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Pratt K, Cotto J, Xu J, Watowicz R, Walston M, Eneli I. Adolescents' and Parents' Perspectives of a Revised Protein-Sparing Modified Fast (rPSMF) for Severe Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3385. [PMID: 31547451 PMCID: PMC6765859 DOI: 10.3390/ijerph16183385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023]
Abstract
The purpose of this pilot study was to assess the acceptability to adolescents (11-18 years old) and their parents using a revised protein-sparing modified fast (rPSMF) for 12 months as an intervention for severe obesity in a tertiary pediatric weight management clinic (PWMC). To assess acceptability (satisfaction, confidence) with the rPSMF protocol, surveys were completed by adolescents and parents at baseline, 1, 3, 6, and 12 months, with adolescent height and weight measured. Analyses were conducted to assess differences in satisfaction and confidence based on adolescent response (weight loss) and adherence to the rPSMF. Adolescents' adherence with the rPSMF was close to 50% in the first 3 months, but dropped to 14.7% at 6 months. Adolescents were most confident with choosing low carbohydrate foods at baseline. Over 12 months, adolescents and parents reported weight loss as "the most liked" part of the rPSMF. Adolescents who were adherent were more satisfied with their weight loss than their non-adherent peers. Parents and adolescents reported lack of food variety and difficulty following the protocol as challenges with the rPSMF. Adolescents and their parents were able to follow the rPSMF protocol, with weight loss, but with decreased adherence over time.
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Affiliation(s)
- Keeley Pratt
- Department of Human Sciences, The Ohio State University, 130 Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210, USA.
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH 43210, USA.
| | - Jennifer Cotto
- Department of Human Sciences, The Ohio State University, 130 Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210, USA
| | - Jinyu Xu
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43210, USA
| | - Rosanna Watowicz
- Department of Nutrition, Case Western University, Cleveland, OH 43210, USA
| | - Marnie Walston
- Department of Pediatrics, Akron Children's Hospital, Akron, OH 43210, USA
| | - Ihuoma Eneli
- Department of Nutrition, Case Western University, Cleveland, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
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Eneli I, Xu J, Tindall A, Watowicz R, Worthington J, Tanner K, Pratt K, Walston M. Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3061. [PMID: 31443606 PMCID: PMC6747308 DOI: 10.3390/ijerph16173061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
Abstract
Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200-1800 calories, 40-60 g of carbohydrate/day and 1.2-1.5 g protein/kg of ideal bodyweight was implemented over 12 months. Twenty-one participants enrolled in the study. Mean age 16.2 ± 1.4 years, females (76.2%) and mean weight at baseline was 119 ± 19.9 kg. Regardless of adherence to the rPSMF, the mean weight change at 1 month was -3.7 ± 3.5 kg, (range -13.5 kg to 0.9 kg); at 3 months was -5.5 ± 5.1 kg, (range -19.3 kg to 1.8 kg) and at 6 months was -4.7 ± 6.6 kg, (range -18.3 kg to 8.6 kg). At 12 months, the mean weight change was -1.3 ± 10.6 kg (range -17.7 kg to 14.8 kg). Parent and child-reported physical and psychosocial quality of life (HRQOL) improved. Despite limited adherence, the rPSMF diet resulted in clinically significant weight loss and improved HRQOL for children and adolescents with severe obesity.
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Affiliation(s)
- Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA.
