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Kerver JM, Brophy-Herb HE, Sturza J, Horodynski MA, Contreras DA, Stein M, Garner E, Hebert S, Williams JM, Kaciroti N, Martoccio T, Van Egeren LA, Choi H, Martin CK, Mitchell K, Dalimonte-Merckling D, Jeanpierre LA, Robinson CA, Lumeng JC. Supporting family meal frequency: Screening Phase results from the Simply Dinner Study. Appetite 2022; 174:106009. [PMID: 35337884 PMCID: PMC9058229 DOI: 10.1016/j.appet.2022.106009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
We aimed to test main, additive, interactive effects, and feasibility of all possible combinations of six intervention components implemented for 8 weeks (Cooking/Serving Resources; Meal Delivery; Ingredient Delivery; Community Kitchen; Nutrition Education; Cooking Demonstrations). Primary outcomes were family meal frequency and preschoolers' dietary quality; secondary outcomes included family meal preparation type, meal preparation barriers, family functioning, and kitchen inventory adequacy. All possible intervention combinations were tested using a randomized factorial trial design in the first phase of a Multiphase Optimization Strategy (MOST). Feasibility was assessed via attendance, delivery logs, and satisfaction. Parent-reported data collection included: socio-demographics, frequency and type of family meals; preschooler dietary intake; perceived barriers to meal planning and preparation; assessment of family functioning; and a kitchen inventory of materials generally needed for meal preparation. Participants (n = 499) were recruited at two Head Start agencies in mid-Michigan with data collection and delivery of some intervention components in participants' homes. Promising intervention bundles were identified by evaluating pre-to post-intervention effect sizes. The combination of Cooking/Serving Resources and Meal Delivery increased family meal frequency (Cohen's d = 0.17), cooking dinner from scratch (d = 0.21), prioritization of family meals (d = 0.23), and kitchen inventory (d = 0.46) and decreased use/consumption of ready-made (d = -0.18) and fast foods (d = -0.23). Effects on diet quality were in the expected direction but effect sizes were negligible. Community Kitchen, Nutrition Education, and Cooking Demonstration showed poor feasibility due to low attendance while Ingredient Delivery was infeasible due to staffing challenges related to its labor intensity. Additionally, although not one of our pre-specified outcomes, Cooking/Serving Resources (RR = 0.74) and Meal Delivery (RR = 0.73) each decreased food insecurity. Cooking/Serving Resources combined with Meal Delivery showed promise as a strategy for increasing family meal frequency.
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Affiliation(s)
- Jean M. Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, East Lansing, MI 48824
| | - Holly E. Brophy-Herb
- Department of Human Development and Family Studies, Michigan State University, 552 W Circle Drive, East Lansing, MI 48824
| | - Julia Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Mildred A. Horodynski
- College of Nursing, Michigan State University, 1355 Bogue St, East Lansing, MI 48824
| | - Dawn A. Contreras
- Michigan State University Extension, Michigan State University, East Lansing, MI 48824
| | - Mara Stein
- Department of Human Development and Family Studies, Michigan State University, 552 W Circle Drive, East Lansing, MI 48824
| | - Erika Garner
- Michigan State University Extension, Michigan State University, East Lansing, MI 48824
| | - Sheilah Hebert
- Michigan State University Extension, Michigan State University, East Lansing, MI 48824
| | - Jessica M. Williams
- Department of Human Development and Family Studies, Michigan State University, 552 W Circle Drive, East Lansing, MI 48824
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Tiffany Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD
| | - Laurie A. Van Egeren
- University Outreach and Engagement, Michigan State University, East Lansing, MI 48824
| | - Hailey Choi
- Department of Human Development and Family Studies, Missouri State University, Springfield, MO
| | - Corby K. Martin
- Pennington Biomedical Research Institution, Louisiana State University, Baton Rouge, LA
| | - Koi Mitchell
- Department of Human Development and Family Studies, Michigan State University, 552 W Circle Drive, East Lansing, MI 48824
