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Koball AM, Ames GE, Grothe K. Role of Adverse Childhood Experiences in the Onset of Overweight/Obesity. Curr Obes Rep 2024; 13:574-583. [PMID: 38874702 DOI: 10.1007/s13679-024-00563-2] [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] [Accepted: 03/21/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW The goal of this chapter was to summarize the literature on childhood adversity and obesity, discuss treatment implications with a case example, and provide recommendations for trauma-informed care for clinicians who work with individuals living with obesity. RECENT FINDINGS Adversity in childhood is related directly and indirectly to obesity development. Upstream contributors like adverse childhood experiences (ACEs) and other factors can lead to experiences of toxic stress and increased allostatic load, resulting in downstream effects of obesity and other chronic health conditions. A well-established literature has linked ACEs and obesity suggesting complex interactions between genetic, biological, behavioral, mental health, social, and environmental factors and obesity. Trauma-informed care strategies can be used to optimize care for individuals living with obesity. Care pathways should include individual (clinician) and systemic (organizational) evidence-based interventions.
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Affiliation(s)
| | - Gretchen E Ames
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Karen Grothe
- Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA
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Kernizan D, Connolly S, Turpin D, Zaidi A, Baker-Smith CM. Is Family History for the Management of Cardiovascular Health in Youth Still Relevant in Clinical Practice? Curr Atheroscler Rep 2024:10.1007/s11883-024-01232-4. [PMID: 39190218 DOI: 10.1007/s11883-024-01232-4] [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] [Accepted: 08/15/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE OF REVIEW Family history of premature cardiovascular disease is a strong predictor of individual cardiovascular risk. However, family history is not always available and not always reliable. Roughly 80% of health outcomes are influenced not by genetic risk but by societal factors, including adverse health behaviors and environment. Furthermore, in the present age of genetic testing, laboratory evaluations, and imaging, a key question remains: What is the contemporary relevance of family history screening in the management of cardiovascular disease in youth? RECENT FINDINGS Knowledge of an individual's family history can help clinicians identify not only inherited risk but also familial clustering of unhealthy behaviors and environmental adversity contributing to enhanced cardiovascular disease risk in youth. For those at greatest risk, prevention strategies can be applied sooner and more conservatively. Integrating family history into clinical practice is crucial for cardiovascular risk assessment and for optimizing outcomes, but, in some cases, is more reflective of social factors.
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Affiliation(s)
- Daphney Kernizan
- Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, 2202 State Ave STE 102, Panama City, FL, 32405, USA
- College of Medicine, University of Central Florida, 6535 Nemours Parkway, Orlando, FL, 32827, USA
| | - Sean Connolly
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Road, Wilmington, Delaware, 19803, USA
- Preventive Cardiology Program, Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Road, Wilmington, Delaware, 19803, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dima Turpin
- Preventive Cardiology and Lipid Clinic, 6535 Nemours Parkway, Orlando, FL, 32827, USA
- University of Central Florida, 6535 Nemours Parkway, Orlando, FL, 32827, USA
| | - Abbas Zaidi
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Road, Wilmington, Delaware, 19803, USA
- Preventive Cardiology Program, Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Road, Wilmington, Delaware, 19803, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Road, Wilmington, Delaware, 19803, USA.
- Preventive Cardiology Program, Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Road, Wilmington, Delaware, 19803, USA.
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Braddock A, Browne NT, Houser M, Blair G, Williams DR. Weight stigma and bias: A guide for pediatric clinicians. OBESITY PILLARS 2023; 6:100058. [PMID: 37990653 PMCID: PMC10661884 DOI: 10.1016/j.obpill.2023.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 11/23/2023]
Abstract
Introduction Many children and adolescents with obesity experience weight stigma and bias, which can have detrimental mental health, medical, and social consequences. Weight stigma in the healthcare setting threatens the therapeutic relationship between health care providers and their pediatric patients and families. Methods Data supporting this guidance were derived from cited references. Results Based upon referenced citations, this review offers 7 best practices for pediatric providers to work to reduce weight stigma including: assess for personal weight bias, improve communication, provide a welcoming clinic environment, seek out additional training and informative experiences, evaluate the messaging and culture of the organization, screen for trauma and bullying, and enlist the help of board-certified obesity medicine specialists. Conclusions Providers have an important role in mitigating the harmful effects of weight stigma. It is our hope these recommendations, as well as the other resources provided, will help providers to begin to address their own individual weight biases, as well as the institutional weight biases where we care for patients.
