quebec) and the English-speaking majority. METHODS We used the 2004 Canadian Community Health Survey (CCHS) cycle 2.2 (general health and 24-hour dietary recalls) to describe dietary intake of Francophone Canadians (excluding Quebec) and compare them to the English-speaking majority. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. The mean differences in daily nutrient and food intake were assessed by t and chi-square tests. RESULTS Differences in total energy and daily food intakes by language groups were not observed in the sample; however, significant differences in weekly consumption were found in different age and sex categories: lower fruits and vegetables consumption, and vitamins and macronutrients intakes for older Francophone men and higher intakes of energy and saturated fat from "unhealthy" foods for Francophone men 19-30 years of age. Based on the Acceptable Macronutrients Distribution Range (AMDR), approximately 50% of the sample exceeded their acceptable energy intake from saturated fats, and 80% were below their required intake of linoleic fatty acid. CONCLUSION We confirmed that belonging to Francophone minorities in Canada affects food choices and nutritional well-being of this population. The most vulnerable groups identified by our study were Francophone men in the youngest (19-30) and older (50 and over) age categories. The extent to which the cultural setting influences the diet and, in turn, the health of the minority population needs further examination.
Collapse
Affiliation(s)
- Malek Batal
- University of Ottawa Réseau de recherche appliquée sur la santé des francophones de l'Ontario (RRASFO).
| | | | | | | | | | | | | |
Collapse
|
40
|
Lachal J, Orri M, Speranza M, Falissard B, Lefevre H, Moro MR, Revah-Levy A. Qualitative studies among obese children and adolescents: a systematic review of the literature. Obes Rev 2013; 14:351-68. [PMID: 23210485 DOI: 10.1111/obr.12010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/04/2012] [Accepted: 11/04/2012] [Indexed: 01/24/2023]
Abstract
Childhood obesity is a complex condition involving medical, social, moral and cultural issues. Qualitative approaches are of great value in understanding this complexity. This meta-synthesis of 45 qualitative studies deals specifically with the issue of obesity in children and adolescents from different perspectives--those of obese children and adolescents, of parents, and of health professionals providing support to the family. Our aim was to obtain a coherent view of child and adolescent obesity, focused on clinical and personal experience. The themes derived from the synthesis process fall under three main axes: 'Seeing others, seeing oneself', 'Understanding others, understanding oneself', and 'Treating others, treating oneself'. It emerges that participants in all three groups had equal difficulty in perceiving and labelling obesity, mainly because of their lack of any real common ground. The insufficiency of shared representations destabilizes the therapeutic relationship and its construction: an important issue in the doctor-child-parent relationship in this context is the need to exchange their viewpoints of obesity. Health workers may also expand their understanding of obesity by incorporating the personal experiences of obese children and their parents in order to match treatment plans to their needs and expectations.
Collapse
Affiliation(s)
- J Lachal
- INSERM, U-669 PSIGIAM, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Vine M, Hargreaves MB, Briefel RR, Orfield C. Expanding the role of primary care in the prevention and treatment of childhood obesity: a review of clinic- and community-based recommendations and interventions. J Obes 2013; 2013:172035. [PMID: 23710345 PMCID: PMC3655557 DOI: 10.1155/2013/172035] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/20/2013] [Indexed: 12/24/2022] Open
Abstract
Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.
Collapse
Affiliation(s)
- Michaela Vine
- Mathematica Policy Research, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA.
| | | | | | | |
Collapse
|
42
|
Abstract
In addition to counselling families about regular physical activity and healthy nutrition, clinicians need to identify and help them to address the psychosocial factors that may be contributing to their child's or adolescent's obesity. Affected individuals may suffer from depression, low self-esteem, bullying, and weight bias, experiences that can make achieving desired health outcomes more difficult. Clinicians should try to identify these underlying stressors and ensure that appropriate counselling is implemented.
Collapse
|
43
|
Gerards SMPL, Hummel K, Dagnelie PC, de Vries NK, Kremers SPJ. Parental self-efficacy in childhood overweight: validation of the Lifestyle Behavior Checklist in the Netherlands. Int J Behav Nutr Phys Act 2013; 10:7. [PMID: 23331330 PMCID: PMC3626773 DOI: 10.1186/1479-5868-10-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Evaluating whether parental challenges and self-efficacy toward managing children’s lifestyle behaviors are successfully addressed by interventions requires valid instruments. The Lifestyle Behavior Checklist (LBC) has recently been developed in the Australian context. It consists of two subscales: the Problem scale, which measures parental perceptions of children’s behavioral problems related to overweight and obesity, and the Confidence scale, measuring parental self-efficacy in dealing with these problems. The aim of the current study was to systematically translate the questionnaire into Dutch and to evaluate its internal consistency, construct validity and test-retest reliability. Methods The LBC was systematically translated by four experts at Maastricht University. In total, 392 parents of 3-to13-year-old children were invited to fill out two successive online questionnaires with a two-week interval. Of these, 273 parents responded to the first questionnaire (test, response rate = 69.6%), and of the 202 who could be invited for the second questionnaire (retest), 100 responded (response rate = 49.5%). We assessed the questionnaire’s internal consistency (Cronbach’s α), construct validity (Spearman’s Rho correlation tests, using the criterion measures: restrictiveness, nurturance, and psychological control), and test-retest reliability (Spearman’s Rho correlation tests). Results Both scales had high internal consistency (Cronbach’s α ≥ 0.90). Spearman correlation coefficients indicated acceptable test-retest reliability for both the Problem scale (rs = 0.74) and the Confidence scale (rs = 0.70). The LBC Problem scale was significantly correlated to all criterion scales (nurturance, restrictiveness, psychological control) in the hypothesized direction, and the LBC Confidence scale was significantly correlated with nurturance and psychological control in the hypothesized direction, but not with restrictiveness. Conclusions The Dutch translation of the LBC was found to be a reliable and reasonably valid questionnaire to measure parental perceptions of children’s weight-related problem behavior and the extent to which parents feel confident to manage these problems.
