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Chau S, Oldman S, Smith SR, Lin CA, Ali S, Duffy VB. Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting. Nutrients 2021; 13:223. [PMID: 33466705 PMCID: PMC7828782 DOI: 10.3390/nu13010223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child's activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child's behaviors. The child's PALS responses appeared reasonable (fair-to-good child-parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child's weight or family's food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.
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Affiliation(s)
- Sarah Chau
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Samantha Oldman
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Sharon R. Smith
- CT Children’s Medical Center, University of CT School of Medicine, Hartford, CT 06269-1101, USA;
| | - Carolyn A. Lin
- Communications Department, University of CT, Storrs, CT 06269-1101, USA;
| | - Saba Ali
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
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MacTavish K, Cistrone A, Kingsnorth S, McPherson AC. Communication tools used in childhood obesity discussions: A scoping review. Child Care Health Dev 2020; 46:651-666. [PMID: 32844408 DOI: 10.1111/cch.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Paediatric healthcare professionals (HCPs) play an essential role in the prevention and management of childhood obesity; however, many report considerable barriers to having weight-related conversations, including a lack of confidence. One way to address this is to use communication tools, such as charts, pictures and handouts. This scoping review's objective was to identify the extent and nature of available tools in the published literature that aimed to support HCPs in having positive weight-related conversations with children and families. METHODS CINAHL, Medline and PsycINFO were systematically searched from 2005 to 2019. Articles were selected based on (a) use of an identified communication tool; (b) tool designed for use with children between the ages of 2 and 18 and/or their parents; (c) tool designed to be used in weight-related discussions; and (d) tool designed to be used by HCPs in a formal healthcare setting. RESULTS Of the 3,596 articles yielded after deduplication, 13 unique communication tools were identified. Tools were grouped according to three themes: (a) help communicate child's weight status; (b) provide a communication framework for HCPs; and (c) actively engage children and/or parents in discussions. Many of the tools were recently developed and had not been evaluated in clinical practice. The clinical utility of each tool was evaluated. CONCLUSION This study identified 13 communication tools HCPs could use when having weight-related discussions. However, there was a lack of evaluation and clinical utility. Only one tool had high clinical utility, and not all tools would be recommended for use in practice.
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Affiliation(s)
- Katherine MacTavish
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Cistrone
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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3
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Mansoor Y, Hale I. Parent perceptions of routine growth monitoring: A scoping review. Paediatr Child Health 2020; 26:154-158. [PMID: 33936334 DOI: 10.1093/pch/pxaa041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Despite being a well-accepted part of paediatric care, little is known about the benefits or potential harms of routine growth monitoring (RGM) from a parent's perspective. Objective To explore parental experiences with RGM. Methods Literature searches were performed on Google Scholar, psycINFO, CINAHL, and PubMed. Included studies were published after 2000 and described parental comprehension, preferences, attitudes toward, and/or behaviour change related to RGM. Results Of 24 reviewed studies, four themes were identified: reliance on growth monitoring, understanding, influence on feeding and behaviour, and response to obesity-related classification. RGM was familiar but not strongly preferred to identify a child's weight status. Parental understanding of RGM was poor, particularly among parents with low socioeconomic status. A common belief was that heavier babies were healthier, while smaller babies should prompt concern. Parents may be anxious and change behaviour in response to RGM, such as by halting breastfeeding, supplementing, or restricting their child's diet. Parents frequently discounted RGM information when their child was identified as overweight, and expressed concerns about self-esteem and eating disorders. Conclusion This scoping review identifies that although RGM is familiar and sometimes reassuring to parents, increased consideration should be given to potential harms from parental perspectives when conducting growth monitoring.
