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Pope KJ, Lightfoot AF, Harrison LM, Getz D, Gittelsohn J, Ward D, Hannon TS, Erinosho T. Listening to the community: identifying obesity prevention strategies for rural preschool-aged children. Front Public Health 2024; 12:1372890. [PMID: 38883193 PMCID: PMC11177876 DOI: 10.3389/fpubh.2024.1372890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Multi-level interventions promoting healthy weight in rural preschool children aged 2-5 years are limited. With the goal of developing a community-informed obesity prevention intervention for rural preschool-aged children, the purpose of this descriptive study was to identify: (1) community settings and intervention strategies to prioritize for an intervention; (2) potential implementation challenges and solutions; and (3) immediate interventions the study team and community partners could collaboratively implement. Workshops occurred in two rural communities in Indiana (2 workshops) and North Carolina (2 workshops), with high obesity rates. A guide was developed to moderate discussions and participants voted to rank community settings and intervention strategies. There were 9-15 participants per workshop, including parents, childcare providers, and representatives of community organizations. Community settings identified as priorities for child obesity prevention included the home, educational settings (preschools), food outlets, recreational facilities, and social media. Priority intervention strategies included providing nutrition and physical activity education, increasing access to healthy foods and physical activity in the built environment, and enhancing food security. Potential intervention implementation challenges centered on poor parental engagement; using personalized invitations and providing transportation support to families were proffered solutions. Immediate interventions to collaboratively implement focused on making playgrounds esthetically pleasing for physical activity using game stencils, and nutrition education for families via quarterly newsletters. This participatory approach with community partners provided insight into two rural communities' needs for child obesity prevention, community assets (settings) to leverage, and potential intervention strategies to prioritize. Findings will guide the development of a multi-level community-based intervention.
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Affiliation(s)
- Katherine Jochim Pope
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, United States
| | - Alexandra F Lightfoot
- Department of Health Behavior, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Deborah Getz
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, United States
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | - Dianne Ward
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara S Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Temitope Erinosho
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, United States
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Kepper M, Walsh-Bailey C, Miller ZM, Zhao M, Zucker K, Gacad A, Herrick C, White NH, Brownson RC, Foraker RE. The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study. JMIR Form Res 2024; 8:e55731. [PMID: 38758581 PMCID: PMC11143394 DOI: 10.2196/55731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. OBJECTIVE The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. METHODS A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. RESULTS PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). CONCLUSIONS Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193.
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Affiliation(s)
- Maura Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Zoe M Miller
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Min Zhao
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States
| | - Kianna Zucker
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Angeline Gacad
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cynthia Herrick
- Division of Endocrinology, Washington University School of Medicine, St. Louis, MO, United States
| | - Neil H White
- Division of Pediatric Endocrinology & Diabetes, Washington University School of Medicine, St. Louis, MO, United States
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States
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Robbins LB, Ling J, Pfeiffer KA, Kerver JM, Resnicow K, McCaffery H, Hilliard A, Hobbs L, Donald S, Kaciroti N. Intervention to increase physical activity and healthy eating among under-represented adolescents: GOAL trial protocol. BMJ Open 2024; 14:e080437. [PMID: 38171630 PMCID: PMC10773393 DOI: 10.1136/bmjopen-2023-080437] [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: 10/01/2023] [Accepted: 10/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION To reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition recommendations is important. To address the problem, a 16-week intervention called Guys/Girls Opt for Activities for Life (GOAL) was designed. The purpose of this randomised controlled trial is to evaluate any effect of the intervention, compared with a control condition, on improving: (1) adolescents' % body fat (primary outcome), moderate-to-vigorous PA (MVPA), diet quality and cardiorespiratory fitness from 0 to 4 months; (2) body mass index (BMI), overweight/obesity percentage and quality of life from 0 to 4 months and to 13 months; and (3) perceived social support, self-efficacy and motivation from 0 to 4 months with evaluation of any mediating effect on adolescent PA and diet quality. An exploratory aim is to evaluate any effect of the intervention, compared with the control, on improving parents'/guardians' home environment, MVPA and diet quality from 0 to 4 months; and BMI from 0 to 4 months and to 13 months. METHODS AND ANALYSIS Adolescents (fifth to eighth grade) in 14 schools located in underserved urban communities are randomly assigned to the intervention or usual school offerings. One parent per adolescent is enrolled (882 dyads total). Cohort 1 includes four schools (2022-2023). Cohorts 2 and 3 include 5 schools in 2023-2024 and 2024-2025, respectively. The 16-week intervention has three components: (1) after-school GOAL club for adolescents to engage in PA and healthy eating/cooking activities; (2) three parent-adolescent meetings to empower parents to assist adolescents; and (3) GOAL social networking website for parents to share how they helped their adolescent. ETHICS AND DISSEMINATION The Michigan State University Biomedical Institutional Review Board provided ethical approval for the study. Findings will be shared via the trial registration database, peer-reviewed publications, conferences and community-oriented strategies. TRIAL REGISTRATION NUMBER NCT04213014.
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Affiliation(s)
- Lorraine B Robbins
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Jiying Ling
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Karin A Pfeiffer
- Department of Kinesiology, College of Education, Michigan State University, East Lansing, Michigan, USA
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kenneth Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Harlan McCaffery
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Aisha Hilliard
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Logan Hobbs
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Sheldon Donald
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Niko Kaciroti
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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French SA, Kunin-Batson AS, Sherwood NE, Berge JM, Shanley R. NET-Works paediatric obesity prevention trial: 66 month outcomes. Pediatr Obes 2023; 18:e13055. [PMID: 37171137 PMCID: PMC10462385 DOI: 10.1111/ijpo.13055] [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: 01/02/2023] [Revised: 03/28/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The NET-Works trial (2012-2018) randomized 534 children ages 2-4 years at baseline and their caregivers to either a 3-year multicomponent obesity prevention intervention or a control group. This research examined treatment effects on body mass index and other outcomes at 66 months. METHODS Parent-child dyads (n = 338) who agreed to participate in a 66 month measurement visit were measured for child BMI, physical activity, diet, and cardiometabolic risk factor variables. RESULTS At 66 months, no significant treatment effects were observed on BMI (Effect = -0.38; 95% CI = -1.13, 0.37). Subgroup results were consistent with the NET-Works 36 month results. Children with overweight at baseline in the intervention group gained significantly less BMI versus children with overweight in the control group (Effect = -1.28; 95% CI = -2.48, -0.07). Among Hispanic children, those in the intervention gained significantly less BMI than those in the control group (Effect = -1.04; 95% CI = -1.97, -0.11). CONCLUSIONS Evidence suggests that early intervention with children at highest risk for obesity, using community-based, multicomponent, multisetting interventions, may be effective in reducing excess weight gain and obesity among certain subgroups of children. The intervention appeared to be effective in slowing BMI gain 66 months after randomization among children who were already overweight at ages 2-4 years and among children of Hispanic ethnicity.
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Affiliation(s)
- Simone A French
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Alicia S Kunin-Batson
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nancy E Sherwood
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ryan Shanley
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis Minnesota
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Sun X, Haydel KF, Matheson D, Desai M, Robinson TN. Are mobile phone ownership and age of acquisition associated with child adjustment? A 5-year prospective study among low-income Latinx children. Child Dev 2023; 94:303-314. [PMID: 36056573 PMCID: PMC9780147 DOI: 10.1111/cdev.13851] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/25/2022]
Abstract
This prospective, longitudinal study examined associations between whether and when children first acquire a mobile phone and their adjustment measures, among low-income Latinx children. Children (N = 263; 55% female; baseline Mage = 9.5) and their parents were assessed annually for 5 years from 2012. Children first acquired a mobile phone at a mean (SD) age of 11.62 (1.41) years. Pre-registered multilevel models tested associations linking phone ownership, phone acquisition age, and the interaction between ownership and acquisition age to levels and changing trends of depressive symptoms, school grades, and reported and objectively assessed sleep. Results showed no statistically significant associations, controlling the False Discovery Rate. Findings suggest an absence of meaningful links from mobile phone ownership and acquisition age to child adjustment.