Collapse
Affiliation(s)
- Sanne M P L Gerards
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
| | | | | | | | | |
Collapse
|
44
|
Hernandez RG, Thompson DA, Cheng TL, Serwint JR. Early-childhood obesity: how do low-income parents of preschoolers rank known risk factors? Clin Pediatr (Phila) 2012; 51:663-70. [PMID: 22496175 DOI: 10.1177/0009922812440841] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine parental rankings of known factors related to early-childhood obesity and compare reports between parents of healthy weight and overweight children. METHODS Parents of 2- to 5-year-old children seeking well-child care ranked card-sort statements including risks, barriers, and motivating factors for achieving a healthy weight child. Frequencies and means of ranked factors are reported and compared. RESULTS Of the 150 participants, few parents (7.4%) considered low levels of physical activity a top risk factor compared with other known risks. Inability to control the food choices of alternate caregivers was the greatest perceived barrier to achieving a healthy child weight (34%). There were no differences in rankings by child weight groups. CONCLUSION Low-income parents of preschoolers are aware of high-risk feeding behaviors, but few recognize the risk of inactivity in their young child. Innovations that promote adequate physical activity and engage influential caregivers during counseling are necessary.
Collapse
Affiliation(s)
- Raquel G Hernandez
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | | |
Collapse
|
45
|
Boylan S, Louie JCY, Gill TP. Consumer response to healthy eating, physical activity and weight-related recommendations: a systematic review. Obes Rev 2012; 13:606-17. [PMID: 22404752 DOI: 10.1111/j.1467-789x.2012.00989.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Strong evidence linking poor diet and lack of physical activity to risk of obesity and related chronic disease has supported the development and promotion of guidelines to improve population health. Still, obesity continues to escalate as a major health concern, and so the impact of weight-related guidelines on behaviour is unclear. The aim of this review was to examine consumer response to weight-related guidelines. A systematic literature search was performed using Medline, PsycInfo, ProQuest Central and additional searches using Google and reference lists. Of the 1,765 articles identified, 46 relevant titles were included. Most studies examined attitudes towards content, source, tailoring and comprehension of dietary guidelines. Many respondents reported that guidelines were confusing, and that simple, clear, specific, realistic, and in some cases, tailored guidelines are required. Recognition of guidelines did not signify understanding nor did perceived credibility of a source guarantee utilization of guidelines. There was a lack of studies assessing: the impact of guidelines on behaviour; responses to physical activity guidelines; responses among males and studies undertaken in developing countries. Further research is needed, in particular regarding responses to physical activity guidelines and guidelines in different populations. Communication professionals should assist health professionals in the development of accurate and effective weight-related guidelines.
Collapse
Affiliation(s)
- S Boylan
- Cluster for Public Health Nutrition, Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, New South Wales, Australia.
| | | | | |
Collapse
|
46
|
Warschburger P, Kröller K. "Childhood overweight and obesity: maternal perceptions of the time for engaging in child weight management". BMC Public Health 2012; 12:295. [PMID: 22520114 PMCID: PMC3488478 DOI: 10.1186/1471-2458-12-295] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 04/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing awareness of the impact of parental risk perception on the weight course of the child and the parent's readiness to engage in preventive efforts, but only less is known about factors related to the parental perception of the right time for the implementation of preventive activities. The aim of this study was to examine parental perceptions of the appropriate time to engage in child weight management strategies, and the factors associated with different weight points at which mothers recognize the need for preventive actions. METHODS 352 mothers with children aged 2-10 years took part in the study. We assessed mothers' perceptions of the actual and preferred weight status of their child, their ability to identify overweight and knowledge of its associated health risks, as well as perceptions of the right time for action to prevent overweight in their child. A regression analysis was conducted to examine whether demographic and weight related factors as well as the maternal general risk perception were associated with recognizing the need to implement prevention strategies. RESULTS Although most of the parents considered a BMI in the 75th to 90th percentile a valid reason to engage in the prevention of overweight, 19% of the mothers were not willing to engage in prevention until their child reached the 97th percentile. Whereas the child's sex and the identification of an elevated BMI were significant predictors for parents' recognition of the 75th percentile as right point to engage in prevention efforts, an inability to recognize physical health risks associated with overweight silhouettes emerged as a significant factor predicting which parents would delay prevention efforts until a child's BMI reached the 97th percentile. CONCLUSION Parental misperceptions of overweight and associated health risks constitute unfavorable conditions for preventive actions. Feedback on the health risks associated with overweight could help increase maternal readiness for change.