| | - Jinyu Xu
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Alexis Tindall
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Rosanna Watowicz
- Department of Nutrition, Case Western University, Cleveland, OH 44106, USA
| | - Jennifer Worthington
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kelly Tanner
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Keeley Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Marnie Walston
- Department of Pediatrics, Akron Children's Hospital, Akron, OH 44308, USA
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Foster C, Moore JB, Singletary CR, Skelton JA. Physical activity and family-based obesity treatment: a review of expert recommendations on physical activity in youth. Clin Obes 2018; 8:68-79. [PMID: 29224232 DOI: 10.1111/cob.12230] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/13/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022]
Abstract
Targeting physical inactivity in children is pertinent to aiding in the decrease of childhood obesity rates. Only 33% of adolescents are obtaining the recommended goal of at least 60 min of physical activity per day. The objectives of this review are to summarize professional recommendations for physical activity and exercise in children and adolescents, and identify family-centred strategies that can be implemented by weight management clinicians. Clinically oriented recommendations and policy statements from professional organizations were identified through literature and internet searches, summarized using rubrics of aerobic, muscle strengthening and bone strengthening exercise, then examined for details on family-based focus, inclusion of child developmental stage and age, and application to the prevention and treatment of obesity. Current recommendations give guidelines for the amount of physical activity that children should acquire and how many days a week activities should occur. However, available guidelines need an improved approach to addressing the role of the parents and caregivers in targeting physical activity and weight management in youth. Efforts must be taken in order to make sure that the types of physical activity offered are both suitable and enjoyable. Sports, games, free play and other age appropriate activities are adequate ways to increase moderate to vigorous physical activity in children. Differentiating physical activities types in accordance with developmental stage, level of enjoyment, and family characteristics is needed to establish sustainable habits. One paediatric obesity program has developed approaches to teaching families fun and engaging ways to be active together.
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Affiliation(s)
- C Foster
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - J B Moore
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - C R Singletary
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Alulis S, Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: A qualitative meta-synthesis. Obes Res Clin Pract 2017; 11:627-639. [PMID: 28844833 DOI: 10.1016/j.orcp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child and adolescent obesity trends are rising throughout the world, revealing treatment difficulties and a lack of consensus about treatment. The family system is broadly viewed as a potential setting for facilitation of behaviour change. Therefore, family-based interventions have come into focus. However, the use of theoretical frameworks to strengthen these interventions is rare and very uneven. OBJECTIVE AND METHOD To conduct a qualitative meta-synthesis of family-based interventions for child and adolescent obesity to identify the theoretical frameworks applied, thus understanding how theory is used in practice. A literature review was conducted between January and March 2016. A total of 35 family-based interventions were selected for analysis. RESULTS Eleven interventions explicitly stated that theory guided the development and were classified as theory-inspired. The social cognitive, self-efficacy and Family Systems Theory appeared most frequently. The remaining 24 were classified as theory-related as theoretical elements of self-monitoring; stimulus control, reinforcement and modelling were used. CONCLUSION The designs of family-based interventions reveal numerous inconsistencies and a significant void between research results and health care practice. Based on the analysis, this article proposes three themes to be used as focus points when designing future interventions and when selecting theories for the development of solid, theory-based frameworks for application. The themes are: (1) age of target group, (2) intervention objective, and (3) self-efficacy and readiness for change.
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Affiliation(s)
- Sarah Alulis
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark; Lund University, Paradisgatan 2, 221 00 Lund, Sweden.
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark.
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Asselin J, Osunlana AM, Ogunleye AA, Sharma AM, Campbell-Scherer D. Missing an opportunity: the embedded nature of weight management in primary care. Clin Obes 2015; 5:325-32. [PMID: 26303812 PMCID: PMC5049595 DOI: 10.1111/cob.12115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/25/2015] [Accepted: 07/17/2015] [Indexed: 02/02/2023]
Abstract
The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6-month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi-structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals.