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Dietary patterns and associations with BMI in low-income, ethnic minority youth in the USA according to baseline data from four randomised controlled trials. Br J Nutr 2021; 126:81-91. [PMID: 32993818 DOI: 10.1017/s0007114520003852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Few studies have derived data-driven dietary patterns in youth in the USA. This study examined data-driven dietary patterns and their associations with BMI measures in predominantly low-income, racial/ethnic minority US youth. Data were from baseline assessments of the four Childhood Obesity Prevention and Treatment Research (COPTR) Consortium trials: NET-Works (534 2-4-year-olds), GROW (610 3-5-year-olds), GOALS (241 7-11-year-olds) and IMPACT (360 10-13-year-olds). Weight and height were measured. Children/adult proxies completed three 24-h dietary recalls. Dietary patterns were derived for each site from twenty-four food/beverage groups using k-means cluster analysis. Multivariable linear regression models examined associations of dietary patterns with BMI and percentage of the 95th BMI percentile. Healthy (produce and whole grains) and Unhealthy (fried food, savoury snacks and desserts) patterns were found in NET-Works and GROW. GROW additionally had a dairy- and sugar-sweetened beverage-based pattern. GOALS had a similar Healthy pattern and a pattern resembling a traditional Mexican diet. Associations between dietary patterns and BMI were only observed in IMPACT. In IMPACT, youth in the Sandwich (cold cuts, refined grains, cheese and miscellaneous) compared with Mixed (whole grains and desserts) cluster had significantly higher BMI (β = 0·99 (95 % CI 0·01, 1·97)) and percentage of the 95th BMI percentile (β = 4·17 (95 % CI 0·11, 8·24)). Healthy and Unhealthy patterns were the most common dietary patterns in COPTR youth, but diets may differ according to age, race/ethnicity or geographic location. Public health messages focused on healthy dietary substitutions may help youth mimic a dietary pattern associated with lower BMI.
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Robinson TN, Matheson D, Wilson DM, Weintraub DL, Banda JA, McClain A, Sanders LM, Haskell WL, Haydel KF, Kapphahn KI, Pratt C, Truesdale KP, Stevens J, Desai M. A community-based, multi-level, multi-setting, multi-component intervention to reduce weight gain among low socioeconomic status Latinx children with overweight or obesity: The Stanford GOALS randomised controlled trial. Lancet Diabetes Endocrinol 2021; 9:336-349. [PMID: 33933181 PMCID: PMC8241238 DOI: 10.1016/s2213-8587(21)00084-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/28/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity. METHODS We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836. FINDINGS Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 9·5 (SD 1·4) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -0·25 [95% CI -0·90 to 0·40] kg/m2; Cohen's d=0.10; p=0·45). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-0·73 [-1·07 to -0·39] kg/m2, d=0.55); the same was true over 2 years (-0·63 [-1·13 to -0·14] kg/m2; d =0.33). No differential adverse events were observed. INTERPRETATION The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities. FUNDING US National Institutes of Health.
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Affiliation(s)
- Thomas N Robinson
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, CA, USA; Division of General Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA; Prevention Research Center, Stanford University, Stanford, CA, USA; Department of Medicine, Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
| | - Donna Matheson
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, CA, USA; Division of General Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Darrell M Wilson
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Dana L Weintraub
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, CA, USA; Division of General Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Jorge A Banda
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | | | - Lee M Sanders
- Division of General Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - K Farish Haydel
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, CA, USA; Division of General Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MA, USA
| | | | - June Stevens
- Department of Nutrition, University of Carolina, Chapel Hill, NC, USA; Department of Epidemiology, University of Carolina, Chapel Hill, NC, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA; Department of Medicine, Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
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Robinson TN. Using Metrics of Kilograms (or Pounds) Overweight or Kilograms (or Pounds) Obese to Help Interpret and Communicate Magnitudes of Excess Body Mass Index. JAMA Pediatr 2021; 175:410-412. [PMID: 33346794 PMCID: PMC7754076 DOI: 10.1001/jamapediatrics.2020.5196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses weight data from a cohort of children aged 7 to 11 years to assess a new method of communicating about body mass index, overweight, and obesity with patients and their families.
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Affiliation(s)
- Thomas N. Robinson
- Stanford Solutions Science Lab, Division of General Pediatrics, Department of Pediatrics, Stanford University, Stanford, California,Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California,Department of Epidemiology and Population Health, Stanford University, Stanford, California,Center for Healthy Weight, Stanford University and the Lucile Packard Children’s Hospital Stanford, Stanford, California
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Manousaki D, Barnett TA, Mathieu ME, Maximova K, Simoneau G, Harnois-Leblanc S, Benedetti A, McGrath JJ, Henderson M. Tune out and turn in: the influence of television viewing and sleep on lipid profiles in children. Int J Obes (Lond) 2020; 44:1173-1184. [PMID: 32203106 DOI: 10.1038/s41366-020-0527-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Physical activity is beneficial to lipid profiles; however, the association between sedentary behavior and sleep and pediatric dyslipidemia remains unclear. We aimed to investigate whether sedentary behavior or sleep predicted lipid profiles in children over a 2-year period. SUBJECTS/METHODS Six hundered and thirty children from the QUALITY cohort, with at least one obese parent, were assessed prospectively at ages 8-10 and 10-12 years. Measures of sedentary behavior included self-reported TV viewing and computer/video game use. Seven-day accelerometry was used to derive sedentary behavior and sleep duration. Adiposity was assessed using DEXA scans. Twenty-four-hour dietary recalls yielded estimates of carbohydrate and fat intake. Outcomes included fasting total cholesterol, triglycerides, HDL and LDL-cholesterol. Multivariable models were adjusted for adiposity and diet. RESULTS At both Visit 1 (median age 9.6 year) and Visit 2 (median age 11.6 year), children were of normal weight (55%), overweight (22%), or obese (22%). Every additional hour of TV viewing at Visit 1 was associated with a 7.0% triglyceride increase (95% CI: 3.5, 10.6; P < 0.01) and 2.6% HDL decrease (95% CI: -4.2, -0.9; P < 0.01) at Visit 2; findings remained significant after adjusting for adiposity and diet. Every additional hour of sleep at Visit 1 predicted a 4.8% LDL decrease (95% CI: -9.0, -0.5; P = 0.03) at Visit 2, after adjusting for fat intake; this association became nonsignificant once controlling for adiposity. CONCLUSIONS Longer screen time during childhood appears to deteriorate lipid profiles in early adolescence, even after accounting for other major lifestyle habits. There is preliminary evidence of a deleterious effect of shorter sleep duration, which should be considered in further studies.
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Affiliation(s)
- Despoina Manousaki
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada.,Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Tracie A Barnett
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada.,Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Laval, QC, Canada
| | - Marie-Eve Mathieu
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada.,Department of Kinesiology, University of Montreal, Montreal, QC, Canada
| | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Gabrielle Simoneau
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Soren Harnois-Leblanc
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, Respiratory epidemiology and clinical research unit, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Jennifer J McGrath
- PERFORM Centre & Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Mélanie Henderson
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada. .,Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
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Ram N, Yang X, Cho MJ, Brinberg M, Muirhead F, Reeves B, Robinson TN. Screenomics: A New Approach for Observing and Studying Individuals' Digital Lives. JOURNAL OF ADOLESCENT RESEARCH 2020; 35:16-50. [PMID: 32161431 PMCID: PMC7065687 DOI: 10.1177/0743558419883362] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS This study describes when and how adolescents engage with their fast-moving and dynamic digital environment as they go about their daily lives. We illustrate a new approach - screenomics - for capturing, visualizing, and analyzing screenomes, the record of individuals' day-to-day digital experiences. SAMPLE Over 500,000 smartphone screenshots provided by four Latino/Hispanic youth, age 14-15 years, from low-income, racial/ethnic minority neighborhoods. METHOD Screenomes collected from smartphones for one to three months, as sequences of smartphone screenshots obtained every five seconds that the device is activated, are analyzed using computational machinery for processing images and text, machine learning algorithms, human-labeling, and qualitative inquiry. FINDINGS Adolescents' digital lives differ substantially across persons, days, hours, and minutes. Screenomes highlight the extent of switching among multiple applications, and how each adolescent is exposed to different content at different times for different durations - with apps, food-related content, and sentiment as illustrative examples. IMPLICATIONS We propose that the screenome provides the fine granularity of data needed to study individuals' digital lives, for testing existing theories about media use, and for generation of new theory about the interplay between digital media and development.