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Affiliation(s)
- Yasmeen Mansoor
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Ilona Hale
- Department of Family Practice, University of British Columbia, Kimberley, British Columbia
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Foster BA, Winkler P, Weinstein K, Parra-Medina D. Developing a patient-centered outcome for targeting early childhood obesity across multiple stakeholders. BMC OBESITY 2018; 5:39. [PMID: 30524744 PMCID: PMC6276184 DOI: 10.1186/s40608-018-0216-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022]
Abstract
Background Patient-centered outcome measures for childhood obesity are limited. Identifying outcomes that patients and families consider important could be a viable avenue for better engagement of patients and interventions that are efficacious and acceptable to patients. Latino children experience high rates of obesity, and under-recognition of obesity in preschool aged children is common. Methods We used growth chart data to identify low-income, Latino children 2-5 years of age with obesity who decreased their adiposity (positive deviants) and a set of controls. We used qualitative interview data to identify themes around goals parents used in addressing weight. Then, we applied a modified Delphi approach across groups of caregivers and providers to identify common goals. We conducted focus groups to explore conflicts and congruency between caregivers and providers related to goals. Using the focus group data, we developed a decision tool for use between patients and providers relevant for early childhood obesity. Results We identified 257 children who successfully reduced adiposity (positive deviants) from 1621 eligible growth charts. From interviews with 44 parents (21 positive deviants and 23 controls), we coded and categorized outcomes such as increased happiness, clothing size and improved activity. We recruited 81 parents, grandparents and health care providers to participate in the modified Delphi process of ranking outcomes by importance and feasibility. Focus groups (2, total n = 24) suggested potential methods for a common framework to discuss goals, including a modified growth chart. We created a decision-tool that incorporated a growth chart and a section for discussion of patient-centered goals. A final focus group (1, n = 10) provided feedback on the tool as acceptable and potentially useful. Conclusions The development of a patient-centered tool around achieving a healthy weight in early childhood identified common goals between providers and parents. While the tool has been developed, prospective testing of this patient-centered tool and its effects on engagement, parent motivation, and behavior change would be a useful next step.
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Affiliation(s)
- Byron A Foster
- 1Departments of Pediatrics and Dermatology, Oregon Health & Science University, Portland, OR USA
| | - Paula Winkler
- 2Center for Research to Advance Community Health, University of Texas Health San Antonio, San Antonio, TX USA
| | - Kelsey Weinstein
- 1Departments of Pediatrics and Dermatology, Oregon Health & Science University, Portland, OR USA
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Dawson AM, Brown DA, Williams SM, Taylor BJ, Ross J, Taylor RW. Parental reactions to weight screening in young children: a randomized controlled trial. Pediatr Obes 2018; 13:639-646. [PMID: 27863185 DOI: 10.1111/ijpo.12195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/25/2016] [Accepted: 09/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parental inability to recognize child overweight and physician reluctance to instigate discussion prevents behaviour change. OBJECTIVE To evaluate parental acceptance of child overweight status following screening. METHODS Interviewers used motivational interviewing or best practice care to discuss overweight status of 271 young children (BMI ≥ 85th ) with parents using simple traffic-light BMI charts. Follow-up sessions two weeks later (n = 251, 93%) were coded qualitatively to assess parental reactions to the information (overweight diagnosis) and how it was presented (feedback condition). RESULTS Eight-two percent of parents rated the charts positively with few (8-10%) feeling judged. Motivational interviewing parents viewed feedback as more empathetic (relative risk, 95% CI: 4.07, 1.64-10.09), but more uncomfortable (12.2, 1.48-100.1) than best practice care parents. Overall, 65.2% of parents accepted their child was overweight, 22.1% were ambivalent and 12.7% rejected the information. Although motivational interviewing parents were less likely to accept it (OR, 95% CI: 0.49, 0.37-0.64) and more likely to be ambivalent (2.01, 1.17-3.47), the most important predictor of acceptance was a positive experience of feedback (P < 0.001). CONCLUSIONS Simple traffic-light charts facilitate discussion of child overweight status with parents. Style of feedback is less relevant than ensuring a positive experience for parents to increase acceptance of the weight information.
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Affiliation(s)
- A M Dawson
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - D A Brown
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - S M Williams
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - B J Taylor
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - J Ross
- General Practice, University of Otago, Dunedin, New Zealand
| | - R W Taylor
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Byrne JLS, Cameron Wild T, Maximova K, Browne NE, Holt NL, Cave AJ, Martz P, Ellendt C, Ball GDC. A brief eHealth tool delivered in primary care to help parents prevent childhood obesity: a randomized controlled trial. Pediatr Obes 2018; 13:659-667. [PMID: 27863165 DOI: 10.1111/ijpo.12200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/25/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the feasibility and preliminary impact of an electronic health (eHealth) screening, brief intervention and referral to treatment (SBIRT) delivered in primary care to help parents prevent childhood obesity. METHODS Parents of children (5-17 years) were recruited from a primary care clinic. Children's measured height and weight were entered into the SBIRT on a study-designated tablet. The SBIRT screened for children's weight status, block randomized parents to one of four brief interventions or an eHealth control and provided parents with a menu of optional obesity prevention resources. Feasibility was determined by parents' interest in, and uptake of, the SBIRT. Preliminary impact was based on parents' concern about children's weight status and intention to change lifestyle behaviours post-SBIRT. RESULTS Parents (n = 226) of children (9.9 ± 3.4 years) were primarily biological mothers (87.6%) and Caucasian (70.4%). The proportion of participants recruited (84.3%) along with parents who selected optional resources within the SBIRT (85.8%) supported feasibility. Secondary outcomes did not vary across groups, but non-Caucasian parents classified as inaccurate estimators of children's weight status reported higher levels of concern and intention to change post-SBIRT. CONCLUSIONS Our innovative, eHealth SBIRT was feasible in primary care and has the potential to encourage parents of unhealthy weight children towards preventative action.