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Affiliation(s)
- J Asselin
- Clinical Research Unit, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Obesity Research & Management, University of Alberta, Edmonton, AB, Canada
| | - A M Osunlana
- Department of Medicine, Obesity Research & Management, University of Alberta, Edmonton, AB, Canada
| | - A A Ogunleye
- Clinical Research Unit, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Obesity Research & Management, University of Alberta, Edmonton, AB, Canada
| | - A M Sharma
- Department of Medicine, Obesity Research & Management, University of Alberta, Edmonton, AB, Canada
| | - D Campbell-Scherer
- Clinical Research Unit, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L. Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet 2013; 113:1375-94. [PMID: 24054714 DOI: 10.1016/j.jand.2013.08.004] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Indexed: 12/17/2022]
Abstract
It is the position of the Academy of Nutrition and Dietetics that prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, as well as consistent and integrated messages and environmental support across all sectors of society to achieve sustained dietary and physical-activity behavior change. This position paper provides guidance and recommendations for levels of intervention targeting overweight and obesity prevention and treatment from preschool age through adolescence. Methods included a review of the literature from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based reviews. Multicomponent interventions show the greatest impact for primary prevention; thus, early childhood and school-based interventions should integrate behavioral and environmental approaches that focus on dietary intake and physical activity using a systems-level approach targeting the multilevel structure of the socioecological model as well as interactions and relationships between levels. Secondary prevention and tertiary prevention/treatment should emphasize sustained family-based, developmentally appropriate approaches that include nutrition education, dietary counseling, parenting skills, behavioral strategies, and physical-activity promotion. For obese youth with concomitant serious comorbidities, structured dietary approaches and pharmacologic agents should be considered, and weight-loss surgery can be considered for severely obese adolescents. Policy and environmental interventions are recommended as feasible and sustainable ways to support healthful lifestyles for children and families. The Academy supports commitment of resources for interventions, policies, and research that promote healthful eating and physical-activity behaviors to ensure that all youth have the opportunity to achieve and maintain a weight that is optimal for health.
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Chintamani, Khandelwal R, Agarwal BB, Ramakant. Current Debates in Surgery - A Cross Sectional Study amongst Indian Surgeons. Indian J Surg 2013; 74:213-6. [PMID: 23730046 DOI: 10.1007/s12262-012-0585-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 05/07/2012] [Indexed: 11/29/2022] Open
Abstract
Surgery like all fields of medicine is evolving rapidly and these new techniques are challenging to replace the existing 'standard of care'. Though some of these advances are here to stay, many of them are driven by a handful of surgeons influenced by market forces. In some controversial topics, there is a problem of plenty and it is difficult for a general surgeon to choose from the various options available. In order to address some of these contentious issues, a cross sectional, questionnaire based study was designed. The questionnaire was posted to surgeons across the country and it included 11 questions (single best answer format) on the current debates in surgery. The questionnaire was answered by 778 surgeons and gave rise to interesting observations. The practice of surgery is an interplay of patient- surgeon and market forces and more comprehensive studies are required to address these controversial topics in surgery.
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Affiliation(s)
- Chintamani
- VMMC Safdarjang Hospital, Sir Ganga Ram Hospital and Association of Surgeons of India, New Delhi, India
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Ehrmann DE, Sallinen BJ, IglayReger HB, Gordon PM, Woolford SJ. Slow and steady: readiness, pretreatment weekly strengthening activity, and pediatric weight management program completion. Child Obes 2013; 9:193-9. [PMID: 23635312 DOI: 10.1089/chi.2013.0006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric weight management programs have substantial attrition rates, which have led to recommendations to assess readiness prior to enrollment. Both pretreatment readiness scales and behaviors, such as exercise, have been theorized to predict subsequent program completion. The purpose of this study was to explore the role of self-reported pretreatment exercise in adolescents on completion of a pediatric weight management program and to explore the predictive ability of standard readiness scales. METHODS A total of 146 obese (BMI≥95(th) percentile) pediatric (ages 11-18) participants joined a 6-month multidisciplinary weight management program between March, 2007, and July, 2010. Completers were compared retrospectively to noncompleters on demographic, readiness, and pretreatment exercise practices from clinic-developed intake questionnaires using univariate analyses. Regression analyses specified the degree to which these variables predicted program completion. RESULTS The 6-month completion rate was 53%. There was no relationship between self-reported readiness and program completion. Self-reported pretreatment weekly strengthening activity (SA) was significantly associated with program completion, compared to those who performed SA either never [univariate odds ratio (OR) 3.18, 95% confidence interval (CI) 1.51-6.68, p=0.002; multivariate OR 2.43, 95% CI 1.06-5.58, p=0.036] or daily (univariate OR 4.90, 95% CI 1.74-13.77, p=0.002; multivariate OR 4.69, 95% CI 1.45-15.14, p=0.010). No relationship was found between other forms of exercise and program completion. CONCLUSIONS Self-reported pretreatment weekly SA, but not standard readiness scales, predicted pediatric weight management program completion.