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Affiliation(s)
- Nilam Ram
- Pennsylvania State University, University Park, PA, USA
| | - Xiao Yang
- Pennsylvania State University, University Park, PA, USA
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Truesdale KP, Matheson DM, JaKa MM, McAleer S, Sommer EC, Pratt CA. Baseline diet quality of predominantly minority children and adolescents from households characterized by low socioeconomic status in the Childhood Obesity Prevention and Treatment Research (COPTR) Consortium. BMC Nutr 2019; 5:38. [PMID: 32153951 PMCID: PMC7050800 DOI: 10.1186/s40795-019-0302-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Healthy Eating Index (HEI-2010) is a measure of diet quality that examines conformance with the Dietary Guidelines for Americans. The objectives of this study were to estimate baseline diet quality of predominantly low-income minority children using the HEI-2010 and to identify the most important HEI components to target for dietary intervention. Methods Two or three baseline 24 h dietary recalls were collected in-person or over telephone between May 2012 and June 2014 from 1,745 children and adolescents from four randomized clinical trials in the Childhood Obesity Prevention and Treatment Research (COPTR) Consortium. Nine adequacy and three moderation food components were calculated and averaged to determine overall HEI scores. The overall HEI-2010 scores were categorized as ≥81, 51–80, or ≤ 50 based on the HEI-2005 classification. For each study, mean overall and component HEI scores were estimated using linear regression models. Results Mean (95% CI) overall HEI scores ranged from 47.9 (46.8, 49.0) to 64.5 (63.6, 65.4). Only 0.3 to 8.1% of children and adolescents had HEI-2010 score ≥ 81. The average component score for green and beans was less than 30% of maximum score for all trials. In contrast, the average component score for protein, dairy (except for IMPACT), and empty calories (except forIMPACT) was more than 80% of maximum score. Conclusions Based on HEI-2010 scores, few children and adolescents consumed high quality diets. Dietary interventions for children and adolescents should focus on improving intakes of green vegetables and beans. Clinical trial registry numbers GROW study (clinical trial # NCT01316653); NET-Works study (clinical trial #NCT01606891); Stanford Goals (clinical trial #NCT01642836); IMPACT (clinical trial # NCT01514279).
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Affiliation(s)
- Kimberly P Truesdale
- 1Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Donna M Matheson
- 2Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA USA
| | - Meghan M JaKa
- 3Health Partners Institute for Education and Research, Minneapolis, MN USA
| | - Sarah McAleer
- 4The Center for Child Health and Policy, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH USA
| | - Evan C Sommer
- 5Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Charlotte A Pratt
- 6Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institute of Health, Bethesda, MD USA
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Beets MW, Brazendale K, Weaver RG, Armstrong B. Rethinking Behavioral Approaches to Compliment Biological Advances to Understand the Etiology, Prevention, and Treatment of Childhood Obesity. Child Obes 2019; 15:353-358. [PMID: 31140855 DOI: 10.1089/chi.2019.0109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Keith Brazendale
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Bridget Armstrong
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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A Community Bundle to Lower School-Aged Obesity Rates in a Small Midwestern City. REPORTS 2019. [DOI: 10.3390/reports2030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Multi-component interventions in large communities such as Philadelphia can effectively lower childhood obesity rates. It is less clear whether this type of intervention can be successful in smaller communities with more limited resources. Norwood, Ohio is a small Midwestern city with a population of 19,207. In 2010, Ohio passed a school health law requiring Body Mass Index (BMI) screening of students in kindergarten and grades 3, 5 and 9 along with restrictions on competitive foods and vending machine products and a physical education requirement of 30 min per day. In 2014, Norwood implemented a multi-component childhood obesity prevention and treatment bundle of interventions. Our objective was to describe the effects if this bundle on childhood overweight/obesity (OW/OB) rates. We hypothesized that implementation of the bundle would lower the prevalence of OW/OB in Norwood school children. Methods: In 2012, the Healthy Kids Ohio Act was fully implemented in the Norwood City School District (NCSD). In 2014 a comprehensive bundle was implemented that included: 1. A student gardening program; 2. Supplementation of fresh produce to a local food pantry and a family shelter; 3. A farmers market; 4. A health newsletter; 5. Incentives in the school cafeterias to promote healthy food selection; 6. A 100-mile walking club; 7. “Cook for America” (a “cooked from scratch” intervention for school cafeterias); 8. A school-based obesity treatment clinic; Results: The OW/OB rate in the NCSD was 43% at the time of the Bundle implementation in 2014 and 37% in 2016 (p = 0.029). Conclusions: A childhood OW/OB prevention bundle can be implemented in a small city and is associated with a favorable change in BMI.
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14
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Cui Z, Truesdale KP, Robinson TN, Pemberton V, French SA, Escarfuller J, Casey TL, Hotop AM, Matheson D, Pratt CA, Lotas LJ, Po'e E, Andrisin S, Ward DS. Recruitment strategies for predominantly low-income, multi-racial/ethnic children and parents to 3-year community-based intervention trials: Childhood Obesity Prevention and Treatment Research (COPTR) Consortium. Trials 2019; 20:296. [PMID: 31138278 PMCID: PMC6540365 DOI: 10.1186/s13063-019-3418-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recruitment of participants into community-based randomized controlled trials studying childhood obesity is often challenging, especially from low-income racial/ethnical minorities and when long-term participant commitments are required. This paper describes strategies used to recruit and enroll predominately low-income racial/ethnic minority parents and children into the Childhood Obesity Prevention and Treatment Research (COPTR) consortium. METHODS The COPTR consortium has run four independent 3-year, multi-level (individual, family, school, clinic, and community) community-based randomized controlled trials. Two were prevention trials in preschool children and the other two were treatment trials in pre-adolescents and adolescent youth. All trials reported monthly participant recruitment numbers using a standardized method over the projected 18-24 months of recruitment. After randomization of participants was completed, recruitment staff and investigators from each trial retrospectively completed a survey of recruitment strategies and their perceived top three recruitment strategies and barriers. RESULTS Recruitment was completed in 15-21 months across trials, enrolling a total of 1745 parent-child dyads- out of 6314 screened. The number of children screened per randomized child was 4.6 and 3.5 in the two prevention trials, and 3.1 and 2.5 in the two treatment trials. Recruitment strategies reported included: (1) careful planning, (2) working with trusting community partners, (3) hiring recruitment staff who were culturally sensitive, personality appropriate, and willing to work flexible hours, (4) contacting potential participants actively and repeatedly, (5) recruiting at times and locations convenient for participants, (6) providing incentives to participants to complete baseline measures, (7) using a tracking database, (8) evaluating whether participants understand the activities and expectations of the study, and (9) assessing participants' motivation for participating. Working with community partners, hiring culturally sensitive staff, and contacting potential participants repeatedly were cited by two trials among their top three strategies. The requirement of a 3-year commitment to the trial was cited by two trials to be among the top three recruitment barriers. CONCLUSIONS Comprehensive strategies that include community partnership support, culturally sensitive recruitment staff, and repeated contacts with potential participants can result in successful recruitment of low-income racial/ethnic minority families into obesity prevention and treatment trials. TRIAL REGISTRATION NET-Works trial: ClinicalTrials.gov, NCT01606891 . Registered on 28 May 2012. GROW trial: ClinicalTrials.gov, NCT01316653 . Registered on 16 March 2011. GOALS trial: ClinicalTrials.gov, NCT01642836 . Registered on 17 July 2012. IMPACT trial: ClinicalTrials.gov, NCT01514279 . Registered on 23 January 2012.