| | - Danielle Dalimonte-Merckling
- Department of Human Development and Family Studies, Michigan State University, 552 W Circle Drive, East Lansing, MI 48824
| | | | - Chelsea A. Robinson
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, East Lansing, MI 48824
| | - Julie C. Lumeng
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
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2
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Stern M, Soca Lozano S, Lescano C, Rodriguez C, Redwine L. Developing Adaptando Dieta Y Acción Para Todos (ADAPT): An Intervention to Improve Healthy Lifestyle Behaviors Among Latino Parents and Children Living in Rural Communities. J Immigr Minor Health 2021; 23:88-94. [PMID: 32533505 PMCID: PMC10576241 DOI: 10.1007/s10903-020-01037-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Latino migrant farmworkers are at great risk of obesity and its concomitant negative health impacts. Obesity interventions for this underserved, minority population are limited. We expanded upon our prior intervention work in childhood obesity to develop a multi-family, behavioral intervention, ADAPT. We conducted three phases in the development of the ADAPT program: Phase 1, a needs assessment, Phase 2, in-depth focus groups with Latino parents, their children, and stakeholders, and Phase 3, a feasibility and acceptability trial to inform program optimization. Acceptability and feasibility of ADAPT promoting healthier eating and physical activity behaviors was found. Each phase of the project led to implementation changes to ADAPT, resulting in greater intervention optimization. Participants reported key facilitators and barriers to our intervention, expressing great interest in participation. They particularly liked our mindfulness session. We are currently examining the feasibility of integrating mindfulness to optimize ADAPT efficacy.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, University of South Florida, 13301 Bruce B. Downs Blvd., MHC 2510, Tampa, FL, 33612, USA.
| | | | - Celia Lescano
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | | | - Laura Redwine
- College of Nursing, University of South Florida, Tampa, FL, USA
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3
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Stern M, Gray HL, Ruble K, Soca Lozano S, Albizu-Jacob A, Williams JM, Godder K, Fuemmeler B, Mazzeo S. A cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity: Rationale and study protocol of NOURISH-T. Contemp Clin Trials 2021; 102:106296. [PMID: 33515782 DOI: 10.1016/j.cct.2021.106296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Approximately 40-50% of pediatric cancer survivors (PCS) are overweight or obese; increasing their risk for metabolic syndrome and other negative long-term physical health complications. Using our successful pilot trial testing the preliminary feasibility and efficacy of NOURISH for Healthy Transitions (NOURISH-T), we refined our intervention, now NOURISH-T+, and will implement these refinements in this larger, multi-site randomized control trial. Parents of PCS with overweight/obesity (BMI ≥ 85th%ile), age 5-12, ≥6 months off treatment are randomly assigned to the NOURISH-T+ intervention or Enhanced Usual Care (EUC) comparison. Parents in NOURISH-T+ will participate in a 6-session, manualized intervention, with an additional dietician session and 2 PCS sessions, as well as post-intervention booster sessions. EUC consists of a one-time informational session, nationally available brochures and follow-up check-ins. Both study conditions will be conducted remotely via a videoconferencing platform. Parents and PCS will be assessed on anthropometric measures, physical activity (PA) and dietary behaviors at baseline, 3-, 6-, and 12-months post-intervention. We will enroll a diverse group of 260 parents/PCS dyads from four pediatric oncology clinics with the aim of evaluating the efficacy of our intervention across diverse pediatric oncology clinics. Our main aim is to compare the impact of NOURISH-T+ with EUC on PCS BMI z-score. Secondary aims are to compare intervention impact on PCS PA and eating behaviors and parent BMI and behaviors as well as to explore potential moderators of the intervention. Our longer-term goal is to establish a framework for future translation and dissemination of NOURISH-T+.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America.