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Sallinen BJ, Schaffer S, Woolford SJ. In their own words: learning from families attending a multidisciplinary pediatric weight management program at the YMCA. Child Obes 2013; 9:200-7. [PMID: 23631344 DOI: 10.1089/chi.2012.0106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A family-based multidisciplinary weight management program for obese children 7-11 years old was implemented by a pediatric weight management center and local YMCA. The purpose of this study was to explore parents' and children's perceptions of the program to gain insight about factors that may enhance engagement and retention of families in weight management treatment. METHODS Families were invited to participate in a telephone interview after their participation in the program. The interviews assessed satisfaction with program components, acceptability of the intervention, barriers to treatment participation, and suggestions for improvement. RESULTS A total of 34 semistructured telephone interviews were performed, including 19 parents and 15 children. The majority of children (mean age=9.2±1.5 years) interviewed were female (74%) and recipients of Medicaid (79%). The population was racially diverse (63% black, 26% white, 11% other). Results suggest families were generally very positive about the program and viewed the major components of the program as helpful (i.e., nutrition, exercise, behavior). Families particularly enjoyed exercise and cooking demonstrations, whereas self-monitoring activities and learning about behavior change strategies were less enjoyable. Parents noted that increasing the length of individual sessions would likely be beneficial. Families who did not complete the program cited factors such as transportation barriers (e.g., gas money, distance), scheduling conflicts, and unmet expectations as contributing to their decision to discontinue participation. CONCLUSIONS This study may have implications for how to enhance family-based pediatric weight management programs for children ages 7-11 years.
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Affiliation(s)
- Bethany J Sallinen
- Pediatric Comprehensive Weight Management Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
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Woolford SJ, Sallinen BJ, Schaffer S, Clark SJ. Eat, play, love: adolescent and parent perceptions of the components of a multidisciplinary weight management program. Clin Pediatr (Phila) 2012; 51:678-84. [PMID: 22492836 PMCID: PMC3598577 DOI: 10.1177/0009922812440839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Participants' perceptions may be associated with the high attrition rates reported by weight management programs. OBJECTIVE To explore participants' perceptions of a weight management program. METHODS Semistructured interviews were performed (spring 2010) with past participants of the Michigan Pediatric Outpatient Weight Evaluation and Reduction program. Transcripts were reviewed and themes identified. RESULTS Parents (38) and adolescents (25) were interviewed separately; similar themes emerged. Theme 1: Support/encouragement-Participants emphasized the importance of a supportive environment with a positive, compassionate approach from providers. Theme 2: Exercise-Fun, achievable activities were a valued means of making exercise enjoyable and building self-efficacy. Theme 3: Nutrition-Hands on demonstrations and tangible suggestions were preferred over activities such as self-monitoring. Theme 4: Behavioral factors-Participants valued the opportunity to hear their peers' experiences. However, individual/family sessions addressing their personal concerns were also viewed as important. CONCLUSION Beyond program content, participants valued a supportive environment emphasizing health over habitus.