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Affiliation(s)
- Zhaohui Cui
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas N Robinson
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Victoria Pemberton
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Simone A French
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Juan Escarfuller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Terri L Casey
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Anne M Hotop
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Donna Matheson
- Stanford Solutions Science Lab, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Charlotte A Pratt
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Lynn J Lotas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Eli Po'e
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharon Andrisin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Snacking characteristics and patterns and their associations with diet quality and BMI in the Childhood Obesity Prevention and Treatment Research Consortium. Public Health Nutr 2019; 22:3189-3199. [PMID: 31112114 DOI: 10.1017/s1368980019000958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe snacking characteristics and patterns in children and examine associations with diet quality and BMI. DESIGN Children's weight and height were measured. Participants/adult proxies completed multiple 24 h dietary recalls. Snack occasions were self-identified. Snack patterns were derived for each sample using exploratory factor analysis. Associations of snacking characteristics and patterns with Healthy Eating Index-2010 (HEI-2010) score and BMI were examined using multivariable linear regression models. SETTING Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, USA: NET-Works, GROW, GOALS and IMPACT studies. PARTICIPANTS Predominantly low-income, racial/ethnic minorities: NET-Works (n 534, 2-4-year-olds); GROW (n 610, 3-5-year-olds); GOALS (n 241, 7-11-year-olds); IMPACT (n 360, 10-13-year-olds). RESULTS Two snack patterns were derived for three studies: a meal-like pattern and a beverage pattern. The IMPACT study had a similar meal-like pattern and a dairy/grains pattern. A positive association was observed between meal-like pattern adherence and HEI-2010 score (P for trend < 0⋅01) and snack occasion frequency and HEI-2010 score (β coefficient (95 % CI): NET-Works, 0⋅14 (0⋅04, 0⋅23); GROW, 0⋅12 (0⋅02, 0⋅21)) among younger children. A preference for snacking while using a screen was inversely associated with HEI-2010 score in all studies except IMPACT (β coefficient (95 % CI): NET-Works, -3⋅15 (-5⋅37, -0⋅92); GROW, -2⋅44 (-4⋅27, -0⋅61); GOALS, -5⋅80 (-8⋅74, -2⋅86)). Associations with BMI were almost all null. CONCLUSIONS Meal-like and beverage patterns described most children's snack intake, although patterns for non-Hispanic Blacks or adolescents may differ. Diets of 2-5-year-olds may benefit from frequent meal-like pattern snack consumption and diets of all children may benefit from decreasing screen use during eating occasions.
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Lee RE, Soltero EG, Ledoux TA, Sahnoune I, Saavadra F, Mama SK, McNeill LH. Sustainability via Active Garden Education: Translating Policy to Practice in Early Care and Education. THE JOURNAL OF SCHOOL HEALTH 2019; 89:257-266. [PMID: 30723904 PMCID: PMC6407699 DOI: 10.1111/josh.12734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 10/03/2017] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND We describe the development of sustainability via active garden education (SAGE), an early care and education (ECE) garden-based curriculum developed from a 5-year community partnership to link national health policy guidelines with ECE accreditation standards. METHODS National health guidelines and ECE accreditation standards were reviewed, and community advisory board members, ECE staff, and parents provided feedback and support throughout the development of the curriculum. The SAGE curriculum components were guided by the Ecologic Model of Physical Activity and Social Cognitive Theory. Strengths-weaknesses-opportunities-threat analyses were used to refine and revise the curriculum to overcome challenges to implementation. RESULTS Twelve 1-hour, developmentally appropriate, modularized lessons were created using the garden as a metaphor for human development. Lessons featured songs, simple games, pretend play, modeling, and garden activities. Parents were engaged via weekly newsletters with information about activities in the classroom, strategies to improve health habits at home, and free community resources. CONCLUSION SAGE partnered scientific theory and rigor with community ingenuity and innovation to create a clear translation of policy guidelines to easily implementable practice in a fun and engaging manner.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004
| | - Erica G Soltero
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004
| | - Tracey A Ledoux
- Health and Human Performance, University of Houston, Houston, TX 77204
| | - Iman Sahnoune
- University of Texas Medical Branch, Galveston, TX 77555
| | - Fiorella Saavadra
- Health and Human Performance, University of Houston, Houston, TX 77204-6015
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas, Houston, TX 77030
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Reeves B, Ram N, Robinson TN, Cummings JJ, Giles CL, Pan J, Chiatti A, Cho MJ, Roehrick K, Yang X, Gagneja A, Brinberg M, Muise D, Lu Y, Luo M, Fitzgerald A, Yeykelis L. Screenomics: A Framework to Capture and Analyze Personal Life Experiences and the Ways that Technology Shapes Them. HUMAN-COMPUTER INTERACTION 2019; 36:150-201. [PMID: 33867652 PMCID: PMC8045984 DOI: 10.1080/07370024.2019.1578652] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Digital experiences capture an increasingly large part of life, making them a preferred, if not required, method to describe and theorize about human behavior. Digital media also shape behavior by enabling people to switch between different content easily, and create unique threads of experiences that pass quickly through numerous information categories. Current methods of recording digital experiences provide only partial reconstructions of digital lives that weave - often within seconds - among multiple applications, locations, functions and media. We describe an end-to-end system for capturing and analyzing the "screenome" of life in media, i.e., the record of individual experiences represented as a sequence of screens that people view and interact with over time. The system includes software that collects screenshots, extracts text and images, and allows searching of a screenshot database. We discuss how the system can be used to elaborate current theories about psychological processing of technology, and suggest new theoretical questions that are enabled by multiple time scale analyses. Capabilities of the system are highlighted with eight research examples that analyze screens from adults who have generated data within the system. We end with a discussion of future uses, limitations, theory and privacy.
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18
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Disparities in childhood overweight and obesity by income in the United States: an epidemiological examination using three nationally representative datasets. Int J Obes (Lond) 2019; 43:1210-1222. [PMID: 30718822 DOI: 10.1038/s41366-019-0331-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/16/2018] [Accepted: 01/16/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Overweight and obesity (OWOB) is a global epidemic. Adults and adolescents from low-income households are at higher risk to be OWOB. This study examined the relationship between income and OWOB prevalence in children and adolescents (518 years) in the United States (US) within and across race/ethnicities, and changes in this relationship from 1971 to 2014. SUBJECTS/METHODS A meta-analysis of a nationally representative sample (N = 73,891) of US children and adolescents drawn from three datasets (i.e., National Health and Nutrition Examination Survey, National Longitudinal Survey of Youth, & the Early Childhood Longitudinal Program) which included 14 cross-sectional waves spanning 1971-2014 was conducted. The exposure was household income-to-poverty ratio (low income = 0.00-1.00, middle income = 1.01-4.00, high income >4.00) with prevalence of overweight or obesity (body mass index ≥ 85th percentile) as the outcome. RESULTS Children and adolescents from middle-income and high-income households were 0.78 (95% CI = 0.72, 0.83) and 0.68 (95% CI = 0.59, 0.77) times as likely to be OWOB compared to children and adolescents in low-income households. Separate analyses restricted to each racial/ethnic group showed children and adolescents from middle- and high-income households were less likely to be OWOB compared to their low-income peers within the White, Hispanic, and Other race/ethnic groups. Children and adolescents from low-income households who were Black were not more likely to be OWOB than their high- and middle-income counterparts. Analyses within each income stratum indicated that race/ethnicity was not related to the prevalence of OWOB in low-income households. However, racial/ethnic differences in OWOB were evident for children and adolescents in middle- and high-income households. Disparities in the prevalence of OWOB between low-income children and adolescents and their middle- and high-income counterparts have increased from 1971 to 2014. CONCLUSIONS Income and OWOB are related in US children and adolescents. Racial/ethnic differences in the prevalence of OWOB emerge in middle- and high-income households. Disparities in OWOB prevalence are growing.