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Kathy Ruble
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sandra Soca Lozano
- College of Education, University of South Florida, Tampa, FL, United States of America
| | - Alexandra Albizu-Jacob
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America
| | - Jeffrey M Williams
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America
| | - Kamar Godder
- Nicklaus Children's Hospital, Miami, FL, United States of America
| | - Bernard Fuemmeler
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America
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4
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Stern M, Redwine L, Soca Lozano S, Rancourt D, Rodriguez C, Gray HL, Lock S, Bailey R. Design and rationale for ADAPT+: Optimizing an intervention to promote healthy behaviors in rural, Latino youth with obesity and their parents, using mindfulness strategies. Contemp Clin Trials 2020; 101:106243. [PMID: 33307226 DOI: 10.1016/j.cct.2020.106243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Latino youth living in rural areas represent an ethnic and geographical minority population at increased risk for obesity and obesity-related complications. We previously modified our child obesity intervention to be a multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to better meet the needs of our target population, rural Latino youth with obesity (8-12 years old) and their parents. Recognizing the role of parent stress on obesity, the main goal of this study is to 1) further refine and optimize the original ADAPT multi-family behavioral obesity intervention protocol to include mindfulness parent stress reduction strategies (now called ADAPT+) and then 2) assess the feasibility of ADAPT+ implementation via a small randomized control trial (RCT) with rural Latino families. Two aims guide the study. For Aim 1 we conduct a series of focus groups with stakeholders and parents, and then conduct a one-arm trial with both parents and their children to obtain feedback for further refining each of our eight integrated ADAPT+ sessions. Aim 2 tests the acceptability and feasibility of our intervention with multi-family groups of Latinos in two rural communities over time (pre-intervention, post-intervention, 3-month follow-up) in a randomized pilot trial (ADAPT+ vs. Enhanced Usual Care [EUC] comparison). This study is intended to set the groundwork for a larger clinical trial to test ADAPT+'s efficacy to improve rural Latino families' eating and physical activity behaviors.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America.
| | - Laura Redwine
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America
| | - Sandra Soca Lozano
- College of Education, University of South Florida, Tampa, FL, United States of America
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, FL, United States of America
| | - Carmen Rodriguez
- College of Nursing, University of South Florida, Tampa, FL, United States of America
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Sharen Lock
- New Tampa Yoga, Tampa, FL, United States of America
| | - Rocio Bailey
- Hispanic Services Council, Tampa, FL, United States of America
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5
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Recruitment and retention of families interested in a parent-based pediatric obesity intervention. Contemp Clin Trials Commun 2019; 16:100467. [PMID: 31701041 PMCID: PMC6831663 DOI: 10.1016/j.conctc.2019.100467] [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: 06/15/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 11/27/2022] Open
Abstract
Recruitment and retention in pediatric obesity treatment remains challenging, especially for groups at highest risk of this condition, including African Americans. However, most investigations examine attrition during intervention or follow-up. Little is known about those who refuse enrollment, or drop out at baseline. Thus, the trajectory of recruitment, enrollment, and retention, especially at these early stages, is not well understood, limiting knowledge of treatment access. This study examined enrollment in a pediatric weight management intervention. We provide demographic information on nested consort flow groups. We compared non-overlapping interest/enrollment groups to examine differences between those who progressed to the next consort flow group and those who did not; specifically the four groups examined were: (1) eligible at screening, did not attend baseline (nchildren = 261), (2) attended baseline, did not enroll (nchildren = 46), (3) enrolled, did not complete posttesting (nchildren = 81), and (4) completed posttesting (nchildren = 284). Of enrolled families, >70% were African American; >78% completed posttesting. No differences emerged across groups on sex, ethnicity, or race (ps > .05). Attrition was unrelated to initial child BMI. In this trial, the goal of enrolling diverse parents of children with obesity was achieved, and most enrollees completed treatment.
