Evidence base for the prevention and management of child obesity

Blindspot in the evidence base: A systematic review of psychological interventions for children and adolescents with intellectual disabilities and co-occurring obesity

BACKGROUND

Children and adolescents with intellectual disabilities (C&A-ID) face many disadvantages in healthcare research and service delivery. Intellectual disabilities have been found to precipitate weight-related problems, and together, they may be indicators of rare genetic diseases (RGDs). C&A-ID may require support for health problems exacerbated by primary diagnoses. While it is generally agreed that C&A-ID have more complex needs than typically developing individuals, psychological services to address these needs are under-explored.

AIMS

This systematic review aimed to identify psychological interventions for weight management in C&A-ID.

METHOD

MEDLINE, PsycINFO, CINAHL, The Cochrane Library and SCOPUS were systematically searched. Data extraction and quality appraisal were performed for all eligible studies RESULTS: The search strategy yielded seven studies published in English between 2010 and 2022. All interventions addressed obesity through multi-disciplinary programmes and resulted in weight reductions, with most interventions theoretically influenced by principles of behaviourism. Quality appraisal revealed methodological weaknesses in six of seven studies, such as heterogeneity in samples, interventions, and outcome measures, disallowing meta-analyses and weakening the generalisability of interventions to diverse contexts and groups CONCLUSIONS AND IMPLICATIONS: A genuine disconnect between empirical evidence and services for C&A with complex needs was observed. This emphasises an urgency for increased inclusion in clinical and behavioural research and for robust enquiries to test/adapt psychological interventions for weight management for C&A-ID. The findings of this review hold clinical utility for clinicians working with C&A-ID, and with RGDs such as Bardet-Biedl, Prader-Willi and Down syndromes. Recommendations and a conceptual framework are provided herein for enhanced efficacy of interventions.

Investigating the nutritional value of foods targeting children

PURPOSE

This study aimed to investigate the nutritional values of some low-nutrition packaged foods widely sold in supermarkets and encouraged for consumption.

METHODS

The study used 435 packaged foods from six hypermarkets with high sale capacities in Ankara to analyze their contents of energy/total fat/saturated fat/carbohydrate/sugar/salt based on label information.

RESULTS

Among the products in the scope of the study, the highest values were found in chocolates for fat (33.0 ± 4.28/100 g) and sugar (45.6 ± 5.95/100 g), wafers for saturated fat (19.2 ± 3.89/100 g), and crackers for sodium (0.9 ± 0.23/100 g). Among the 435 packaged foods investigated in the study, the products exceeded the limits designated in the health codes declared by the Turkish Food Codex Labeling Directive in 83.4% of the instances in terms of sugar, 93.7% of the instances in terms of total fat, 92.4% of the instances in terms of saturated fat, and 70.3% of the instances in terms of sodium.

CONCLUSION

Energy/fat/sugar/salt contents were high in the packaged products that are especially targeted for children for higher consumption. Children's frequent and excessive consumption of these products contribute to the prevalence of childhood obesity and increase in related health risks.

LEVEL OF EVIDENCE

Level V, descriptive study.

The FTO rs9939609 polymorphism and obesity risk in teens: Evidence-based meta-analysis

OBJECTIVE

This meta-analysis aims evaluate the association of the polymorphism rs9939609 of FTO with the risk of obesity among children and adolescents, based on the assessment of four genetic models: codominant, dominant, recessive alleles model.

METHODS

Case-control studies, published between the years 2011-2015, were selected from tree available databases (PubMed, Scopus and Web of Science) and were analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Thirteen studies were included totalling 15,613 participants, divided into 7311 cases and 8302 controls.

RESULTS

The FTO rs9939609 polymorphism was significantly associated with increased risk of obesity in children and adolescents for homozygous genotypes AA and heterozygous AT (TT vs. AT+AA: OR=0.723, 95% CI 0.629 to 0.832; p<0.0001).

CONCLUSION

This meta-analysis shows that the FTO rs9939609 polymorphism in the gene is a risk factor for obesity in children and adolescents with the presence of the A allele, both homozygous genotype AA situation, as heterozygous AT.

The difficult conversation: a qualitative evaluation of the 'Eat Well Move More' family weight management service

OBJECTIVE

The Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4-16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates.

RESULTS

We conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12). Data were analysed using thematic analysis. School nurses highlighted three main barriers to making a referral: parent engagement, child autonomy, and concerns over the National Child Measurement Programme letter. GPs highlighted that addressing obesity among children is a 'difficult conversation' with several complex issues related to and sustaining that difficulty. In conclusion, referral into weight management services in the community may persistently lag if a larger and more complex tangle of barriers lie at the point of school nurse and GP decision-making. The national prevalence of, and factors associated with this hesitation to discuss weight management issues with parents and children remains largely unknown.

The association between childcare arrangements and risk of overweight and obesity in childhood: a systematic review

Over 80% of preschool-aged children experience non-parental childcare. Childcare type has the potential to influence weight outcomes, but its impact on childhood overweight/obesity is not well established. This review aims to (i) systematically evaluate the effects of childcare type on childhood overweight/obesity risk and (ii) investigate the impact of childcare intensity and age at commencement. Five electronic databases were searched for observational studies quantifying an association between childcare type ≤5 years and weight outcomes <18 years. Twenty-four studies were included (n = 127,529 children). Thirteen studies reported increased risk of overweight/obesity in children attending informal care (n = 9) or centre care (n = 4) vs. parental care. Seven studies reported decreased risk of overweight/obesity for children in centre vs. 'non-centre' care (parental and informal). Four studies reported no association between informal or centre care and overweight/obesity. Early (<3 years) informal care, especially by a relative, was associated with increased risk of overweight/obesity. Higher intensity childcare, especially when commenced early (<1 year), increased overweight/obesity risk. Later (≥3 years) centre care was associated with decreased risk of overweight/obesity. Early informal care, earlier commencement age and higher intensity represent a risk for childhood obesity. Exploration of the obesogenic aspects of these contexts is essential to inform preventative measures.