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Brigden A, Parslow RM, Linney C, Higson-Sweeney N, Read R, Loades M, Davies A, Stoll S, Beasant L, Morris R, Ye S, Crawley E. How are behavioural interventions delivered to children (5-11 years old): a systematic mapping review. BMJ Paediatr Open 2019; 3:e000543. [PMID: 31909219 PMCID: PMC6937047 DOI: 10.1136/bmjpo-2019-000543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Behavioural interventions are used to prevent, manage and treat a wide variety of conditions including obesity, diabetes, chronic pain, asthma and emotional difficulties. There has been inadequate attention to the delivery of behavioural interventions to younger children (5-11 years old). OBJECTIVE Our objectives were to describe the characteristics of behavioural interventions for children aged 5-11 years. DATA SOURCES We searched five databases: CINAHL, EMBASE, PsycINFO, MEDLINE and Cochrane Library, from January 2005 to August 2019. STUDY SELECTION The inclusion criteria were (1) children aged 5-11, (2) cognitive and/or behavioural interventions, (3) randomised controlled trials and (4) 2005 onward. Two researchers independently identified studies for inclusion. DATA EXTRACTION Two researchers independently extracted data from eligible papers. RESULTS The search identified 10 541 papers. We extracted information on 117 interventions (from 152 papers). Many of the interventions were categorised as complex. This was particularly true for clinical populations; 78.7% were delivered to both the child and parent, and 33.9% took place across multiple settings, typically health and school settings. Most (70.9%) were 'First Wave' (behavioural) interventions, and few (4.3%) were 'Third Wave' (characterised by metacognition, acceptance and mindfulness). Thirty-nine per cent used interactive techniques (play, arts, story and/or games). Purely digital and paper-based interventions were rare, but around a third used these tools as supplements to face-face delivery. There were differences in interventions for younger (5-7 years) and older (8-11 years) children. CONCLUSIONS Interventions designed and delivered to children should be developmentally sensitive. This review highlights characteristics of interventions delivered to children 5-11 years old: the involvement of the child's parent, using behavioural (rather than cognitive) modalities, using interactive techniques and some interventions were delivered across multiple settings.
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Affiliation(s)
- Amberly Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roxanne Morin Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catherine Linney
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Rebecca Read
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Maria Loades
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Anna Davies
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Stoll
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Morris
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Siyan Ye
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
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Gregory JW. Prevention of Obesity and Metabolic Syndrome in Children. Front Endocrinol (Lausanne) 2019; 10:669. [PMID: 31632348 PMCID: PMC6779866 DOI: 10.3389/fendo.2019.00669] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
In recent decades, the prevalence of overweight and obesity has become increasingly common such that it is now the major nutritional problem worldwide. Obesity occurs when dietary energy intake exceeds energy expenditure and has arisen in many societies due to an increasingly "obesogenic" environment in which physical activity has declined and yet children continue to be exposed to unhealthy, energy-dense diets. Additional risks for the development of obesity also include psychological issues and genetic factors. Obesity has many adverse health consequences including development of insulin resistance, Type 2 diabetes, and the metabolic syndrome. There are also important genetic influences on the likelihood of developing insulin resistance. Given the limited success of therapeutic interventions to treat obesity and the metabolic syndrome, there has been an increased interest in preventative strategies. These are likely to be most successful when targeting the young and will require a combination of approaches which will need inter-disciplinary collaborations across health and local government to target families, schools, and local environments to facilitate behavior changes which influence young people's eating behaviors and habitual levels of physical activity.
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Gittelsohn J, Novotny R, Trude ACB, Butel J, Mikkelsen BE. Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010030. [PMID: 30586845 PMCID: PMC6339209 DOI: 10.3390/ijerph16010030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Rachel Novotny
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Jean Butel
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Bent Egberg Mikkelsen
- Department of Learning & Philosophy, Aalborg University, A.C. Meyers Vænge 15, DK-2450 Copenhagen SV, Denmark.
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Zhou M, Lalani C, Banda JA, Robinson TN. Sleep duration, timing, variability and measures of adiposity among 8- to 12-year-old children with obesity. Obes Sci Pract 2018; 4:535-544. [PMID: 30574347 PMCID: PMC6298203 DOI: 10.1002/osp4.303] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Sleep disruption in laboratory studies increases adiposity and decreases glucose tolerance. However, few epidemiological studies have used objective measures of sleep. This study aims to assess associations between sleep duration, timing and regularity with measures of adiposity. METHODS This is a cross-sectional study of 188 children with obesity (age: 10.50 ± 1.39 years; body mass index: 29.24 ± 5.04 kg m-2). Nightly sleep duration, bedtime and wake time were measured by multiple-day actigraphy and parent reports. Per cent overweight (per cent over median body mass index for age and sex) was chosen as the primary measure of obesity status. Objective measures of height, weight, waist circumference, blood pressure, fasting blood lipids, glucose, insulin, glycated haemoglobin and C-reactive protein were obtained. Television screen time and total caloric intake were assessed via parent questionnaire. RESULTS Each hour later in weekday bedtime was associated with an additional 6.17 per cent overweight (95% confidence interval [CI]: 1.42-10.92). Each hour greater in day-to-day variability in weekday bedtime and weekday wake time was associated with an additional 10.20 (95% CI: 0.50-19.91) and 10.02 (95% CI: 1.55-18.50) per cent overweight, respectively. Associations were similar after controlling for other obesity-related behaviours (television screen time, total caloric intake and physical activity.). CONCLUSIONS Among children with obesity, later bedtime and greater variability in bedtime and wake time are associated with greater adiposity, independent of other obesity-related behaviours. Early bedtime and wake time and consistent day-to-day sleep timing may be strategies to reduce adiposity in high-risk children.
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Affiliation(s)
- M. Zhou
- Stanford University School of MedicineStanfordCAUSA
| | - C. Lalani
- Stanford University School of MedicineStanfordCAUSA
| | - J. A. Banda
- Department of Health and KinesiologyPurdue UniversityWest LafayetteINUSA
| | - T. N. Robinson
- Stanford Solutions Science Lab and Division of General Pediatrics, Department of Pediatrics and Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA
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Home Visitations for Delivering an Early Childhood Obesity Intervention in Denver: Parent and Patient Navigator Perspectives. Matern Child Health J 2018; 22:1589-1597. [DOI: 10.1007/s10995-018-2553-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 3:CD009728. [PMID: 29499084 PMCID: PMC5865125 DOI: 10.1002/14651858.cd009728.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
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Affiliation(s)
- Anne Martin
- University of EdinburghCentre for Population Health SciencesMedical School, Teviot PlaceEdinburghUKEH8 9AG
- University of GlasgowMRC/CSO Social and Public Health Sciences Unit200 Renfield StreetGlasgowUKG2 3QB
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghEH8 8AQUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
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Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 1:CD009728. [PMID: 29376563 PMCID: PMC6491168 DOI: 10.1002/14651858.cd009728.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
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Affiliation(s)
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEDINBURGHUKEH8 8AQ
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Management of Childhood Obesity and Overweight in Primary Care Visits: Gaps Between Recommended Care and Typical Practice. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Berge JM, Adamek M, Caspi C, Loth KA, Shanafelt A, Stovitz SD, Trofholz A, Grannon KY, Nanney MS. Healthy Eating and Activity Across the Lifespan (HEAL): A call to action to integrate research, clinical practice, policy, and community resources to address weight-related health disparities. Prev Med 2017. [PMID: 28647543 DOI: 10.1016/j.ypmed.2017.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite intense nationwide efforts to improve healthy eating and physical activity across the lifespan, progress has plateaued. Moreover, health inequities remain. Frameworks that integrate research, clinical practice, policy, and community resources to address weight-related behaviors are needed. Implementation and evaluation of integration efforts also remain a challenge. The purpose of this paper is to: (1) Describe the planning and development process of an integrator entity, HEAL (Healthy Eating and Activity across the Lifespan); (2) present outcomes of the HEAL development process including the HEAL vision, mission, and values statements; (3) define the planned integrator functions of HEAL; and (4) describe the ongoing evaluation of the integration process. HEAL team members used a theoretically-driven, evidence-based, systemic, twelve-month planning process to guide the development of HEAL and to lay the foundation for short- and long-term integration initiatives. Key development activities included a review of the literature and case studies, identifying guiding principles and infrastructure needs, conducting stakeholder/key informant interviews, and continuous capacity building among team members. Outcomes/deliverables of the first year of HEAL included a mission, vision, and values statements; definitions of integration and integrator functions and roles; a set of long-range plans; and an integration evaluation plan. Application of the HEAL integration model is currently underway through community solicited initiatives. Overall, HEAL aims to lead real world integrative work that coalesce across research, clinical practice, and policy with community resources to inspire a culture of health equity aimed at improving healthy eating and physical activity across the lifespan.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota, United States.
| | | | - Caitlin Caspi
- Department of Family Medicine and Community Health, Division of Health Disparities, University of Minnesota, United States
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota, United States
| | - Amy Shanafelt
- Clinical and Translation Science Institute, University of Minnesota, United States
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, United States
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, United States
| | - Katherine Y Grannon
- Department of Family Medicine and Community Health, Division of Health Disparities, University of Minnesota, United States
| | - Marilyn S Nanney
- Department of Family Medicine and Community Health, Division of Health Disparities, University of Minnesota, United States
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Stevens J, Pratt C, Boyington J, Nelson C, Truesdale KP, Ward DS, Lytle L, Sherwood NE, Robinson TN, Moore S, Barkin S, Cheung YK, Murray DM. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations. Am J Prev Med 2017; 52:115-124. [PMID: 28340973 PMCID: PMC5571824 DOI: 10.1016/j.amepre.2016.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. METHODS NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. RESULTS Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. CONCLUSIONS The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.