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Woolford SJ, Sallinen BJ, Clark SJ, Iglayreger HB, Gordon PM. Association Between Physician Recommendation for Adolescents to Join a Weight Loss Program and BMI Change. J Prim Care Community Health 2012; 3:83-7. [PMID: 23803450 DOI: 10.1177/2150131911421202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore whether reasons for enrollment in a pediatric multidisciplinary weight management program (PMWMP) are associated with subsequent weight loss. METHOD A retrospective analysis of obese adolescents (12-18 years old, body mass index [BMI] > 95th percentile) who enrolled in a PMWMP from April 2007 to March 2009, and had BMI measurements at weeks 1 and 12. Reasons for enrollment were obtained from parents' responses to an enrollment questionnaire (which allowed selection of more than one reason). The most common reasons for enrollment were computed. Linear regression was used to explore associations between mean change in BMI and reasons for enrollment, controlling for demographic and anthropometric factors. RESULTS Most of the 90 adolescents who met the inclusion criteria were female (70%) and white (57%). Mean age was 14.5 years and mean initial BMI was 42 kg/m(2). The most common reasons for enrolling in the PMWMP were due to concerns about adolescents' physical health (96%), concerns about adolescents' mental health (76%), and because of a physician recommendation (73%). The mean 12-week change in BMI showed a greater decrease for those who enrolled due to a physicians' recommendation versus those who did not (-1.5 vs -0.5 kg/m(2): P < .05). This finding remained significant even when controlling for the covariates of interest. CONCLUSIONS A physician's recommendation to join a PMWMP appears to be associated with greater weight loss among obese adolescents than other reasons for enrollment. Further research should explore how physician involvement affects long-term weight loss.
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Affiliation(s)
- Susan J Woolford
- Pediatric Comprehensive Weight Management Center, University of Michigan, Ann Arbor, MI, USA
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Skelton JA, Goff DC, Ip E, Beech BM. Attrition in a Multidisciplinary Pediatric Weight Management Clinic. Child Obes 2011; 7:185-193. [PMID: 21966612 PMCID: PMC3181116 DOI: 10.1089/chi.2011.0010] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND: Pediatric weight management clinics experience significant dropout, and few studies have investigated this problem. The objective of this study was to identify family and clinic characteristics associated with attrition from a tertiary care pediatric weight management clinic. METHODS: This was a prospective and retrospective clinical database study of a multidisciplinary clinic for obese children 2-18 years with a weight-related co-morbidity. All patients seen between November, 2007, and July, 2009, were included. Characteristics of Active and Inactive families were compared using chi-squared and t-tests, and logistic regression was used to identify independent correlates of program status. A one-page survey was mailed to all Inactive families. RESULTS: A total of 133 patients were seen during the study period. Their mean age was 12 years old, mean BMI was 38 kg/m(2), 53% were female, 52% represented racial/ethnic minorities, and 50% were Medicaid recipients. In all, 32% dropped out of treatment. Inactive children had significantly lower BMI z-scores, were older, and were more likely to have poor school performance than active children. Similar results were found on regression analysis: Children with higher BMI z-scores, commercial insurance, average school performance, and a major weight-related co-morbidity were less likely to be inactive. The most common parent-reported reasons for dropping out were: Child not wanting to make changes, weight not improving, child desired to leave program, and program not meeting parent or child's expectations. CONCLUSIONS: Attrition from pediatric weight management treatment is high, with age, weight, school performance, and health associated with dropout. Parents mostly reported child-related issues, including lack of weight loss, as reasons for dropout.
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Affiliation(s)
- Joseph A. Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.,Brenner FIT (Families In Training) Program, Brenner Children's Hospital, North Carolina Baptist Hospital, Winston-Salem, NC
| | - David C. Goff
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bettina M. Beech
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.,Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
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Abstract
Paediatric obesity continues to be one of the most important health issues facing children and families today, and there remains a need for effective treatment options. There are a few reports in the literature demonstrating high rates of attrition from paediatric weight management programmes, ranging from 27% to 73%. While some studies show that racial/ethnic minorities, the economically disadvantaged and those with higher levels of obesity are at risk, other studies do not. There is some consistency in reasons given by families for attrition from treatment, most often scheduling issues and programmes not meeting family needs or expectations. This review highlights identified contributors to attrition from paediatric weight management and provides a framework to study this problem, based on models of adherence to paediatric medical regimens.
