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Staiano AE, Button AM, Baker A, Beyl R, Conn AM, Lima A, Lindros J, Newton RL, Stein RI, Welch RR, Cook S, Wilfley DE. A pragmatic trial of a family-centered approach to childhood obesity treatment: Rationale and study design. Contemp Clin Trials 2024; 138:107459. [PMID: 38278478 PMCID: PMC10922779 DOI: 10.1016/j.cct.2024.107459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Family-based behavioral treatment (FBT) is an effective intensive health behavior and lifestyle treatment for obesity reduction in children and adolescents, but families have limited access. The purpose of this randomized, pragmatic, comparative effectiveness trial was to examine changes in child relative weight in a 12-month, enhanced standard of care (eSOC) intervention combined with FBT (eSOC+FBT) vs. eSOC alone. METHODS Children aged 6 to 15 years with obesity, and their primary caregiver, were recruited from primary care clinics. Families were randomized 1:1 to eSOC, a staged approach led by the primary care provider that gradually intensified dependent on a child's response to care and aligns with the American Medical Association guidelines, or the eSOC+FBT arm, which included regular meetings with a health coach for healthy eating, physical activity, positive parenting strategies, and managing social and environmental cues. Both treatments align with the 2023 American Academy of Pediatrics clinical practice guidelines. Assessments occurred at baseline, midpoint (month 6), end-of-intervention (month 12), and follow-up (month 18). Primary outcome was change from baseline to 12 months in child percent overweight (percentage above the median body mass index in the general US population normalized for age and sex). Secondary outcomes were parent weight, child psychosocial factors, heterogeneity of treatment effects, and cardiometabolic risk factors. Exploratory outcomes assessed reach, effectiveness, adoption, implementation, and maintenance. CONCLUSION This pragmatic trial will generate evidence for the comparative effectiveness of implementing two guidelines-based approaches in primary care for obesity reduction in children and adolescents. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843424.
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Affiliation(s)
- Amanda E Staiano
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America.
| | - Alyssa M Button
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Alison Baker
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robbie Beyl
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Anne-Marie Conn
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Angela Lima
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Jeanne Lindros
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Richard I Stein
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - R Robinson Welch
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Stephen Cook
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Denise E Wilfley
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
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Park SH, Cormier E, Grove K, Kelley SJ, Faith MS. Health-related behaviors and weight-related outcomes within sibling pairs: A systematic review. J Pediatr Nurs 2023; 73:e154-e163. [PMID: 37582674 DOI: 10.1016/j.pedn.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Siblings reciprocally contribute to mutual social and physical development. The aim of this review was to examine the health-related behaviors and weight-related outcomes within child-sibling pairs and to determine how these factors vary by sibling composition. METHODS Following the PRISMA guidelines, a systematic review of studies published since 2000 obtained from MEDLINE, CINAHL, PubMed, Cochrane Reviews, Web of Science, PsycINFO, Health and Wellness, and Science Direct was performed. The eligibility criteria for inclusion were: 1) peer-reviewed and published in English; 2) included children ages 2 to 20 and their siblings; and 3) explored health-related behaviors (i.e., diet) and/or weight-related outcomes (i.e., body weight) within child-sibling dyads. RESULTS A total of 13 studies were included in the review. The study findings are summarized according to three major themes: 1) sibling concordance in health-related behaviors and weight-related outcomes, 2) differences in health-related behaviors within weight-concordant/weight-discordant sibling dyads, and 3) influence of sibling composition on health-related behaviors and weight-related outcomes. CONCLUSIONS Family-based interventions for childhood obesity may benefit from including siblings as key family members in promoting children's health-related behaviors and preventing excessive weight gain. Future studies should explore variable sibling dynamics (e.g., adoptive siblings) in more culturally/racially diverse families to further explore the role of a sibling in a child's health. IMPLICATIONS TO PRACTICE The findings of this study may help healthcare providers in developing effective family-based obesity interventions for families with more than one child in their household.
