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Aman-Braaksma S, Croker H, Viner RM, Nicholls D. Exploring predictors and moderators of response to multimodal obesity treatment in children. Arch Dis Child 2023; 108:405-409. [PMID: 36746608 DOI: 10.1136/archdischild-2022-325013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether specific psychological factors influence intervention effects for children with severe obesity in a clinical setting. DESIGN Secondary analyses of data about attention deficit/hyperactivity disorder (ADHD) characteristics, body satisfaction, social and emotional functioning, and the primary outcome, change in body mass index (BMI), were available for 41 out of 72 children and their families randomised to family-based behavioural treatment over 6 months or waiting list control. Regression analyses, with an interaction term for treatment condition, were performed to explore baseline factors and moderators of outcome. RESULTS Parents reporting their child's emotional well-being as high and high maternal education significantly predicted less weight loss for the total sample, with no effect of ethnicity, age, sex or baseline BMI. Children's social functioning was a significant moderator of treatment effect; children with high social function showed a decrease in BMI after 6 months of therapy (R2=0.08-0.13), whereas an increase in BMI was observed in children with high social function who waited for treatment. For children with poor social function, no treatment effect was observed-subjects lost weight in both conditions. No significant moderation effect was found for body (dis)satisfaction, emotional status, comorbid depression or ADHD, adjusting for baseline BMI, age, sex and ethnicity. CONCLUSIONS These preliminary findings suggest directions for development of tailored obesity programmes. Professionals engaged in treatment of childhood obesity should consider a child's emotional and social functioning when considering group obesity intervention, as well as the risks of no intervention.
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Affiliation(s)
| | - Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London, London, UK
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2
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Rosenbaum M, Garofano R, Liimatta K, McArthur K, Paul E, Starc T, Sopher AB, Thaker V, Baidal JW. The Families Improving Health Together (FIT) Program: Initial evaluation of retention and research in a multispecialty clinic for children with obesity. Obes Sci Pract 2021; 7:357-367. [PMID: 34401195 PMCID: PMC8346376 DOI: 10.1002/osp4.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity affects ∼17% of US children, with parallel increases in multiple comorbidities, especially among African-, Asian-, Hispanic-, and Native-Americans. Barriers to patient retention in pediatric obesity programs include lack of centralized care, and frequent subspecialty MD visits which conflict with patient school attendance and parental work attendance as well as with support service utilization. Lack of integration of multispecialty clinical care with interdisciplinary research is a major barrier to fuller exploration of the treatment, prevention, and understanding of obesity in childhood. OBJECTIVE To test the hypothesis, a novel multispecialty/interdisciplinary clinical and research infrastructure with strong emphasis on a primary obesity care physician for children with early-onset (<9 years) obesity (Families Improving health Together [FIT]) could promote lower patient attrition (primary goal) and foster productive research in pediatric obesity (secondary goal). RESULTS Data support the hypotheses. Over 15 months, FIT reported a >90% participant retention (p < 0.001 vs. expected rate based on other studies of similar programs). Though 90% of children had at least one adiposity-related comorbidity and 70% had at least two, there was no need for additional subspecialist visits with cardiologists, endocrinologists, gastroenterologists, or molecular geneticists. Three abstracts were presented at national meetings, and two manuscripts were published all with junior faculty as primary authors. CONCLUSION This pilot study suggests that an integrated multispecialty/interdisciplinary approach to children with obesity improves patient retention and can be integrated successfully with research.
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Affiliation(s)
- Michael Rosenbaum
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Robert Garofano
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Kalle Liimatta
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Kerry McArthur
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Erin Paul
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Thomas Starc
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Aviva B. Sopher
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Vidhu Thaker
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Jennifer Woo Baidal
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
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Budhwani H, Bulls M, Naar S. Proof of Concept for the FLEX Intervention: Feasibility of Home Based Coaching to Improve Physical Activity Outcomes and Viral Load Suppression among African American Youth Living with HIV. J Int Assoc Provid AIDS Care 2021; 20:2325958220986264. [PMID: 33406973 PMCID: PMC7797566 DOI: 10.1177/2325958220986264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
FLEX is a Motivational Interviewing, home-based coaching program that
concurrently targets HIV-related and physical activity goals among African
American youth living with HIV in the United States. To create and pilot test
FLEX, we leveraged a 2-step exploratory sequential mixed methods design informed
by the ORBIT model with initial qualitative work followed by pre-post analysis
of quantitative outcomes, concluding with qualitative exit surveys. Data were
evaluated pre- and 3-months post-intervention. Recruitment was 90%. Participants
reported high program satisfaction and program adherence (76% completion rate).