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Affiliation(s)
- J L S Byrne
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - K Maximova
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - N E Browne
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - N L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - A J Cave
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - P Martz
- Public Health and Wellness Branch, Government of Alberta, Edmonton, Alberta, Canada
| | - C Ellendt
- Primary Health Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - G D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Alexander DS, Alfonso ML, Cao C. Development and psychometric testing of the childhood obesity perceptions (COP) survey among African American caregivers: A tool for obesity prevention program planning. EVALUATION AND PROGRAM PLANNING 2016; 59:33-40. [PMID: 27521872 DOI: 10.1016/j.evalprogplan.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/26/2016] [Indexed: 06/06/2023]
Abstract
Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver's perceptions of childhood obesity in rural communities is an important prevention effort. This article's objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (α=0.70-0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs.
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Affiliation(s)
- Dayna S Alexander
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Asheville, NC 28804, United States; Georgia Southern University, Jiann-Ping Hsu College of Public Health, Department of Community Health Behavior & Education, Statesboro, GA 30460, United States.
| | - Moya L Alfonso
- Georgia Southern University, Jiann-Ping Hsu College of Public Health, Department of Community Health Behavior & Education, Statesboro, GA 30460, United States.
| | - Chunhua Cao
- University of South Florida, Department of Educational Measurement and Research, Tampa, FL 33620, United States.
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Towner EK, Clifford LM, McCullough MB, Stough CO, Stark LJ. Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps. Pediatr Clin North Am 2016; 63:481-510. [PMID: 27261546 PMCID: PMC6246919 DOI: 10.1016/j.pcl.2016.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.
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Affiliation(s)
- Elizabeth K Towner
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Wayne State University, IBio 6135 Woodward Avenue, H206, Detroit, MI 48202, USA.
| | - Lisa M Clifford
- Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA
| | - Mary Beth McCullough
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Cathleen Odar Stough
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
| | - Lori J Stark
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 3015, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
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Avis JLS, Komarnicki A, Farmer AP, Holt NL, Perez A, Spence N, Ball GDC. Tools and resources for preventing childhood obesity in primary care: A method of evaluation and preliminary assessment. PATIENT EDUCATION AND COUNSELING 2016; 99:769-775. [PMID: 26742609 DOI: 10.1016/j.pec.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/30/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To pilot-test a mixed methods approach to evaluate tools and resources (TRs) that healthcare providers (HCPs) use for preventing childhood obesity in primary care, and report a preliminary descriptive assessment of commonly-used TRs. METHODS This mixed methods study included individual, semi-structured interviews with purposefully-sampled HCPs in Alberta, Canada; interviews were digitally recorded and analyzed thematically (phase I). Two independent reviewers used three assessment checklists to evaluate commonly-used TRs (phase II). HCPs provided feedback on our coding scheme and checklist data (phase III). RESULTS Three themes described how HCPs (n=19) used TRs: purpose of use (e.g., clinical support), logistical factors (e.g., accessibility), and decision to use (e.g., suitability). The latter theme overlapped with constructs of suitability on the checklists. Overall, participants used 15 TRs, most of which scored 'average' on the checklists. CONCLUSION Phases I and II provided unique insights on the evaluation of TRs used for preventing childhood obesity. Criteria on the checklists overlapped with HCPs' perceptions of TR suitability, but did not reflect logistical factors that influenced their use of TRs. PRACTICE IMPLICATIONS Developers of TRs should collaborate with HCPs to ensure that subjective and objective criteria are used to optimize TR suitability in the primary care setting.