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Affiliation(s)
- So Hyun Park
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea.
| | - Eileen Cormier
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL 32306, United States of America.
| | - Kelly Grove
- GIS and Earth Sciences, Paul A. M. Dirac Library, 110 N. Woodward Ave., Tallahassee, FL 32306, United States of America.
| | - Susan J Kelley
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Urban Life Building, Atlanta, GA 30302-3995, United States of America.
| | - Myles S Faith
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo - The State University of New York, 420 Baldy Hall, Buffalo, NY 14260-1000, United States of America.
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Button AM, Paluch RA, Schechtman KB, Wilfley DE, Geller N, Quattrin T, Cook SR, Eneli IU, Epstein LH. Parents, but not their children, demonstrate greater delay discounting with resource scarcity. BMC Public Health 2023; 23:1983. [PMID: 37828503 PMCID: PMC10568819 DOI: 10.1186/s12889-023-16832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity. METHODS The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested. RESULTS Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders. CONCLUSIONS These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.
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Affiliation(s)
- Alyssa M Button
- Division of Population and Public Health Science, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Rocco A Paluch
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA
| | - Kenneth B Schechtman
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA
| | - Stephen R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA.
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Larizza C, Bosoni P, Quaglini S, Chasseur M, Bevolo V, Zuccotti G, Calcaterra V. V-care: An application to support lifestyle improvement in children with obesity. Int J Med Inform 2023; 177:105140. [PMID: 37463558 DOI: 10.1016/j.ijmedinf.2023.105140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Obesity is increasing in the pediatric population, and it represents an important risk factor for the life-long development of several diseases. Although health promotion represents the mainstay of obesity prevention and treatment, lifestyle modification programs are often unsuccessful. OBJECTIVES The purpose of this article is to introduce the V-care app, a mobile health platform specifically developed to offer effective interaction and support young people in a long-term obesity treatment, combining different strategies to maximize the results of the lifestyle modification program and minimize the possibility of dropouts. METHODS The V-care app is based on a conventional client-server architecture, but novelties of our approach are the involvement of families in the lifestyle modification program, and the design inspired to psychological/behavioral change theories, with the aim of raising the chance of patients' compliance to the program. V-care implements a goal-based behavioral intervention, providing specific feedbacks according to the patient's performance. A pilot usability and acceptability study was performed on a sample of thirteen children aged 6-12 years, using a questionnaire with a 5-points Likert scale to evaluate eight system features, identified as essential requirements based on the analysis of strengths and weaknesses of similar systems in literature. RESULTS The pilot study highlighted very high rate of overall friendliness and perceived utility evaluation, while some critical issues emerged especially for the chatbot section, which may be due to the novelty of the technology. The positive evaluation of the design choices is confirmed by the average score greater than 3 for all the questions. CONCLUSIONS The V-care app represents a digital innovation in the pediatric healthcare, and it could be introduced in children's primary healthcare nationwide, with the aim to offer an intervention program for controlling and preventing childhood obesity.
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Affiliation(s)
- Cristiana Larizza
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy.
| | - Pietro Bosoni
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy.
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy.
| | | | | | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy; Department of Biomedical and Clinical Science, University of Milan, Italy.
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Italy.
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Ramel M, Wilfley DE, Tabak R, Lew D, Moursi NA, Kilanowski C, Cook SR, Eneli IU, Quattrin T, Schechtman KB, Epstein LH. Relationships examined: Parent and child readiness to change and sociodemographic characteristics in family based weight loss treatment. Pediatr Obes 2023; 18:e13062. [PMID: 37282798 PMCID: PMC11342443 DOI: 10.1111/ijpo.13062] [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: 09/08/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Family based treatment is an effective, multipronged approach to address obesity as it plagues families. OBJECTIVE To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study. METHODS Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline. RESULTS A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (-0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, -0.10, p < 0.05), and Other, non-Hispanic (-0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non-Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change. CONCLUSIONS Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.