Preliminary findings indicate reductions in participants’ viral loads and
improvements across 4 measures of physical activity.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, 9968University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL, USA
| | - Maurice Bulls
- Behavior Change Consulting (BCC), Kansas City, KS, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, 12236Florida State University (FSU) College of Medicine, Tallahassee, FL, USA
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López-Gil JF, Oriol-Granado X, Izquierdo M, Ramírez-Vélez R, Fernández-Vergara O, Olloquequi J, García-Hermoso A. Healthy Lifestyle Behaviors and Their Association with Self-Regulation in Chilean Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5676. [PMID: 32781539 PMCID: PMC7460131 DOI: 10.3390/ijerph17165676] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Self-regulation comprises a series of important competencies, such as the ability to control inner states or responses toward thoughts, attention, emotions, or even performance. The relationship between self-regulation and different healthy lifestyle behaviors among children has not been examined in depth to date. The aim of this study was to explore the association between physical activity, screen time levels, and/or Mediterranean Diet adherence and self-regulation in Chilean children. METHODS A total of 1561 children aged 8-12 years from eight public schools with low socioeconomic status were included. Physical activity, screen time, Mediterranean Diet, and self-regulation were assessed with validated questionnaires. RESULTS Children who were classified as active or those who reported less than 2 h per day of screen time had higher self-regulation than those who were classified as inactive or counterparts with 2 h per day or more of screen time, respectively. Using joint categories, active children both with low and high screen time showed higher self-regulation compared to inactive/high screen time peers. Additionally, active groups with adherence or non-adherence to the Mediterranean Diet had higher self-regulation compared to inactive and non-adherence peers. CONCLUSION Having a greater number of healthy habits, mainly regular physical activity, was associated with higher self-regulation, which might be one potential strategy to promote child social-emotional development.
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Affiliation(s)
- José Francisco López-Gil
- Departamento de Actividad Física y Deporte, Facultad de Ciencias del Deporte, Universidad de Murcia (UM), 30720 San Javier, Region of Murcia, Spain;
| | - Xavier Oriol-Granado
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, Fernández Concha 700, Las Condes, Santiago 7550196, Chile;
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, 31008 Pamplona, Navarra, Spain; (M.I.); (R.R.-V.)
- GICAEDS Group, Faculty of Physical Culture, Sport and Recreation, Universidad Santo Tomás, Bogotá 110311, Colombia
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, 31008 Pamplona, Navarra, Spain; (M.I.); (R.R.-V.)
| | - Omar Fernández-Vergara
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago 71783-5, Chile;
| | - Jordi Olloquequi
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile;
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, 31008 Pamplona, Navarra, Spain; (M.I.); (R.R.-V.)
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, USACH, Santiago 71783-5, Chile;
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Arteaga SS, Esposito L, Osganian SK, Pratt CA, Reedy J, Young-Hyman D. Childhood obesity research at the NIH: Efforts, gaps, and opportunities. Transl Behav Med 2018; 8:962-967. [PMID: 30329138 PMCID: PMC6454453 DOI: 10.1093/tbm/iby090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood obesity is a major public health challenge. This article describes an overview of the National Institutes of Health (NIH) behavioral and social sciences childhood obesity research efforts. The overview will highlight five areas of childhood obesity research supported by the NIH: (a) basic behavioral and social sciences; (b) early childhood; (c) policies, programs, and environmental strategies; (d) health disparities; and (e) transagency and public-private collaboration. The article also describes potential gaps and opportunities in the areas of childhood obesity and severe obesity, measurement, and sleep.