Collapse
Affiliation(s)
- Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Str, 24/25, 14476, Potsdam, Germany.
| | | |
Collapse
|
47
|
Nieman P, LeBlanc CMA. Les aspects psychosociaux de l’obésité chez les enfants et les adolescents. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.4.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Kuhl ES, Clifford LM, Stark LJ. Obesity in preschoolers: behavioral correlates and directions for treatment. Obesity (Silver Spring) 2012; 20:3-29. [PMID: 21760634 DOI: 10.1038/oby.2011.201] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.
Collapse
Affiliation(s)
- Elizabeth S Kuhl
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | | | | |
Collapse
|
49
|
Perrin EM, Skinner AC, Steiner MJ. Parental recall of doctor communication of weight status: national trends from 1999 through 2008. ACTA ACUST UNITED AC 2011; 166:317-22. [PMID: 22147758 DOI: 10.1001/archpediatrics.2011.1135] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine time trends in parental reports of health professional notification of childhood overweight over the last decade and to determine the characteristics most associated with such notification. DESIGN Secondary data analysis using χ(2) tests to examine the relationships between multiple factors on the reports of parents and/or caregivers (hereinafter "parents") and logistic regression for multivariate analysis. SETTING National Health and Nutrition Examination Survey, 1999 through 2008. PARTICIPANTS Parents of 4985 children aged 2 to 15 years with body mass index (BMI) in the 85th percentile or higher based on measured height and weight. MAIN OUTCOME MEASURES Affirmative answer to the following question: "Has a doctor or health professional ever told you that your child is overweight?" RESULTS During 1999 through 2008, 22% of parents of children with BMIs in the 85th percentile or higher reported having been told by a doctor or health professional that their child was overweight; recall of notification was actually more likely among nonwhite and poor children. This percentage increased from 19.4% to 23.2% from the 1999-2004 period and further accelerated in the 2007-2008 period to 29.1%. The time trend persisted in multivariate analyses, with significantly more parents reporting having been told in 2007 through 2008 than in 1999 through 2000. CONCLUSION Fewer than one-quarter of parents of overweight children report having been told that their child was overweight. While reports of notification have increased over the last decade (perhaps because of [1] revised definitions of overweight and obesity, [2] increased concern about children with BMIs in the 85th to 95th sex- and age-specific percentiles, or [3] improved recall by parents), further research is necessary to determine where and why communication of weight status breaks down.
Collapse
Affiliation(s)
- Eliana M Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 231 MacNider Hall, Chapel Hill, NC 27599-7225, USA.
| | | | | |
Collapse
|
50
|
Puhl RM, Peterson JL, Luedicke J. Parental perceptions of weight terminology that providers use with youth. Pediatrics 2011; 128:e786-93. [PMID: 21949145 DOI: 10.1542/peds.2010-3841] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Little research has been performed to examine patient perceptions of weight-related language, especially related to childhood obesity. In this study we assessed parental perceptions of weight-based terminology used by health care providers to describe a child's excess weight and assessed perceived connotations associated with these terms including stigma, blame, and motivation to reduce weight. METHODS A national sample of American parents with children aged 2 to 18 years (N = 445) completed an online survey to assess their perceptions of 10 common terms to describe excess body weight in youth (including "extremely obese," "high BMI," "weight problem," "unhealthy weight," "weight," "heavy," "obese," "overweight," "chubby," and "fat"). Parents were asked to use a 5-point rating scale to indicate how much they perceived each term to be desirable, stigmatizing, blaming, or motivating to lose weight. RESULTS Regression models revealed that the terms "weight" and "unhealthy weight" were rated as most desirable, and "unhealthy weight" and "weight problem" were rated as the most motivating to lose weight. The terms "fat," "obese," and "extremely obese" were rated as the most undesirable, stigmatizing, blaming, and least motivating. Parents' ratings were consistent across sociodemographic variables, body weight, and child's body weight. CONCLUSIONS The results of this study have important implications for the improvement of health care for youth with obesity; it may be advantageous for health care providers to use or avoid using specific weight-based language during discussions about body weight with families. Pediatricians play a key role in obesity prevention and treatment, but their efforts may be undermined by stigmatizing or offensive language that can hinder important discussions about children's health.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards St, New Haven, CT 06511, USA.
| | | | | |
Collapse
|