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Affiliation(s)
- Melissa Ramel
- Department of Family and Consumer Sciences, Fontbonne University, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Nasreen A. Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Ihouma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth B. Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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6
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Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB. Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA 2023; 329:1947-1956. [PMID: 37314275 PMCID: PMC10265310 DOI: 10.1001/jama.2023.8061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023]
Abstract
Importance Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration ClinicalTrials.gov Identifier: NCT02873715.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Ihuoma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Lew
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Peter Dore
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Rocco A. Paluch
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
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Heerman WJ, Paul IM, Staiano AE. Behavioral Interventions for Treating Childhood Obesity. JAMA 2023; 329:1920-1921. [PMID: 37314286 DOI: 10.1001/jama.2023.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Ian M Paul
- Penn State College of Medicine, Hershey, Pennsylvania
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Skjåkødegård HF, Hystad S, Bruserud I, Conlon RPK, Wilfley D, Frisk B, Roelants M, Juliusson PB, Danielsen YS. Perceived barriers in family-based behavioural treatment of paediatric obesity - Results from the FABO study. Pediatr Obes 2023; 18:e12992. [PMID: 36468217 PMCID: PMC10078207 DOI: 10.1111/ijpo.12992] [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: 06/01/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND To date, few studies have investigated perceived barriers among those who participate in and drop out of family-based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice. OBJECTIVES To compare perceived barriers to participating in a family-based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment. METHODS Data were analysed from 90 families of children and adolescents (mean (M) age = 12.8 years, standard deviation (SD) = 3.05) with severe obesity enrolled in a 17-session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5-point Likert scale (1 = never a problem, 5 = very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment, 2. Treatment demands and issues, 3. Perceived relevance of treatment, 4. Relationship with the therapist. RESULTS Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment (M = 2.03, SD = 0.53 vs. M = 1.70, SD = 0.42), p = 0.010 and perceived relevance of treatment (M = 2.27, SD = 0.48 vs. M = 1.80, SD = 0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed. CONCLUSION Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.
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Affiliation(s)
| | - Sigurd Hystad
- Department of Psychosocial ScienceUniversity of BergenBergenNorway
| | - Ingvild Bruserud
- Faculty of HealthVID Specialized UniversityBergenNorway
- Department of PediatricsHaukeland University HospitalBergenNorway
| | - Rachel P. K. Conlon
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Denise Wilfley
- Department of PsychiatryWashington University School of MedicineSt. LouisMissouriUSA
| | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Department of PhysiotherapyHaukeland University HospitalBergenNorway
| | - Mathieu Roelants
- Department of Public Health and Primary CareKU Leuven, University of LeuvenLeuvenBelgium
| | - Petur B. Juliusson
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Children and Youth ClinicHaukeland University HospitalBergenNorway
- Department of Health Registry Research and DevelopmentNorwegian Institute of Public HealthBergenNorway
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Al-Agailat L, Littlejohn E. Emerging Pediatric Obesity Epidemic with the COVID-19 Pandemic as an Influence. Pediatr Ann 2023; 52:e48-e50. [PMID: 36779879 DOI: 10.3928/19382359-20230102-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Obesity remains a significant public health issue that leads to serious acute and chronic diseases. The prevalence of childhood obesity is on the rise, especially when taking into consideration the novel coronavirus disease 2019 (COVID-19) pandemic. Pediatricians and primary care providers can help support children at risk for many obesity-related comorbidities by using a family based approach for intervention. In this review, we will provide a brief overview of childhood obesity with COVID-19 pandemic ramifications and guidance for pediatricians to provide needed support and initial treatment. [Pediatr Ann. 2023;52(2):e48-e50.].
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Skjåkødegård HF, Conlon RPK, Hystad SW, Roelants M, Olsson SJG, Frisk B, Wilfley DE, Danielsen YS, Juliusson PB. Family-based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial. Clin Obes 2022; 12:e12513. [PMID: 35218145 PMCID: PMC9286578 DOI: 10.1111/cob.12513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
To compare the effectiveness of family-based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel-design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6-18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut-off for overweight (%IOTF-25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre- to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10-0.28, p < .001) and %IOTF-25 (5.48%, 95%CI: 2.74-8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: -0.22 to -0.10, p < .001) and %IOTF-25 (6.53%, 95% CI: -8.45 to -4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: -0.03 to 0.09, p = .30) and %IOTF-25 (-1.04%, 95% CI: -2.99 to -0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre- to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight-related outcomes compared to TAU.