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Affiliation(s)
- Jillian L S Avis
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Angela Komarnicki
- Department of Agricultural, Food & Nutrition Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna P Farmer
- Department of Agricultural, Food & Nutrition Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Nicholas L Holt
- Faculty of Physical Education & Recreation, University of Alberta, Edmonton, AB, Canada
| | - Arnaldo Perez
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Spence
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Department of Agricultural, Food & Nutrition Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB, Canada; Pediatric Centre for Weight and Health, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
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Simmonds M, Burch J, Llewellyn A, Griffiths C, Yang H, Owen C, Duffy S, Woolacott N. The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis. Health Technol Assess 2016; 19:1-336. [PMID: 26108433 DOI: 10.3310/hta19430] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is uncertain which simple measures of childhood obesity are best for predicting future obesity-related health problems and the persistence of obesity into adolescence and adulthood. OBJECTIVES To investigate the ability of simple measures, such as body mass index (BMI), to predict the persistence of obesity from childhood into adulthood and to predict obesity-related adult morbidities. To investigate how accurately simple measures diagnose obesity in children, and how acceptable these measures are to children, carers and health professionals. DATA SOURCES Multiple sources including MEDLINE, EMBASE and The Cochrane Library were searched from 2008 to 2013. METHODS Systematic reviews and a meta-analysis were carried out of large cohort studies on the association between childhood obesity and adult obesity; the association between childhood obesity and obesity-related morbidities in adulthood; and the diagnostic accuracy of simple childhood obesity measures. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and a modified version of the Quality in Prognosis Studies (QUIPS) tool. A systematic review and an elicitation exercise were conducted on the acceptability of the simple measures. RESULTS Thirty-seven studies (22 cohorts) were included in the review of prediction of adult morbidities. Twenty-three studies (16 cohorts) were included in the tracking review. All studies included BMI. There were very few studies of other measures. There was a strong positive association between high childhood BMI and adult obesity [odds ratio 5.21, 95% confidence interval (CI) 4.50 to 6.02]. A positive association was found between high childhood BMI and adult coronary heart disease, diabetes and a range of cancers, but not stroke or breast cancer. The predictive accuracy of childhood BMI to predict any adult morbidity was very low, with most morbidities occurring in adults who were of healthy weight in childhood. Predictive accuracy of childhood obesity was moderate for predicting adult obesity, with a sensitivity of 30% and a specificity of 98%. Persistence of obesity from adolescence to adulthood was high. Thirty-four studies were included in the diagnostic accuracy review. Most of the studies used the least reliable reference standard (dual-energy X-ray absorptiometry); only 24% of studies were of high quality. The sensitivity of BMI for diagnosing obesity and overweight varied considerably; specificity was less variable. Pooled sensitivity of BMI was 74% (95% CI 64.2% to 81.8%) and pooled specificity was 95% (95% CI 92.2% to 96.4%). The acceptability to children and their carers of BMI or other common simple measures was generally good. LIMITATIONS Little evidence was available regarding childhood measures other than BMI. No individual-level analysis could be performed. CONCLUSIONS Childhood BMI is not a good predictor of adult obesity or adult disease; the majority of obese adults were not obese as children and most obesity-related adult morbidity occurs in adults who had a healthy childhood weight. However, obesity (as measured using BMI) was found to persist from childhood to adulthood, with most obese adolescents also being obese in adulthood. BMI was found to be reasonably good for diagnosing obesity during childhood. There is no convincing evidence suggesting that any simple measure is better than BMI for diagnosing obesity in childhood or predicting adult obesity and morbidity. Further research on obesity measures other than BMI is needed to determine which is the best tool for diagnosing childhood obesity, and new cohort studies are needed to investigate the impact of contemporary childhood obesity on adult obesity and obesity-related morbidities. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005711. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jane Burch
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Huiqin Yang
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Christopher Owen
- Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - Steven Duffy
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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Avis JLS, Holt NL, Maximova K, van Mierlo T, Fournier R, Padwal R, Cave AL, Martz P, Ball GDC. The Development and Refinement of an e-Health Screening, Brief Intervention, and Referral to Treatment for Parents to Prevent Childhood Obesity in Primary Care. Telemed J E Health 2015; 22:385-94. [PMID: 26451901 DOI: 10.1089/tmj.2015.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nearly one-third of Canadian children can be categorized as overweight or obese. There is a growing interest in applying e-health approaches to prevent unhealthy weight gain in children, especially in settings that families access regularly. Our objective was to develop and refine an e-health screening, brief intervention, and referral to treatment (SBIRT) for parents to help prevent childhood obesity in primary care. MATERIALS AND METHODS Our SBIRT, titled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), was developed by our research team and an e-health intervention development company. RIPPLE was based on existing SBIRT models and contemporary literature on children's lifestyle behaviors. Refinements to RIPPLE were guided by feedback from five focus groups (6-10 participants per group) that documented perceptions of the SBIRT by participants (healthcare professionals [n = 20], parents [n = 10], and researchers and graduate trainees [n = 8]). Focus group commentaries were transcribed in real time using a court reporter. Data were analyzed thematically. RESULTS Participants viewed RIPPLE as a practical, well-designed, and novel tool to facilitate the prevention of childhood obesity in primary care. However, they also perceived that RIPPLE may elicit negative reactions from some parents and suggested improvements to specific elements (e.g., weight-related terms). CONCLUSIONS RIPPLE may enhance parents' awareness of children's weight status and motivation to change their children's lifestyle behaviors but should be improved prior to implementation. Findings from this research directly informed revisions to our SBIRT, which will undergo preliminary testing in a randomized controlled trial.
