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Scott-Sheldon LAJ, Hedges LV, Cyr C, Young-Hyman D, Khan LK, Magnus M, King H, Arteaga S, Cawley J, Economos CD, Haire-Joshu D, Hunter CM, Lee BY, Kumanyika SK, Ritchie LD, Robinson TN, Schwartz MB. Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019. Child Obes 2020; 16:S221-S248. [PMID: 32936038 PMCID: PMC7482126 DOI: 10.1089/chi.2020.0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Larry V Hedges
- Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Chris Cyr
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Laura Kettel Khan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather King
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Sonia Arteaga
- Office of the Director, National Institutes of Health, National Institutes of Health, Bethesda, MD, USA
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
- Department of Economics, Cornell University, Ithaca, NY, USA
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University, Saint Louis, MO, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Y Lee
- CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley, CA, USA
| | - Thomas N Robinson
- Departments of Pediatrics and Medicine, Stanford Solutions Science Lab, Stanford University, Stanford, CA, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
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2
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Simon SL, Goetz AR, Meier M, Brinton J, Zion C, Stark LJ. Sleep duration and bedtime in preschool-age children with obesity: Relation to BMI and diet following a weight management intervention. Pediatr Obes 2019; 14:e12555. [PMID: 31215768 PMCID: PMC6812590 DOI: 10.1111/ijpo.12555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sleep duration is associated with obesity in preschoolers. Weight-management interventions may be an opportunity to incorporate sleep health recommendations. OBJECTIVES To examine changes in sleep in preschool-age children with obesity following a family-based weight-management intervention (Learning about Activity and Understanding Nutrition for Child Health [LAUNCH]) compared with motivational interviewing and standard care conditions. Additionally, we examined associations between sleep with body mass index (BMI) z score (BMIz) and diet. METHODS One hundred fifty-one children (4.6 ± 0.93 y) completed baseline (pretreatment) and posttreatment (week 24) assessments, including anthropometrics, 24-hour dietary recalls, and a 7-day sleep diary. Analysis of variance (ANOVA) and chi-squared tests compared sleep variables between groups; linear regression models examined effects of sleep on BMIz and dietary intake at posttreatment, controlling for baseline values. RESULTS Bedtime and sleep duration were not significantly different between treatment groups from baseline to posttreatment. After adjusting for baseline sleep, earlier bedtime was associated with lower BMIz (95% CI, 0.00-0.04; .03), intake of added sugars (95% CI, 0.70-4.32; .007), and sweet/dessert food servings (95% CI, 0.00-0.19; .04) at posttreatment. Longer night-time sleep duration was associated with fewer added sugars at posttreatment, adjusting for baseline sleep (95% CI, -3.79 to -0.35; .02). CONCLUSIONS More comprehensive sleep intervention incorporated into weight-management intervention may be necessary to promote positive changes for preschoolers with obesity. A focus on earlier bedtime and longer sleep duration appears to be important given associations between sleep duration and bedtime with BMIz and dietary intake.
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Affiliation(s)
- Stacey L. Simon
- Division of Pulmonary & Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Amy R. Goetz
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Maxene Meier
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - John Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Cynthia Zion
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lori J. Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
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Stark LJ, Filigno SS, Kichler JC, Bolling C, Ratcliff MB, Robson SM, Simon SL, McCullough MB, Clifford LM, Stough CO, Zion C, Mara CA. Maintenance Following a Randomized Trial of a Clinic and Home-based Behavioral Intervention of Obesity in Preschoolers. J Pediatr 2019; 213:128-136.e3. [PMID: 31230889 PMCID: PMC6765427 DOI: 10.1016/j.jpeds.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess maintenance of improved weight outcomes in preschoolers with obesity 6 and 12 months following a randomized clinical trial comparing a home- and clinic-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health [LAUNCH]) to motivational interviewing and standard care. STUDY DESIGN Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012, and June 8, 2015, were followed 6 and 12 months post-treatment. Child and caregiver weight, height, and caloric intake, child physical activity, and home environment were assessed. The primary outcome was maintenance of greater reduction of percent over the 50th percentile body mass index (BMI%50th) by LAUNCH compared with motivational interviewing and standard care at the 6- and 12-month follow-up. RESULTS Significantly lower child BMI%50th was maintained for LAUNCH compared with motivational interviewing at 12-month follow-up and to standard care at the 6-month follow-up; however, the effect sizes were maintained for comparison with standard care at 12-month follow-up. LAUNCH had significantly lower daily caloric intake compared with motivational interviewing and standard care at both follow-ups and maintained significantly fewer high-calorie foods in the home compared with standard care at 6 and 12 months and compared with motivational interviewing at 12 months. However, caloric intake increased by 12% from post-treatment. LAUNCH caregivers did not maintain improved BMI at follow-up. CONCLUSIONS LAUNCH showed success in reducing weight in preschoolers. However, maintaining treatment gains post-treatment is more difficult. Treatment may need to last longer than 6 months to achieve optimal results. TRIAL REGISTRATION Clinicaltrials.gov: NCT01546727.