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Affiliation(s)
- J A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Abstract
BACKGROUND With the rising prevalence of childhood obesity over the last several decades, and the call for more family-based intervention research to combat childhood obesity, it is important to examine the extant research on family-based interventions in order to make recommendations and improve future research. OBJECTIVE To conduct a meta-analysis of family-based interventions targeting childhood obesity in the last decade in order to inform the research in the next decade. METHODS A literature review was conducted between December 2009-April 2010. Studies published between the years 2000-2009 that used family-based interventions to treat childhood obesity were included. A total of 20 studies met inclusionary criteria. RESULTS Although results varied by study design, the majority of studies had a moderate to large effect size for change in the target child's BMI (BMI percentile, zBMI, percent overweight) after participating in a family-based intervention. Long-term change varied by study, but the majority of studies produced sustainable change in child BMI, although smaller effect sizes. Change in secondary variables (dietary intake, sugar-sweetened beverage intake, physical activity) were substantially different between studies and are reported as trends. CONCLUSION To date, there is preliminary evidence suggesting that family-based interventions targeting childhood obesity are successful in producing weight loss in the short and long-term. Including families in weight loss treatment of obese children warrants further implementation and study. Limitations with the research, recommendations for future research, and implications for practitioners working with overweight/obese children are discussed.
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Affiliation(s)
- Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Jessie C. Everts
- Department of Family Social Science, University of Minnesota, Minneapolis, MN
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Abstract
BACKGROUND/OBJECTIVE Published data regarding outcomes of pediatric behavioral weight management are mainly from research interventions. The authors wished to explore outcomes from a clinical program. METHODS A retrospective analysis of data from obese adolescents enrolled in the Michigan Pediatric Outpatient Weight Evaluation and Reduction program (April 2007 to June 2008). The multidisciplinary program included group sessions, individual visits, and exercise classes. Linear regression was used to explore associations between change in body mass index (BMI) and age, sex, race, and insurance. RESULTS N = 67. Mean age was 14.5 years; 71% female, 50% Medicaid enrollees, and 30% African American. Mean initial BMI was 40. Mean change in BMI was -2.3 for those completing the 24-week program (n = 48; P < .01). Reduction in BMI was not associated with participants' demographic characteristics. CONCLUSIONS A clinical multidisciplinary weight loss program for adolescents can lead to decreases in BMI after 24 weeks. Further work is needed to assess long-term outcomes.
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Seo DC, Sa J. A meta-analysis of obesity interventions among U.S. minority children. J Adolesc Health 2010; 46:309-23. [PMID: 20307819 DOI: 10.1016/j.jadohealth.2009.11.202] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 05/26/2009] [Accepted: 11/16/2009] [Indexed: 12/26/2022]
Abstract
PURPOSE To quantitatively evaluate the efficacy of interventions designed to prevent or treat obesity among U.S. minority children using meta-analytic techniques. METHODS A total of 40 intervention trials involving 10,725 children aged 6-19 years were examined. RESULTS Interventions with more components showed a higher mean effect size than those with fewer components: among 32 controlled trials, d = .07 for one-component (n = 6); d = .08 for two-component (n = 15); d = .33 for three-component (n = 10); and d = .71 for four-component (n = 1) interventions. Interventions with parental involvement (n = 22, d = .21) and lifestyle interventions (n = 14, d = .34) showed a greater mean effect size than those without parental involvement (n = 10, d = .05) or lifestyle interventions (n = 18, d = .04), despite the fact that their 90% confidence intervals overlapped. Among uncontrolled trials (n = 8), two-component interventions (n = 5) yielded d = .86 and three-component interventions (n = 3) yielded d = .96. CONCLUSIONS Evidence indicates that, among U.S. minority children, obesity interventions with three or more components might be more efficacious than those using fewer components. Parental involvement, lifestyle change, culturally-based adaptation, and interactive computer programs seem to show promise in the reduction of obese minority children.
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Affiliation(s)
- Dong-Chul Seo
- Department of Applied Health Science, Indiana University, Bloomington, Indiana 47405, USA.