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Bean MK, Thornton LM, Jeffers AJ, Gow R, Mazzeo SE. Impact of motivational interviewing on engagement in a parent-exclusive paediatric obesity intervention: randomized controlled trial of NOURISH+MI. Pediatr Obes 2019; 14:e12484. [PMID: 30515995 PMCID: PMC6474345 DOI: 10.1111/ijpo.12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Attrition and treatment adherence are notorious challenges in paediatric obesity interventions. OBJECTIVE To evaluate if brief, pretreatment motivational interviewing (MI) can improve retention (at baseline, post-assessment and follow-up assessment) and adherence (i.e. attendance) in a parent-exclusive paediatric obesity intervention. METHODS MI was implemented with parents as an adjunct to a larger randomized controlled trial of Nourishing Our Understanding of Role-modeling to Improve Support and Health (NOURISH+ ), a parent intervention for children with overweight ages 5-11 years. Parents (N = 112) were randomized to receive two MI sessions (one telephone and one in person) or reminder calls. RESULTS Parents (91% women; 52% African American) who completed one telephone MI session were more likely to attend baseline (74%) compared with parents who received reminder calls only (53%, p < .001). After a second MI session, there were no group differences in treatment initiation (p > .05). Treatment attendance, post or 4-month follow-up assessment completion did not differ between conditions (p > .05). CONCLUSION One MI session implemented prior to treatment can improve baseline attendance; a second MI session did not enhance these effects. A single-session telephone-based MI pretreatment might be a cost and time-effective strategy to enhance recruitment efforts. Further strategies to address retention and treatment attendance are needed.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy J. Jeffers
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Rachel Gow
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA,Department of Psychology, Virginia Commonwealth University, Richmond, VA
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Lydecker JA, Riley KE, Grilo CM. Associations of parents' self, child, and other "fat talk" with child eating behaviors and weight. Int J Eat Disord 2018; 51. [PMID: 29542177 PMCID: PMC6002914 DOI: 10.1002/eat.22858] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Fat talk, negative communication about weight, is common in the media, peer groups, and families. Little is known about parental fat talk directed at oneself or others. This study examined associations between different forms of parental fat talk and child disordered eating behaviors and weight, and differences by child sex and age. METHOD Parents of preadolescents or adolescents (n = 581) reported fat talk about themselves (self-fat talk), others (obesity-fat talk), and their child (child-fat talk). RESULTS 76.0% of parents reported regular self-fat talk in front of children, 51.5% reported obesity-fat talk, and 43.6% reported child-fat talk. Fat talk did not differ significantly between parents of preadolescents and adolescents but was more common with sons than daughters. Of the three forms of fat talk, only child-fat talk was associated with all child eating and weight variables (binge eating, overeating, secretive eating, and overweight/obesity); associations were strongest for adolescent girls. Child sex was associated with secretive eating and overweight/obesity. CONCLUSIONS Parents reported using different forms of fat talk frequently. Parent self- and obesity-fat talk were reported more frequently, but child-fat talk was the most strongly associated with children's eating and weight. Because of associations with disordered eating behaviors, intervening to reduce fat talk might contribute to improving pediatric disordered eating and weight-related interventions.
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Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kristen E. Riley
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Amherst College, Amherst, MA, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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8
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Stern M, Bleck J, Ewing LJ, Davila E, Lynn C, Hale G, Mazzeo S. NOURISH-T: Targeting caregivers to improve health behaviors in pediatric cancer survivors with obesity. Pediatr Blood Cancer 2018; 65:e26941. [PMID: 29350459 PMCID: PMC5867222 DOI: 10.1002/pbc.26941] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Obesity rates in pediatric cancer survivors (PCS) are alarmingly high. Although healthy lifestyle changes may prevent future health complications, promoting healthy behaviors in PCS is challenging, and few interventions have successfully addressed this issue. PROCEDURE This randomized control trial evaluated the feasibility and preliminary effectiveness of a parent-focused six-session intervention, NOURISH-T (Nourishing Our Understanding of Role Modeling to Improve Support and Health for Healthy Transitions), compared with enhanced usual care (EUC) on the outcomes of caregiver and PCS anthropometric measurements, eating behaviors, and physical activity. Behavioral and self-report assessments of caregivers and PCS in both conditions were conducted at baseline, postintervention, and at a 4-month follow-up. RESULTS In comparison to no change among EUC caregivers, NOURISH-T caregivers showed small yet significant decreases from baseline through follow-up on BMI, waist-hip ratio, and total