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Affiliation(s)
| | - Rachel P. K. Conlon
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Sigurd W. Hystad
- Department of Psychosocial ScienceUniversity of BergenBergenNorway
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU LeuvenUniversity of LeuvenLeuvenBelgium
| | | | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Department of PhysiotherapyHaukeland University HospitalBergenNorway
| | - Denise E. Wilfley
- Department of PsychiatryWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Petur B. Juliusson
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Children and Youth ClinicHaukeland University HospitalBergenNorway
- Department of Health Registry Research and DevelopmentNorwegian Institute of Public HealthBergenNorway
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Jeffries NO, Troendle JF, Geller NL. Evaluating treatment effects in group sequential multivariate longitudinal studies with covariate adjustment. Biometrics 2022:10.1111/biom.13659. [PMID: 35246977 PMCID: PMC9986831 DOI: 10.1111/biom.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/13/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
Jeffries et al. (2018) investigated testing for a treatment difference in the setting of a randomized clinical trial with a single outcome measured longitudinally over a series of common follow-up times while adjusting for covariates. That paper examined the null hypothesis of no difference at any follow-up time versus the alternative of a difference for at least one follow-up time. We extend those results here by considering multivariate outcome measurements, where each individual outcome is examined at common follow-up times. We consider the case where there is interest in first testing for a treatment difference in a global function of the outcomes (e.g., weighted average or sum) with subsequent interest in examining the individual outcomes, should the global function show a treatment difference. Testing is conducted for each follow-up time and may be performed in the setting of a group sequential trial. Testing procedures are developed to determine follow-up times for which a global treatment difference exists and which individual combinations of outcome and follow-up time show evidence of a difference while controlling for multiplicity in outcomes, follow-up, and interim analyses. These approaches are examined in a study evaluating the effects of tissue plasminogen activator on longitudinally obtained stroke severity measurements.
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Affiliation(s)
- Neal O Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - James F Troendle
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Nancy L Geller
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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Fowler LA, Hampl SE, Dreyer Gillette ML, Staiano AE, Kracht CL, Graham AK, Gabbert S, Springstroh K, Thomas F, Nelson L, Hampp AE, Carlson JA, Welch R, Wilfley DE. Translating Family-Based Behavioral Treatment for Childhood Obesity into a User-Friendly Digital Package for Delivery to Low-Income Families through Primary Care Partnerships: The MO-CORD Study. Child Obes 2021; 17:S30-S38. [PMID: 34569844 PMCID: PMC8575055 DOI: 10.1089/chi.2021.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project 3.0 (CORD), the Missouri CORD (MO-CORD) team aims to increase access to and dissemination of an efficacious pediatric obesity treatment, family-based behavioral treatment (FBT), among low-income families. This article describes the MO-CORD team's approach to translating FBT into a digital package for delivery to low-income families through primary care practices. Methods: Using digital technology, the primary care setting, and existing reimbursement mechanisms, the MO-CORD team is developing a scalable user-centered design informed treatment package of FBT. This package will be implemented in primary care clinics and delivered to children (5-12 years) with obesity from low-income households in rural and urban communities. The digital platform includes three main components: (1) provider and interventionist training, (2) interventionist-facing materials, and (3) family-facing treatment materials. User-centered design techniques and continuous iterative stakeholder feedback are utilized to emphasize tailoring to a low-income population, along with scalability and sustainability of the digital package. Conclusions: The MO-CORD project addresses the critical need to increase access to obesity treatment for children from low-income households and establishes a platform for future large-scale (i.e., nation-wide) dissemination of evidence-based pediatric weight-management interventions. This study determines whether the digital FBT package can be implemented within real-world settings to create a system by which children with obesity and their families can be effectively treated in primary care settings.
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Affiliation(s)
- Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah E. Hampl
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | | | | | | | - Andrea K. Graham
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sherri Gabbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Springstroh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Fanice Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Aubrie E. Hampp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jordan A. Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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