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Affiliation(s)
- Lori J. Stark
- Department of Pediatrics, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stephanie Spear Filigno
- Department of Pediatrics, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jessica C. Kichler
- Department of Pediatrics, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Shannon M. Robson
- Department of Behavioral Health and Nutrition, University
of Delaware, Newark, Delaware
| | - Stacey L. Simon
- Department of Pediatrics, Division of Pulmonary Medicine,
Children’s Hospital Colorado, Aurora, CO
| | | | - Lisa M. Clifford
- Department of Pediatrics, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Cynthia Zion
- Department of Pediatrics, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH
| | - Constance A. Mara
- Department of Pediatrics, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH
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4
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Odar Stough C, McCullough MB, Robson SL, Bolling C, Spear Filigno S, Kichler JC, Zion C, Clifford LM, Simon SL, Ittenbach RF, Stark LJ. Are Preschoolers Meeting the Mark? Comparing the Dietary, Activity, and Sleep Behaviors of Preschoolers With Obesity to National Recommendations. J Pediatr Psychol 2019; 43:452-463. [PMID: 29048553 DOI: 10.1093/jpepsy/jsx130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/30/2017] [Indexed: 01/10/2023] Open
Abstract
Objective National health organizations and expert committees have issued recommendations for health behaviors related to obesity risk. Behavioral and family-based weight management interventions for preschoolers often target improving adherence to these recommendations, but it is unknown how the health behaviors of preschoolers with obesity enrolled in weight control treatments (WCTs) compare with these guidelines. In this study, the dietary intake, activity, and sleep behaviors of preschoolers with obesity enrolled in a family-based behavioral WCT are described and compared with national health behavior recommendations. Methods Health behaviors of 151 preschoolers with obesity (M age = 4.60, SD = 0.93) enrolled in a clinical trial of a weight management program were measured at baseline through caregiver-report questionnaires, three 24-hr dietary recalls, and accelerometers. Results In total, 70% of the sample exceeded daily caloric recommendations, only 10 and 5% met recommendations for fruit and vegetable intake, respectively, and only 30% met the recommendation of consuming no sugar-sweetened beverages. The majority of the sample met the daily recommendations for 60 min of moderate-to-vigorous activity (80%), < 2 hr of screen time (68%), and sleep duration (70%). Conclusions Behavioral weight management interventions for preschoolers with obesity should target the health behaviors where children are not meeting recommendations.
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Affiliation(s)
| | - Mary Beth McCullough
- Department of Psychiatry and Human Behavior, Hasbro Children's Hospital/Alpert Medical School of Brown University
| | - Shannon L Robson
- Department of Behavioral Health and Nutrition, University of Delaware
| | | | - Stephanie Spear Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Jessica C Kichler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Cynthia Zion
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Lisa M Clifford
- Department of Clinical and Health Psychology, University of Florida
| | - Stacey L Simon
- Department of Pediatrics, Division of Pulmonary Medicine, Children's Hospital Colorado
| | - Richard F Ittenbach
- Department of Pediatrics, University of Cincinnati College of Medicine.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center
| | - Lori J Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
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Robson SM, Ziegler ML, McCullough MB, Stough CO, Zion C, Simon SL, Ittenbach RF, Stark LJ. Changes in diet quality and home food environment in preschool children following weight management. Int J Behav Nutr Phys Act 2019; 16:16. [PMID: 30717746 PMCID: PMC6360745 DOI: 10.1186/s12966-019-0777-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/30/2019] [Indexed: 01/21/2023] Open
Abstract