daily caloric intake. However, there was no change with regard to daily fat and sugar intake. NOURISH-T caregivers also showed positive changes in their child feeding behaviors, including decreases in pressuring their child to eat and restricting their child's eating and increased eating together as a family. Similarly, decreases in BMI percentile, waist-hip ratio, and sugary beverage consumption were found for NOURISH-T PCS from baseline to postintervention. NOURISH-T PCS also significantly increased their daily steps, whereas EUC PCS decreased their daily steps. CONCLUSIONS Results suggest that an intervention targeting parents is feasible and demonstrates preliminary effectiveness. NOURISH-T showed a longer term effect on caregivers, and, although shorter term effect, a positive impact on the PCS themselves. Implications for ways to improve NOURISH-T as an intervention for increasing healthy behaviors of PCS are discussed.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, University of South Florida, Tampa, FL, United States
| | - Jennifer Bleck
- Department of Child and Family Studies, University of South Florida, Tampa, FL, United States
| | - Linda J. Ewing
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Esther Davila
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - Courtney Lynn
- Department of Educational and Psychological Studies, University of South Florida, Tampa, FL
| | - Gregory Hale
- All Children’s Hospital/Johns Hopkins Medical Center, St. Petersburg, FL, United States
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, United States
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Kwitowski M, Bean MK, Mazzeo SE. An exploration of factors influencing attrition from a pediatric weight management intervention. Obes Res Clin Pract 2016; 11:233-240. [PMID: 27544283 DOI: 10.1016/j.orcp.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 10/19/2022]
Abstract
Pediatric obesity is a public health concern. High attrition from treatment negatively impacts outcomes, particularly among lower income and ethnic minority populations. NOURISH+ is a parent-exclusive childhood weight management treatment targeting at-risk children aged 5-11 years who are overweight or obese. The current study sought to enhance understanding of attrition among at-risk families. NOURISH+ participants completed a survey assessing barriers to treatment adherence. Among low-income, racially diverse families, practical barriers are pressing concerns. The NOURISH+ parent-exclusive approach, although empirically supported, appears inconsistent with caregivers' expectations. Minimizing practical barriers and enhancing child engagement might reduce attrition and improve outcomes.
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Affiliation(s)
- Melissa Kwitowski
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23298-0140, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA; Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23298-0140, USA
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10
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Lydecker JA, Simpson C, Kwitowski M, Gow RW, Stern M, Bulik CM, Mazzeo SE. Evaluation of Parent-Reported Feeding Practices in a Racially Diverse, Treatment-Seeking Child Overweight/Obesity Sample. CHILDRENS HEALTH CARE 2016; 46:265-281. [PMID: 28959085 DOI: 10.1080/02739615.2016.1163489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined psychometric properties and baseline/post-treatment racial differences in the Child Feeding Questionnaire (CFQ) in parents of overweight/obese children in a randomized controlled obesity trial. Participants were 302 (n=285 mothers, n=17 fathers) diverse (n=207 Black, n=80 White), treatment-seeking parents of children (5-11 years) with overweight/obesity. CFQ data fit an established factor structure (Anderson et al, 2005) in the full sample and subsample of Black parents. Black parents had higher scores than White parents on only Pressure to Eat. The CFQ yields reliable and valid scores in a racially diverse treatment-seeking sample, suggesting its utility in culturally-sensitive pediatric obesity treatment.
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Affiliation(s)
- Janet A Lydecker
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Courtney Simpson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa Kwitowski
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachel W Gow
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marilyn Stern
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Cynthia M Bulik
- Departments of Psychiatry and Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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11
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Loveman E, Al‐Khudairy L, Johnson RE, Robertson W, Colquitt JL, Mead EL, Ells LJ, Metzendorf M, Rees K. Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years. Cochrane Database Syst Rev 2015; 2015:CD012008. [PMID: 26690844 PMCID: PMC8761478 DOI: 10.1002/14651858.cd012008] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Child and adolescent overweight and obesity have increased globally, and are associated with short- and long-term health consequences. OBJECTIVES To assess the efficacy of diet, physical activity and behavioural interventions delivered to parents only for the treatment of overweight and obesity in children aged 5 to 11 years. SEARCH METHODS We performed a systematic literature search of databases including the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS as well trial registers. We checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions delivered to parents only for treating overweight or obesity in children aged 5 to 11 years. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE instrument. Where necessary, we contacted authors for additional information. MAIN RESULTS We included 20 RCTs, including 3057 participants. The number of participants ranged per trial between 15 and 645. Follow-up ranged between 24 weeks and two years. Eighteen trials were parallel RCTs and two were cluster RCTs. Twelve RCTs had two comparisons and eight RCTs had three comparisons. The interventions varied widely; the duration, content, delivery and follow-up of the interventions were heterogeneous. The comparators also differed. This review categorised the comparisons into four groups: parent-only versus parent-child, parent-only versus waiting list controls, parent-only versus minimal contact interventions and parent-only versus other parent-only interventions.Trial quality was generally low with a large proportion of trials rated as high risk of bias on individual risk of bias criteria.In trials comparing a parent-only intervention with a parent-child intervention, the body mass index (BMI) z score change showed a mean difference (MD) at the longest follow-up period (10 to 24 months) of -0.04 (95% confidence interval (CI) -0.15 to 0.08); P = 0.56; 267 participants; 3 trials; low quality evidence. In trials comparing a parent-only intervention with a waiting list control, the BMI z score change in favour of the parent-only intervention at the longest follow-up period (10-12 months) had an MD of -0.10 (95% CI -0.19 to -0.01); P = 0.04; 136 participants; 2 trials; low quality evidence. BMI z score change of parent-only interventions when compared with minimal contact control interventions at the longest follow-up period (9 to 12 months) showed an MD of 0.01 (95% CI -0.07 to 0.09); P = 0.81; 165 participants; 1 trial; low quality evidence. There were few similarities between interventions and comparators across the included trials in the parent-only intervention versus other parent-only interventions and we did not pool these data. Generally, these trials did not show substantial differences between their respective parent-only groups on BMI outcomes.Other outcomes such as behavioural measures, parent-child relationships and health-related quality of life were reported inconsistently. Adverse effects of the interventions were generally not reported, two trials stated that there were no serious adverse effects. No trials reported on all-cause mortality, morbidity or socioeconomic effects.All results need to be interpreted cautiously because of their low quality, the heterogeneous interventions and comparators, and the high rates of non-completion. AUTHORS' CONCLUSIONS Parent-only interventions may be an effective treatment option for overweight or obese children aged 5 to 11 years when compared with waiting list controls. Parent-only interventions had similar effects compared with parent-child interventions and compared with those with minimal contact controls. However, the evidence is at present limited; some of the trials had a high risk of bias with loss to follow-up being a particular issue and there was a lack of evidence for several important outcomes. The systematic review has identified 10 ongoing trials that have a parent-only arm, which will contribute to future updates. These trials will improve the robustness of the analyses by type of comparator, and may permit subgroup analysis by intervention component and the setting. Trial reports should provide adequate details about the interventions to be replicated by others. There is a need to conduct and report cost-effectiveness analyses in future trials in order to establish whether parent-only interventions are more cost-effective than parent-child interventions.
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Affiliation(s)
- Emma Loveman
- Effective Evidence LLP7 Bournemouth RoadEastleighHampshireUKSO53 3DA
| | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Rebecca E Johnson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Wendy Robertson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Jill L Colquitt
- Effective Evidence LLP7 Bournemouth RoadEastleighHampshireUKSO53 3DA
| | - Emma L Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
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Jang M, Chao A, Whittemore R. Evaluating Intervention Programs Targeting Parents to Manage Childhood Overweight and Obesity: A Systematic Review Using the RE-AIM Framework. J Pediatr Nurs 2015; 30:877-87. [PMID: 26121964 DOI: 10.1016/j.pedn.2015.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Intervention programs targeting parents to manage childhood overweight and obesity have emerged based on parents influence on the health behaviors of their children. The purpose of this review was to systematically evaluate intervention programs targeting parents to manage childhood overweight and obesity using the Reach, Efficacy, Adopt, Implementation, and Maintenance (RE-AIM) framework. There was a moderate risk of bias across all studies. The overall proportion of studies (n=7) reporting on each dimension of the RE-AIM framework ranged from 78.6% (reach) to 23.8% (maintenance). The majority of intervention programs demonstrated improvement in child BMI. However intervention programs did not reach families of diverse race/ethnicity, were provided by highly trained professionals, and demonstrated high attrition, thus limiting generalizability.