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Affiliation(s)
- Amy Braddock
- University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Nancy T. Browne
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Marcella Houser
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | | | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
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Gorecki MC, Piotrowski ME, Brown CM, Teli RR, Percy Z, Lane L, Bolling CF, Siegel RM, Copeland KA. STEP IN: Supporting Together Exercise and Play and Improving Nutrition; a Feasibility Study of Parent-Led Group Sessions and Fitness Trackers to Improve Family Healthy Lifestyle Behaviors in a Low-Income, Predominantly Black Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5686. [PMID: 37174204 PMCID: PMC10178511 DOI: 10.3390/ijerph20095686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Pediatric obesity is prevalent and challenging to treat. Although family-centered behavioral management is the gold standard, many families face structural inequities to its access and efficacy. Identifying ways to manage pediatric obesity within primary care is needed. METHODS This feasibility study included three sequential trials of peer-led group sessions occurring biweekly or monthly between 3/2016 and 2/2017. Parent-child dyads were recruited from a large academic primary care clinic via mailed invitations, prioritizing patients living in local zip codes of historical disinvestment. Eligible patients were 6 to 12 years with a body mass index ≥85th percentile, with parent and child interest in making healthy lifestyle changes, and English speaking. RESULTS 27 dyads participated, 77% were non-Hispanic Black. Retention and attendance rates were highest in the initial four-session biweekly pilot (100%, 0 dropouts), high in the full six-session biweekly cohort (83%, 1 dropout), and moderate in the monthly cohort (62.7%, 4 dropouts). Families reported high satisfaction with the sessions (4.75/5). Qualitative comments suggested social connections had motivated behavior change in some families. CONCLUSION Parent-led group sessions for pediatric weight management show promise in engaging families. A future large trial is needed to assess behavior change and anthropometric outcomes.
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Affiliation(s)
- Michelle C. Gorecki
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Megan E. Piotrowski
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Courtney M. Brown
- Department of Pediatrics, Division of Primary Care Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Radhika R. Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zana Percy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Laura Lane
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Christopher F. Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Robert M. Siegel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kristen A. Copeland
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Williams DR, Chaves E, Karp SM, Browne NT. Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity. OBESITY PILLARS 2023; 5:100052. [PMID: 37990746 PMCID: PMC10662032 DOI: 10.1016/j.obpill.2022.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 11/23/2023]
Abstract
Background Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual. Methods This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology. Results TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience. Conclusion Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
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Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Eileen Chaves
- Neuropsychology & Pediatric Psychology, The Ohio State University, College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Sharon M. Karp
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN, 37240, USA
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Paponetti MK, Zwolski C, Porter R, Paterno MV. Leveraging the construct of physical literacy to promote physical activity for youth with obesity - A qualitative analysis of physical therapists' perceptions. OBESITY PILLARS 2023; 5:100054. [PMID: 37990742 PMCID: PMC10662039 DOI: 10.1016/j.obpill.2022.100054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 11/23/2023]
Abstract
Background Promoting physical activity has been identified as a pillar of obesity treatment and prevention. However, youth with obesity often present with physical, affective, and environmental barriers to physical activity engagement. The construct of physical literacy, which has garnered international attention as a holistic approach to understanding human movement, may improve physical activity promotion strategies for youth with obesity. However, literature has shown that healthcare providers are not engaged with the construct of physical literacy. Methods This qualitative study utilized a phenomenological approach and interpretivist epistemology. Three phases of data collection included member checks, semi-structured interviews, and a focus group with physical therapists treating youth with orthopedic and sport injuries. Simultaneous data collection and inductive analysis was designed to identify themes reflecting how participants utilized the construct of physical literacy to promote physical activity in a clinical setting. Results Four overarching themes were identified in our analysis as strategies for promoting activity and physical literacy development: 1) Movement Experience, 2) Individualized Care, 3) Movement Momentum, and 4) External Factors. Conclusion The findings from this study highlight the usefulness of applying a physical literacy lens within physical activity promotion efforts among youth, which may be particularly important for youth with obesity. A high value was placed on the affective and behavioral determinants of physical activity. By applying a physical literacy lens, healthcare providers treating youth with obesity may be better equipped to address barriers and promote participation in physical activities that are enjoyable and build confidence. The findings from this study provide a foundation for future studies examining how healthcare providers can leverage the construct of physical literacy to improve physical activity outcomes among youth.
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Affiliation(s)
- Matthew K. Paponetti
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, 584 County Line Road West, Westerville, OH, 43082, United States
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, United States
| | - Christin Zwolski
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Rose Porter
- Doctor of Physical Therapy Program, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Mark V. Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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