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Affiliation(s)
- Jillian L S Avis
- 1 Department of Pediatrics, University of Alberta , Edmonton, Alberta, Canada
| | - Nicholas L Holt
- 2 Faculty of Physical Education and Recreation, University of Alberta , Edmonton, Alberta, Canada
| | - Katerina Maximova
- 3 School of Public Health, University of Alberta , Edmonton, Alberta, Canada
| | - Trevor van Mierlo
- 4 Evolution Health Systems Inc., Toronto, Ontario, Canada .,5 Business School, University of Reading, Oxfordshire, United Kingdom
| | - Rachel Fournier
- 4 Evolution Health Systems Inc., Toronto, Ontario, Canada .,5 Business School, University of Reading, Oxfordshire, United Kingdom
| | - Raj Padwal
- 6 Department of Medicine, University of Alberta , Edmonton, Alberta, Canada
| | - Andrew L Cave
- 7 Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - Patricia Martz
- 8 Public Health and Wellness Branch , Health Services Division, Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- 1 Department of Pediatrics, University of Alberta , Edmonton, Alberta, Canada .,9 Pediatric Centre for Weight and Health, Stollery Children's Hospital , Edmonton, Alberta, Canada
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Avis JL, Cave AL, Donaldson S, Ellendt C, Holt NL, Jelinski S, Martz P, Maximova K, Padwal R, Wild TC, Ball GD. Working With Parents to Prevent Childhood Obesity: Protocol for a Primary Care-Based eHealth Study. JMIR Res Protoc 2015; 4:e35. [PMID: 25831265 PMCID: PMC4390613 DOI: 10.2196/resprot.4147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/13/2022] Open
Abstract
Background Parents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents’ motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention. Objective (1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents’ concern for, and motivation to, support children’s healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial. Methods This is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III).
Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company.
Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT.
Phase III: Parents (n=200) of children—boys and girls, 5 to 17 years old—will be recruited from a primary care pediatric clinic while they await their children’s clinical appointment. Parents will be randomly assigned to one of five groups—four intervention groups and one control group—as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children’s dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome). Results This research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016. Conclusions The proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children’s healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or “nudge” individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings. Trial Registration ClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).
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Affiliation(s)
- Jillian Ls Avis
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Gorin AA, Wiley J, Ohannessian CM, Hernandez D, Grant A, Cloutier MM. Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health 2014; 14:72. [PMID: 24456698 PMCID: PMC3933325 DOI: 10.1186/1471-2458-14-72] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/05/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old. METHODS/DESIGN Mother-child dyads (targeted n = 150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC + Phone); or 3) BMC plus monthly home visits by a CHW (BMC + Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child's BMI percentile. We hypothesize that BMC + Phone and BMC + Home will produce greater reductions in BMI percentiles than BMC alone and that BMC + Home will produce greater reductions in BMI percentiles than BMC + Phone. DISCUSSION Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families. TRIAL REGISTRATION ClinicalTrials.gov NCT01973153.
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Affiliation(s)
- Amy A Gorin
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - James Wiley
- Children’s Center for Community Research, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Christine McCauley Ohannessian
- Children’s Center for Community Research, Connecticut Children’s Medical Center, University of Connecticut Health Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Dominica Hernandez
- Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - Autherene Grant
- Children’s Center for Community Research, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Michelle M Cloutier
- Children’s Center for Community Research, Connecticut Children’s Medical Center, University of Connecticut Health Center, 282 Washington Street, Hartford, CT 06106, USA
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