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Affiliation(s)
| | - Ariana Chao
- Yale University School of Nursing, Orange, CT
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13
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Stern M, Ewing L, Davila E, Thompson AL, Hale G, Mazzeo S. Design and rationale for NOURISH-T: a randomized control trial targeting parents of overweight children off cancer treatment. Contemp Clin Trials 2015; 41:227-37. [PMID: 25559916 DOI: 10.1016/j.cct.2014.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/15/2022]
Abstract
Approximately 40% of off-treatment pediatric cancer survivors (PCS) are overweight or obese, which increases their risk for negative long-term physical health complications. Consistent with the Institute of Medicine's (IOM) emphasis on patients transitioning from treatment to cancer survivorship and increasing long-term healthy behaviors in these survivors, we plan to conduct a pilot RCT to address the increasing overweight/obesity rates among PCS by targeting their caregivers as agents for PCS behavior change. We plan to focus on parents' behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in PCS and adapt an evidence-informed, manualized parent intervention - NOURISH - found to be effective for parents of overweight and obese children and adolescents in reducing child and adolescent BMI. We plan to adapt NOURISH for caregivers of 5-12 year old PCS (6 months-4 years off active cancer treatment). Our pilot feasibility RCT - NOURISH-T (Nourishing Our Understanding of Role modeling to Improve Support for Healthy Transitions) evaluates: 1) the preliminary efficacy of NOURISH-T for PCS, compared with an Enhanced Usual Care (EUC) control condition, and 2) factors to consider to improve future adaptations of the intervention. The project will enroll caregivers of PCS at two pediatric oncology clinics into the 6-week intervention (or EUC) with assessments occurring pre- and post-6 weeks of intervention, and at a 4-month follow-up.
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Affiliation(s)
- Marilyn Stern
- Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, United States.
| | - Lin Ewing
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Esther Davila
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | | | - Gregory Hale
- All Children's Hospital/Johns Hopkins Medical Center, St. Petersburg, FL, United States
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, United States
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14
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Mazzeo SE, Kelly NR, Stern M, Gow RW, Cotter EW, Thornton LM, Evans RK, Bulik CM. Parent skills training to enhance weight loss in overweight children: evaluation of NOURISH. Eat Behav 2014; 15:225-9. [PMID: 24854808 PMCID: PMC4672736 DOI: 10.1016/j.eatbeh.2014.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/12/2013] [Accepted: 01/22/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although there is general agreement that parents should be involved in pediatric obesity treatment, few studies have investigated the effectiveness of interventions that target parents exclusively. Moreover, the effectiveness of this approach has not been adequately assessed with racially diverse families, particularly African Americans(AA), a group at high risk for elevated Body Mass Index (BMI). METHODS NOURISH (Nourishing Our Understanding of Role modeling to Improve Support and Health) is a culturally-sensitive parenting intervention targeting overweight (AA) children (ages 6-11; MBMI = 98.0%ile). Families (N = 84; 61% AA, 37% White) were randomly assigned to NOURISH or a control group. RESULTS NOURISH families significantly improved on child BMI from pre- to post-testing after adjustment for random effects, baseline BMI, and child race. NOURISH parents were very satisfied with the intervention and would recommend it to other parents; 91% strongly or moderately agreed that NOURISH helped them eat in a healthier manner. CONCLUSIONS These pilot data suggest that NOURISH is acceptable and, with refinement, offers promise for reducing pediatric BMI. Outcomes, lessons learned, and parent feedback will inform a larger randomized controlled trial.
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Affiliation(s)
- Suzanne E. Mazzeo
- Department of Pediatrics and Psychology, Virginia Commonwealth University, Richmond, VA
| | - Nichole R. Kelly
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Marilyn Stern
- Department of Pediatrics and Psychology, Virginia Commonwealth University, Richmond, VA
| | - Rachel W. Gow
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | | | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Ronald K. Evans
- Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
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15
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Bean MK, Jeffers AJ, Tully CB, Thornton LM, Mazzeo SE. Motivational interviewing with parents of overweight children: study design and methods for the NOURISH + MI study. Contemp Clin Trials 2014; 37:312-21. [PMID: 24530488 PMCID: PMC4025966 DOI: 10.1016/j.cct.2014.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/30/2014] [Accepted: 02/05/2014] [Indexed: 11/24/2022]
Abstract
There is an urgent need for innovative approaches to pediatric obesity treatment. There is also a demand for targeted strategies that reduce attrition and improve treatment adherence. Intervening exclusively with parents of overweight children is a novel approach with demonstrated efficacy in reducing child body mass index (BMI) percentile. Motivational interviewing (MI), a brief communication style for exploring and resolving ambivalence about behavior change, might enhance treatment engagement when implemented as part of obesity interventions. The aim of this report is to provide the rationale and methods for a novel study of MI with parents in the treatment of their children's overweight. We designed and are currently implementing NOURISH+MI, a randomized controlled trial examining the feasibility and efficacy of an adjunct values-based MI intervention, implemented within a culturally-tailored parent intervention for overweight children ages 5-11 years, NOURISH(+) (Nourishing Our Understanding of Role modeling to Improve Support and Health). Specifically, we are randomly assigning 60 parents to this adjunctive treatment, and investigating if adding two MI sessions prior to the NOURISH(+) group intervention will enhance treatment effects. We will be able to compare NOURISH+MI participants with those from the two NOURISH(+) treatment conditions (NOURISH(+) and control). We hypothesize that children whose parents participate in NOURISH+MI will demonstrate lower attrition and greater adherence with NOURISH(+), ultimately leading to greater treatment effects, compared with children whose parents are randomized to NOURISH(+) or a control group. Findings will contribute to the emerging literature examining the efficacy of MI within pediatric obesity interventions.