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Affiliation(s)
- S Sonia Arteaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Layla Esposito
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stavroula K Osganian
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charlotte A Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jill Reedy
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Science Research, National Institutes of Health, Bethesda, MD, USA
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Winnicki E, Dharmar M, Tancredi DJ, Nguyen S, Butani L. Effect of BMI on allograft function and survival in pediatric renal transplant recipients. Pediatr Nephrol 2018; 33:1429-1435. [PMID: 29574612 DOI: 10.1007/s00467-018-3942-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/12/2018] [Accepted: 03/07/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether pre-transplant body mass index (BMI) affects renal allograft function and survival in pediatric renal transplant recipients. STUDY DESIGN This is a retrospective cohort study using the Organ Procurement and Transplantation Network data from 2000 to 2013 to compare time to total allograft loss (allograft failure or death), prevalence of delayed graft function, prevalence of acute rejection, and estimated glomerular filtration rate (eGFR) post-transplant in pediatric renal transplant recipients categorized by BMI z-score. RESULTS A total of 8804 kidney transplant recipients met our inclusion criteria, and of those, 6% were underweight, 14% were overweight, and 17% were obese pre-transplant. The adjusted hazard ratio (HR) for allograft failure was significantly higher for obese recipients compared to normal weight recipients (HR 1.25, 95% CI 1.1, 1.42); for every 1 point increase in BMI z-score, there was a 7% increased hazard of allograft failure (HR 1.07; 95% CI 1.03-1.1, p < 0.001). The prevalence of delayed graft function and acute rejection increased with higher BMI z-score category; however, this difference did not reach statistical significance. eGFR at 1 and 5 years post-transplant decreased with higher BMI z-score although it was only statistically significant at 1 year. CONCLUSIONS Obesity is prevalent in pediatric renal transplant recipients, and obese, but not overweight or underweight, pediatric renal transplant recipients have an increased risk of allograft failure. Implementation of effective obesity interventions in pediatric renal transplant recipients is of critical importance to improve longevity of the renal allograft.
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Affiliation(s)
- Erica Winnicki
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Madan Dharmar
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Stephanie Nguyen
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Lavjay Butani
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
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Mensah GA. The Journey From Research Discovery to Optimal Heart Health for All. Glob Heart 2018; 13:61-64. [PMID: 29627103 DOI: 10.1016/j.gheart.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Miller AL, Gearhardt AN, Fredericks EM, Katz B, Shapiro LF, Holden K, Kaciroti N, Gonzalez R, Hunter C, Lumeng JC. Targeting self-regulation to promote health behaviors in children. Behav Res Ther 2018; 101:71-81. [PMID: 29050636 PMCID: PMC5801044 DOI: 10.1016/j.brat.2017.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 01/10/2023]
Abstract
Poor self-regulation (i.e., inability to harness cognitive, emotional, motivational resources to achieve goals) is hypothesized to contribute to unhealthy behaviors across the lifespan. Enhancing early self-regulation may increase positive health outcomes. Obesity is a major public health concern with early-emerging precursors related to self-regulation; it is therefore a good model for understanding self-regulation and health behavior. Preadolescence is a transition when children increase autonomy in health behaviors (e.g., eating, exercise habits), many of which involve self-regulation. This paper presents the scientific rationale for examining self-regulation mechanisms that are hypothesized to relate to health behaviors, specifically obesogenic eating, that have not been examined in children. We describe novel intervention protocols designed to enhance self-regulation skills, specifically executive functioning, emotion regulation, future-oriented thinking, and approach bias. Interventions are delivered via home visits. Assays of self-regulation and obesogenic eating behaviors using behavioral tasks and self-reports are implemented and evaluated to determine feasibility and psychometrics and to test intervention effects. Participants are low-income 9-12 year-old children who have been phenotyped for self-regulation, stress, eating behavior and adiposity through early childhood. Study goals are to examine intervention effects on self-regulation and whether change in self-regulation improves obesogenic eating.
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Affiliation(s)
- Alison L Miller
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Center for Human Growth and Development, University of Michigan, 300 North Ingalls Street, Ann Arbor, MI 48109, United States.
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109, United States.
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
| | - Benjamin Katz
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109, United States.
| | - Lilly Fink Shapiro
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Kelsie Holden
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Niko Kaciroti
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Center for Human Growth and Development, University of Michigan, 300 North Ingalls Street, Ann Arbor, MI 48109, United States.
| | - Richard Gonzalez
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109, United States.
| | - Christine Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, United States.
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, 300 North Ingalls Street, Ann Arbor, MI 48109, United States; Department of Pediatrics, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
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Heifetz A, James T, Morao I, Bodkin MJ, Biggin PC. Guiding lead optimization with GPCR structure modeling and molecular dynamics. Curr Opin Pharmacol 2016; 30:14-21. [DOI: 10.1016/j.coph.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 01/04/2023]
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