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Affiliation(s)
- June Stevens
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Josephine Boyington
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Cheryl Nelson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leslie Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Thomas N Robinson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - David M Murray
- Division of Program Coordination, Planning, and Strategic Initiatives, NIH, Bethesda, Maryland
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Appelhans BM, Moss OA, Cerwinske LA. Systematic review of paediatric weight management interventions delivered in the home setting. Obes Rev 2016; 17:977-88. [PMID: 27231126 DOI: 10.1111/obr.12427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/08/2016] [Accepted: 04/19/2016] [Indexed: 12/30/2022]
Abstract
To increase their accessibility, paediatric weight management interventions are increasingly designed to be delivered in the home setting by trained staff. This systematic review summarizes the available evidence for interventions featuring home visitation and identifies key gaps in the literature. PubMed, CINAHL, Cochrane and PsycINFO were searched for intervention studies that reported change in objectively measured adiposity outcomes in youth ages 2-18 years. Studies published between 1 January 1995 and 12 February 2016 were analysed. Of 15 eligible studies, nine reported that interventions with home visitation were either superior to a control/comparison condition or achieved significant within-subjects reductions in adiposity. Interventions in which professional staff (e.g. dietitians and exercise trainers) conducted home visits tended to be more efficacious than those delivered by paraprofessional or community-based staff, as were interventions with more frequent contact. Most studies were judged to have low or unclear risk of bias across various domains. As most studies compared interventions with home visits with less intensive and qualitatively different approaches, it remains unclear whether home visitation per se enhances weight loss efficacy. Overall, paediatric weight management interventions that feature home visitation are promising, but the incremental benefit of the home visitation treatment modality remains to be rigorously evaluated. © 2016 World Obesity.
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Affiliation(s)
- B M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA. .,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - O A Moss
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.,Department of Food and Nutrition, Rush University Medical Center, Chicago, IL, USA
| | - L A Cerwinske
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.,Department of Food and Nutrition, Rush University Medical Center, Chicago, IL, USA
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Gonzalez G. Primary Care Interventions to Reduce Childhood Obesity in Latino Families. J Pediatr Health Care 2016; 30:471-9. [PMID: 26677979 DOI: 10.1016/j.pedhc.2015.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/30/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Increasing rates of obesity in Latino children call for culturally sensitive primary care interventions. Despite recent efforts to address this growing disparity, little is known about cultural variables that influence obesity management programs in Latino children. METHODS A literature search was conducted using CINHAL, Scopus, PubMed, and PsycINFO to review the state of the science regarding primary care interventions to decrease obesity in Latino children. The author analyzed the effects of several cultural practices on obesity and made recommendations based on their clinical implications for weight reduction management programs. RESULTS Obesity in Latino children is a multifactorial problem influenced by family behaviors, cultural perceptions of weight and health, traditional dietary norms, and socioeconomic status. Current practice lags behind national obesity management recommendations and is further hindered by a lack of consideration of the roles of key cultural differences in Latino families. DISCUSSION It is imperative to recognize the importance of family preferences and culture when developing weight reduction programs so as to foster long-term behavior changes. More research assessing the efficacy of culturally competent interventions is necessary to guide national efforts to address this increasing disparity.
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Heerman WJ, White RO, Hotop A, Omlung K, Armstrong S, Mathieu I, Sherwood NE, Barkin SL. A Tool Kit to Enhance the Informed Consent Process for Community-Engaged Pediatric Research. IRB 2016; 38:8-14. [PMID: 29442474 PMCID: PMC5806528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- William J Heerman
- Assistant professor in the Division of General Pediatrics at Vanderbilt University Medical Center
| | - Richard O White
- Assistant professor in the Department of Community Internal Medicine at the Mayo Clinic in Jacksonville, Florida
| | - Annie Hotop
- Senior coordinator in the Division of Epidemiology & Community Health at the University of Minnesota
| | - Karen Omlung
- Community program specialist in the Division of Epidemiology & Community Health at the University of Minnesota
| | - Sharelle Armstrong
- Research assistant in the Division of General Pediatrics at Vanderbilt University Medical Center when this article was written
| | - Irène Mathieu
- Student in the School of Medicine at Vanderbilt University when this article was written
| | - Nancy E Sherwood
- Senior investigator and the director of scientific development in the Health-Partners Institute for Education and Research
| | - Shari L Barkin
- Professor in the Division of General Pediatrics at Vanderbilt University Medical Center
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Ewart-Pierce E, Mejía Ruiz MJ, Gittelsohn J. "Whole-of-Community" Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions. Curr Obes Rep 2016; 5:361-74. [PMID: 27379620 PMCID: PMC5962013 DOI: 10.1007/s13679-016-0226-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.
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Affiliation(s)
- Ella Ewart-Pierce
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - María José Mejía Ruiz
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Wood CT, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater AM, Perrin EM. Bottle Size and Weight Gain in Formula-Fed Infants. Pediatrics 2016; 138:peds.2015-4538. [PMID: 27273748 PMCID: PMC4925078 DOI: 10.1542/peds.2015-4538] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Formula-fed infants may be at greater risk for overfeeding and rapid weight gain. Different size bottles are used for feeding infants, although little is known about whether bottle size is related to weight gain in bottle-fed infants. METHODS Data from the Greenlight Intervention Study, a cluster randomized trial to prevent childhood obesity at 4 pediatric resident clinics, were used to analyze the exposure to regular (<6 oz) or large (≥6 oz) bottle size at the 2-month visit on changes in weight, weight-for-age z score (WAZ), and weight-for-length z score (WLZ) at the 6-month visit. Using multivariable regression, we adjusted for potential confounders (birth weight, gender, age, weight measures at 2 months, parent race/ethnicity, education, household income and size, time between 2- and 6-month visits, and first child status). RESULTS Forty-five percent (n = 386; 41% black, 35% Hispanic, 23% white, 2% other) of infants at the 2-month visit were exclusively formula-fed, and 44% used large (≥6 oz) bottles. Infants whose parents fed with large bottles had 0.21 kg (95% confidence interval [CI]: 0.05 to 0.37) more weight change, 0.24 U (95% CI: 0.07 to 0.41) more change in WAZ, and 0.31 U (95% CI: 0.08 to 0.54) more change in WLZ during this period than infants fed with regular bottles. CONCLUSIONS Using a large bottle in early infancy independently contributed to greater weight gain and change in WLZ at the 6-month visit. Although growth in infancy is complex, bottle size may be a modifiable risk factor for rapid infant weight gain and later obesity among exclusively formula-fed infants.
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Affiliation(s)
- Charles T. Wood
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina;,Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Asheley C. Skinner
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, New York, New York
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee M. Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California; and
| | - Alan M. Delamater
- Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Desai M, Mitani AA, Bryson SW, Robinson T. Multiple Imputation When Rate of Change is the Outcome of Interest. JOURNAL OF MODERN APPLIED STATISTICAL METHODS 2016; 15:160-192. [PMID: 30766452 DOI: 10.22237/jmasm/1462075740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little research has been devoted to multiple imputation (MI) of derived variables. This study investigates various MI approaches for the outcome, rate of change, when the analysis model is a two-stage linear regression. Simulations showed that competitive approaches depended on the missing data mechanism and presence of auxiliary terms.