Background Family-based obesity treatment interventions can successfully reduce energy intake in preschoolers. An implicit goal of obesity treatment interventions is to improve diet quality, but diet quality has been less examined as a treatment outcome in studies of preschoolers. The purpose of this study was to conduct a secondary analysis comparing the change in diet quality and home food environment in preschoolers assigned to a behavioral family-based obesity intervention (LAUNCH), motivational interviewing (MI) condition, or standard care (STC) condition. Methods Three 24-h dietary recalls were completed at baseline and 6-months and were analyzed using NDS-R software; diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Availability of foods and beverages in the home was assessed through direct observation using the Home Health Environment tool that classifies foods and beverages as ‘red’ or ‘green’ based upon fat and sugar content. Repeated measures linear mixed effects models were used to examine changes in diet quality and home food environment between conditions (LAUNCH, MI, STC). Results At 6-months, preschoolers in the LAUNCH condition had a higher HEI-2010 total score (62.8 ± 13.7) compared to preschoolers in the MI (54.7 ± 13.4, P = 0.022) and STC (55.8 ± 11.6, P = 0.046) conditions. Regarding the home food environment, families in LAUNCH had significantly less ‘red’ foods in their home at 6-months (12.5 ± 3.4 ‘red’ foods) compared to families in MI (14.0 ± 3.7 ‘red’ foods, P = 0.030), and STC (14.3 ± 3.4 ‘red’ foods, P = 0.006). There were no statistically significant differences across home food environments for number of ‘green’ foods. Conclusion Family-based obesity treatment interventions for preschoolers can improve overall diet quality and alter the home food environment through reductions in ‘red’ foods. Trial registration Clinicaltrials.gov, NCT01546727. Registered March 7, 2012.
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Affiliation(s)
- Shannon M Robson
- Department of Behavioral Health and Nutrition, University of Delaware, 26 N College Avenue, Newark, DE, 19716, USA.
| | - Melissa L Ziegler
- Biostatistics Core, College of Health Sciences, University of Delaware, 540 S. College Avenue, Newark, DE, 19713, USA
| | - Mary Beth McCullough
- Psychology Department, Suffolk University, 73 Tremont Street, Boston, MA, 02108, USA
| | - Cathleen Odar Stough
- Department of Psychology, University of Cincinnati, 47 W Corry Blvd Edwards 1 Bldg Suite 4130, P.O. Box 210376, Cincinnati, OH, 45219, USA
| | - Cynthia Zion
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 3015, Cincinnati, OH, 45229, USA
| | - Stacey L Simon
- Department of Pediatrics, Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 13123 E 16th Ave B395 Aurora, Aurora, CO, 80045, USA
| | - Richard F Ittenbach
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 5041, Cincinnati, OH, 45229, USA
| | - Lori J Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 3015, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA
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6
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Stark LJ, Filigno SS, Bolling C, Ratcliff MB, Kichler JC, Robson SM, Simon SL, McCullough MB, Clifford LM, Stough CO, Zion C, Ittenbach RF. Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial. J Pediatr 2018; 192:115-121.e1. [PMID: 29150147 PMCID: PMC5732872 DOI: 10.1016/j.jpeds.2017.09.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/07/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To test the hypotheses that an innovative skills-based behavioral family clinic and home-based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool-aged children with obesity. STUDY DESIGN Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18-session clinic and home-based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression-based analysis of covariance models. RESULTS A total of 151 of the 167 children randomized met intent-to-treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = -0.32, SD = ±0.33) compared with motivational interviewing (mean = -0.05, SD = ±0.27), P < .001, ω2 = 0.74 and compared with standard care (mean = -0.13, SD = ±0.31), P < .004, ω2 = 0.75. CONCLUSIONS In preschool-age children, an intensive 6-month behavioral skills-based intervention is necessary to reduce obesity. TRIAL REGISTRATION Clinicaltrials.gov NCT01546727.
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Affiliation(s)
- Lori J. Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stephanie Spear Filigno
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Jessica C. Kichler
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shannon M. Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
| | - Stacey L. Simon
- Department of Pediatrics, Division of Pulmonary Medicine, Children’s Hospital Colorado, Aurora, CO
| | - Mary Beth McCullough
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lisa M. Clifford
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Cynthia Zion
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Richard F. Ittenbach
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
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O'Brien EC, Geraghty AA, McAuliffe FM. Successful strategies to improve follow-up for longitudinal birth cohort studies. Contemp Clin Trials 2017; 57:8-9. [DOI: 10.1016/j.cct.2017.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/11/2017] [Indexed: 10/20/2022]
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