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Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, United States.
| | - Amy J Jeffers
- Department of Psychology, Virginia Commonwealth University, United States
| | - Carrie B Tully
- Department of Psychology, Virginia Commonwealth University, United States
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, United States
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, United States; Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, United States
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Bean MK, Wilson DB, Thornton LM, Kelly N, Mazzeo SE. Dietary intake in a randomized-controlled pilot of NOURISH: a parent intervention for overweight children. Prev Med 2012; 55:224-7. [PMID: 22735041 PMCID: PMC3787076 DOI: 10.1016/j.ypmed.2012.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/13/2012] [Accepted: 06/16/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE NOURISH is a community-based treatment program for parents of overweight and obese children (ages 6-11, BMI ≥ 85 th percentile). This study examined the impact of Nourishing Our Understanding of Role modeling to Improve Support and Health on child and parent dietary intake, secondary trial outcomes. METHODS In Virginia from 2008 to 2009, this randomized controlled pilot was implemented and dietary assessment of parents and children conducted at baseline, post-test, and 6-month follow-up. Parents (85% female, 62% African American, mean BMI=34.1 ± 9.1) were randomized into intervention (n=46) or control (n=50) groups. Children's (mean age=8.6 ± 1.5) mean Body Mass Index percentile was 98.1 ± 2.6. Parents completed 24-hour dietary records for themselves and their child(ren). Repeated measures analyses assessed treatment effects over time. T-tests evaluated within-group changes from baseline to post-test and to follow-up, using a modified intent-to-treat approach. RESULTS Both groups reported significant dietary changes, with few treatment effects found. For parents in NOURISH, significant improvements were found in intakes of total kilocalories/day, grams/day of carbohydrates and sugar, and percent calories from protein (p<0.05). Among control group children, significant improvements in total kilocalories/day and grams/day of carbohydrates and sugar were found (p<0.05). CONCLUSIONS Among parents who self-select into a childhood obesity program, minimal intervention can elicit short-term dietary changes comparable to those of a structured intervention.
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Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, PO Box 980140, Richmond, VA 23298-0140, USA
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An exploration of body dissatisfaction and perceptions of Black and White girls enrolled in an intervention for overweight children. Body Image 2011; 8:379-84. [PMID: 21700518 PMCID: PMC3170454 DOI: 10.1016/j.bodyim.2011.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/24/2011] [Accepted: 05/08/2011] [Indexed: 11/21/2022]
Abstract
Silhouette measures are one approach to assessing body dissatisfaction in children, although little is known about their use among racially diverse, overweight girls seeking weight-loss treatment. This study assessed racial differences in body dissatisfaction and body size perceptions of 58 girls (ages 6-11, 66% Black, 34% White) participating in a randomized trial for pediatric overweight. Body dissatisfaction did not differ between races; 99% of girls reported an ideal figure smaller than their current one. Black girls selected a larger silhouette to represent their ideal body size, and most girls in both racial groups underestimated their actual size. Outcomes strengthen the argument that, despite an overall preference for a larger body size, obesity might mitigate cultural factors that protect Black girls from body dissatisfaction. Additional research is needed to enhance understanding of children's body size perceptions and dissatisfaction to inform assessment and treatment of pediatric obesity and associated disordered eating symptoms.
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