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Affiliation(s)
- Manisha Desai
- Professor of Biomedical Informatics Research in the Department of Medicine, Stanford University, Stanford, CA
| | - Aya A Mitani
- Graduate student in the Department of Biostatistics, Boston University, Boston, MA
| | - Susan W Bryson
- Staff scientist in the Department of Pediatrics, Stanford University, Stanford, CA
| | - Thomas Robinson
- Professor in the Department of Pediatrics and Medicine, Stanford University, Stanford, CA
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36
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Wood CT, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater A, Ravanbakht SN, Perrin EM. Association Between Bottle Size and Formula Intake in 2-Month-Old Infants. Acad Pediatr 2016; 16:254-9. [PMID: 26525989 PMCID: PMC4808476 DOI: 10.1016/j.acap.2015.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/24/2015] [Accepted: 08/01/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine range of bottle sizes used and examine the relationship between bottle size and total daily consumption of infant formula. METHODS Cross-sectional analysis of baseline data collected as part of Greenlight, a cluster randomized trial to prevent childhood obesity at 4 pediatric resident clinics. The Greenlight study included healthy, term infants. For our analysis, parents of exclusively formula-fed infants reported volume per feed, number of feeds per day, and bottle size, which was dichotomized into small (<6 oz) or large (≥6 oz). We identified determinants of bottle size, and then examined relationships between bottle size and volume fed with log-transformed ordinary least squares regression, adjusting for infant age, sex, birth weight, current weight, race/ethnicity, and enrollment in Special Supplemental Nutrition Program for Women, Infants, and Children. RESULTS Of 865 participants in the Greenlight study, 44% (n = 378; 21.8% white, 40.6% black, 35.3% Hispanic, 2.4% other) of infants were exclusively formula fed at 2 months. Median volume per day was 30 oz (interquartile range 12), and 46.0% of infants were fed with large bottles. Adjusted for covariates, parents using larger bottles reported feeding 4 oz more formula per day (34.2 oz, 95% confidence interval 33.5-34.9 vs 29.7 oz, 95% confidence interval 29.2-30.3, P = .03). CONCLUSIONS Among exclusively formula-fed infants, use of a larger bottle is associated with parental report of more formula intake compared to infants fed with smaller bottles. If infants fed with larger bottles receive more formula, these infants may be overfed and consequently at risk for obesity.
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Affiliation(s)
- Charles T. Wood
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Asheley C. Skinner
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - H. Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, 550 First Avenue, New York, NY 10016
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, 6103 Medical Center East, Nashville, TN 37232
| | - Lee M. Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, 117 Encina Commons, Stanford, CA 94305
| | - Alan Delamater
- Department of Pediatrics, University of Miami School of Medicine, 1601 NW 12 Avenue, #4046, Miami, FL 33136
| | - Sophie N. Ravanbakht
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Banda JA, Haydel KF, Davila T, Desai M, Bryson S, Haskell WL, Matheson D, Robinson TN. Effects of Varying Epoch Lengths, Wear Time Algorithms, and Activity Cut-Points on Estimates of Child Sedentary Behavior and Physical Activity from Accelerometer Data. PLoS One 2016; 11:e0150534. [PMID: 26938240 PMCID: PMC4777377 DOI: 10.1371/journal.pone.0150534] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/15/2016] [Indexed: 12/17/2022] Open
Abstract
Objective To examine the effects of accelerometer epoch lengths, wear time (WT) algorithms, and activity cut-points on estimates of WT, sedentary behavior (SB), and physical activity (PA). Methods 268 7–11 year-olds with BMI ≥ 85th percentile for age and sex wore accelerometers on their right hips for 4–7 days. Data were processed and analyzed at epoch lengths of 1-, 5-, 10-, 15-, 30-, and 60-seconds. For each epoch length, WT minutes/day was determined using three common WT algorithms, and minutes/day and percent time spent in SB, light (LPA), moderate (MPA), and vigorous (VPA) PA were determined using five common activity cut-points. ANOVA tested differences in WT, SB, LPA, MPA, VPA, and MVPA when using the different epoch lengths, WT algorithms, and activity cut-points. Results WT minutes/day varied significantly by epoch length when using the NHANES WT algorithm (p < .0001), but did not vary significantly by epoch length when using the ≥ 20 minute consecutive zero or Choi WT algorithms. Minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA varied significantly by epoch length for all sets of activity cut-points tested with all three WT algorithms (all p < .0001). Across all epoch lengths, minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA also varied significantly across all sets of activity cut-points with all three WT algorithms (all p < .0001). Conclusions The common practice of converting WT algorithms and activity cut-point definitions to match different epoch lengths may introduce significant errors. Estimates of SB and PA from studies that process and analyze data using different epoch lengths, WT algorithms, and/or activity cut-points are not comparable, potentially leading to very different results, interpretations, and conclusions, misleading research and public policy.
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Affiliation(s)
- Jorge A. Banda
- Stanford Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - K. Farish Haydel
- Stanford Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Tania Davila
- Stanford Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Susan Bryson
- Stanford Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - William L. Haskell
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Donna Matheson
- Stanford Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Thomas N. Robinson
- Stanford Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, United States of America
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States of America
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Jansen LA. The Optimistic Bias and Illusions of Control in Clinical Research. IRB 2016; 38:8-14. [PMID: 27188031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Schaefer SE, Camacho-Gomez R, Sadeghi B, Kaiser L, German JB, de la Torre A. Assessing Child Obesity and Physical Activity in a Hard-to-Reach Population in California's Central Valley, 2012-2013. Prev Chronic Dis 2015. [PMID: 26203815 PMCID: PMC4515914 DOI: 10.5888/pcd12.140577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction In California’s agricultural Central Valley, the rate of childhood obesity is higher than the national average. Adequate physical activity contributes to obesity prevention and its assessment is useful to evaluate the impact of interventions. Methods Niños Sanos, Familia Sana (Healthy Children, Healthy Family [NSFS]) uses community-based participatory research to implement an intervention program to reduce childhood obesity among people of Mexican origin in the Central Valley. Anthropometric measurements were conducted on more than 650 children enrolled in NSFS. Physical activity data from a subgroup of children aged 4 to 7 years (n = 134) were collected via a wearable accelerometer. Results Children were classified on the basis of age and sex-adjusted body mass index as healthy weight (57.7%); overweight (19.3%), or obese (23%). Logistic regression showed that moderate to vigorous physical activity (MVPA) was associated with a child’s likelihood of having a healthy BMI (odds ratio: 1.03; 95% CI, 1.01–1.05; P = .017). Conclusion NSFS’s community-based participatory approach resulted in successful use of a commercial electronic device to measure physical activity quantity and quality in this hard-to-reach population. Promotion of adequate daily MVPA is an appropriate and necessary component of NSFS’s childhood obesity prevention strategy.
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Affiliation(s)
- Sara E Schaefer
- Foods for Health Institute, 2141 Robert Mondavi Institute, One Shields Ave, Davis, CA 95616.
| | - Rosa Camacho-Gomez
- Center for Transnational Health, University of California, Davis, Californi
| | - Banefsheh Sadeghi
- Center for Transnational Health, University of California, Davis, Californi
| | - Lucia Kaiser
- Department of Nutrition, University of California, Davis
| | - J Bruce German
- Foods for Health Institute, University of California, Davis, California
| | - Adela de la Torre
- Center for Transnational Health, University of California, Davis, Californi
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Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions. Curr Obes Rep 2015; 4:157-73. [PMID: 26213643 PMCID: PMC4512668 DOI: 10.1007/s13679-015-0160-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.
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Affiliation(s)
- Elisabeth M. Seburg
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Barbara A. Olson-Bullis
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Dani M. Bredeson
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Marcia G. Hayes
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
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Yun L, Boles RE, Haemer MA, Knierim S, Dickinson LM, Mancinas H, Hambidge SJ, Davidson AJ. A randomized, home-based, childhood obesity intervention delivered by patient navigators. BMC Public Health 2015; 15:506. [PMID: 26002612 PMCID: PMC4492174 DOI: 10.1186/s12889-015-1833-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/13/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although Colorado is perceived as a healthy state, in 2010, 14.1 % of children aged 2-5 were overweight and 9.1 % were obese. Despite the high prevalence of obesity in this population, evidence to support particular strategies to treat obese preschoolers is lacking. The efficacy of home-based, childhood obesity interventions to reduce a child's body mass index is inconclusive. However, this model uniquely provides an opportunity to observe and intervene with the home food and activity environment and engage the entire family in promoting changes that fit each family's unique dynamics. METHODS/DESIGN Eligible participants are children aged 2-5 years who attended a well-child care visit at a Denver Health Community Health Service clinic within 12 months prior to recruitment and on that visit had a body mass index (BMI) >85th percentile-for-age. Participants are randomly recruited at study inception and allocated to the intervention in one of five defined 6-month stepped wedge engagements; the delayed intervention groups serves as control groups until the start of the intervention. The program is delivered by a patient navigator at the family' home and consists of a 16-session curriculum focused on 1) parenting styles, 2) nutrition, and 3) physical activity. At each visit, a portion of curriculum is delivered to guide parents and children in selecting one goal for behavior change in each of three work areas to work on during the following week. The primary study outcome measure is change in BMI z-score from baseline to post-intervention period. DISCUSSION This childhood obesity study, innovative for its home-based intervention venue, provides rich data characterizing barriers and facilitators to healthy behavior change within the home. The study population is innovative as it is focused on preschool-aged, Latino children from low-income families; this population has not typically been targeted in obesity management assessments. The home-based intervention is linked to clinical care through update letters and assessment of the program's impact to the child's medical providers. Informing primary care providers about a child's accomplishments and challenges, allows the clinician to support the health weight effort when seeing families during subsequent clinical visits. TRIAL REGISTRATION ClinicalTrials.gov NCT02024360 Registered December 21, 2013.
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Affiliation(s)
- Lourdes Yun
- Denver Public Health, 605 Bannock Street, Denver, CO, 80204, USA.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Matthew A Haemer
- Department of Pediatrics, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Shanna Knierim
- Denver Health Ambulatory Care Services, Department of Pediatrics, 777 Bannock Street, Denver, 80204, USA.
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado Denver, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
| | - Heather Mancinas
- Denver Public Health, 605 Bannock Street, Denver, CO, 80204, USA.
| | - Simon J Hambidge
- Denver Health, Division of Ambulatory Care, 666 Bannock Street, Denver, 80204, USA.
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Abstract
Diseases once associated with older adulthood, type 2 diabetes and cardiovascular disease, are increasingly diagnosed in children and adolescents. Interventions designed to assist adults in modifying dietary and physical activity habits have been shown to help prevent the development of type 2 diabetes and cardiovascular disease in adults. Given the unfortunate rise in both of these diseases in pediatric populations, it is increasingly important to begin prevention efforts in childhood or prenatally. There is strong empirical support for utilizing lifestyle interventions to prevent these diseases in adults; it is not clear whether the same holds true for pediatric populations. The present review examines lifestyle management efforts to prevent type 2 diabetes and cardiovascular disease in children across socioecological levels. Recommendations are made for expanding the traditional focus of lifestyle interventions from dietary and physical activity behaviors to target additional risks for these diseases such as smoking and depression in youth.
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Affiliation(s)
- Dorothy J. Van Buren
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid, St. Louis, MO 63110 USA
| | - Tiffany L. Tibbs
- School of Advanced Studies and College of Social Sciences, University of Phoenix, 3157 E. Elwood St., Phoenix, AZ 85034 USA
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English L, Lasschuijt M, Keller KL. Mechanisms of the portion size effect. What is known and where do we go from here? Appetite 2014; 88:39-49. [PMID: 25447010 DOI: 10.1016/j.appet.2014.11.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/26/2014] [Accepted: 11/03/2014] [Indexed: 01/26/2023]
Abstract
Childhood obesity is a persistent problem worldwide, and of particular concern in the United States. Clarifying the role of the food environment in promoting overeating is an important step toward reducing the prevalence of obesity. One potential contributor to the obesity epidemic is the increased portion sizes of foods commonly served. Portion sizes of foods served both at home and away from home have dramatically increased over the past 40 years. Consistently, short-term studies have demonstrated that increasing portion size leads to increased food intake in adults and children, a phenomenon known as the portion size effect. However, the mechanisms underlying this effect are poorly understood. Understanding these mechanisms could assist in clarifying the relationship between portion size and weight status and help inform the development of effective obesity interventions. First, we review the role of visual cues, such as plate size, unit, and utensil size as a potential moderator of the portion size effect. In addition, we discuss meal microstructure components including bite size, rate, and frequency, as these may be altered in response to different portion sizes. We also review theories that implicate post-ingestive, flavor-nutrient learning as a key moderator of the portion size effect. Furthermore, we present preliminary data from an ongoing study that is applying neuroimaging to better understand these mechanisms and identify modifiable child characteristics that could be targeted in obesity interventions. Our tentative findings suggest that individual differences in cognitive (e.g. loss of control eating) and neural responses to food cues may be critical in understanding the mechanisms of the portion size effect. To advance this research area, studies that integrate measures of individual subject-level differences with assessment of food-related characteristics are needed.
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Affiliation(s)
- Laural English
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, United States
| | - Marlou Lasschuijt
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, United States; Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Kathleen L Keller
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, United States; Department of Food Science, The Pennsylvania State University, University Park, PA 16802, United States.
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Barr-Anderson DJ, Singleton C, Cotwright CJ, Floyd MF, Affuso O. Outside-of-school time obesity prevention and treatment interventions in African American youth. Obes Rev 2014; 15 Suppl 4:26-45. [PMID: 25196405 DOI: 10.1111/obr.12204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/12/2023]
Abstract
Outside-of-school time (OST; i.e. before/after-school hours, summer time), theory-based interventions are potential strategies for addressing increased obesity among African American youth. This review assessed interventions across multiple settings that took place during OST among African American youth aged 5-18 years old. Seven databases were searched for studies published prior to October 2013; 28 prevention and treatment interventions that assessed weight or related behaviours as a primary or secondary outcome were identified. Overall, these studies reported heterogeneous intervention length, theoretical frameworks, methodological quality, outcomes, cultural adaption and community engagement; the latter two attributes have been identified as potentially important intervention strategies when working with African Americans. Although not always significant, generally, outcomes were in the desired direction. When examining programmes by time of intervention (i.e. after-school, summer time, time not specified or multiple time periods), much of the variability remained, but some similarities emerged. After-school studies generally had a positive impact on physical activity, fruit/vegetable consumption and caloric intake, or body composition. The single summer time intervention showed a trend towards reduced body mass index. Overall findings suggest that after-school and summer programmes, alone or perhaps in combination, offer potential benefits for African American youth and could favourably influence diet and physical activity behaviour.
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Affiliation(s)
- D J Barr-Anderson
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
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Pratt CA, Boyington J, Esposito L, Pemberton VL, Bonds D, Kelley M, Yang S, Murray D, Stevens J. Childhood Obesity Prevention and Treatment Research (COPTR): interventions addressing multiple influences in childhood and adolescent obesity. Contemp Clin Trials 2013; 36:406-13. [PMID: 23999502 DOI: 10.1016/j.cct.2013.08.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/23/2013] [Accepted: 08/24/2013] [Indexed: 11/28/2022]
Abstract
This paper is the first of five papers in this issue that describes a new research consortium funded by the National Institutes of Health. It describes the design characteristics of the Childhood Obesity Prevention and Treatment Research (COPTR) trials and common measurements across the trials. The COPTR Consortium is conducting interventions to prevent obesity in pre-schoolers and treat overweight or obese 7-13 year olds. Four randomized controlled trials will enroll a total of 1700 children and adolescents (~50% female, 70% minorities), and will test innovative multi-level and multi-component interventions in multiple settings involving primary care physicians, parks and recreational centers, family advocates, and schools. For all the studies, the primary outcome measure is body mass index; secondary outcomes, moderators and mediators of intervention include diet, physical activity, home and neighborhood influences, and psychosocial factors. COPTR is being conducted collaboratively among four participating field centers, a coordinating center, and NIH project offices. Outcomes from COPTR have the potential to enhance our knowledge of interventions to prevent and treat childhood obesity.
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