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Hazbun OM, Azcona C, Alfredo Martínez J, Martí A. Management of overweight and obesity in adolescents: an integral lifestyle approach. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1138-0322(09)73427-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Eneli IU, Cunningham A, Woolford SJ. The pediatric multidisciplinary obesity program: An update. PROGRESS IN PEDIATRIC CARDIOLOGY 2008. [DOI: 10.1016/j.ppedcard.2008.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Meriwether RA, Lobelo F, Pate RR. Themed Review: Clinical Interventions to Promote Physical Activity in Youth. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827607308557] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
National recommendations call for children and adolescents to accumulate at least 60 minutes of moderate to vigorous physical activity on most days of the week and for physicians to counsel their patients about physical activity. Physical inactivity tracks from childhood into adulthood, and among youth, it is associated with unfavorable risk factor profiles that promote the development of cardiovascular and metabolic chronic diseases. Few studies of clinical interventions to promote physical activity in children and youth have been published, and the paucity of evidence describing effective interventions and significant barriers limit delivery of counseling. However, existing studies provide evidence about elements of counseling most likely to be effective to guide clinical interventions and inform future research. Based on a literature review, this article offers guidance for incorporating physical activity promotion into clinical care, identifies gaps in current evidence, and suggests methodologic considerations for future research.
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Affiliation(s)
- Rebecca A. Meriwether
- Departments of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina,
| | - Felipe Lobelo
- Exercise Science, Arnold School of Public Health University of South Carolina School of Medicine, Columbia, South Carolina
| | - Russell R. Pate
- Exercise Science, Arnold School of Public Health University of South Carolina School of Medicine, Columbia, South Carolina
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Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120 Suppl 4:S254-88. [PMID: 18055654 DOI: 10.1542/peds.2007-2329f] [Citation(s) in RCA: 533] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.
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Affiliation(s)
- Bonnie A Spear
- Department of Pediatrics, University of Alabama at Birmingham, AL 35233, USA.
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Jelalian E, Wember YM, Bungeroth H, Birmaher V. Practitioner review: bridging the gap between research and clinical practice in pediatric obesity. J Child Psychol Psychiatry 2007; 48:115-27. [PMID: 17300550 DOI: 10.1111/j.1469-7610.2006.01613.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current review highlights findings from the empirical pediatric obesity treatment literature, with particular attention to diet, physical activity, and behavior interventions. Evaluation and treatment considerations relevant to working with overweight children and adolescents with psychiatric comorbidities are reviewed. METHODS Review of the relevant treatment literature, with a focus on randomized clinical trials, was conducted. Recommendations regarding treatment of children and adolescents with psychiatric comorbidities are based on relevant prospective studies of the relationship between weight status and psychological variables and studies with adult populations. RESULTS Well-established pediatric weight control interventions have been conducted in research settings. These studies provide a starting point, but are limited by homogeneous samples that may exclude participants with psychiatric comorbidities. Practitioners treating obese children and adolescents with psychiatric disorders are encouraged to assess individual, familial, and contextual variables specific to weight (e.g., motivation and existing support to change current eating and physical activity patterns, extent of weight-related conflict within family, impact of weight on current functioning) in order to prioritize treatment objectives. CONCLUSIONS The review concludes with a discussion of current empirical and practical challenges, including explicitly targeting obese children and adolescents with psychiatric concerns and determining appropriateness of pursuing weight control interventions in this population.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry, Rhode Island Hospital, Brown Medical School, Providence, RI, USA.
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Liusuwan RA, Widman LM, Abresch RT, Johnson AJ, McDonald CM. Behavioral intervention, exercise, and nutrition education to improve health and fitness (BENEfit) in adolescents with mobility impairment due to spinal cord dysfunction. J Spinal Cord Med 2007; 30 Suppl 1:S119-26. [PMID: 17874697 PMCID: PMC2031996 DOI: 10.1080/10790268.2007.11754615] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/28/2007] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Determine the effects of a nutrition education and exercise intervention on the health and fitness of adolescents with mobility impairment due to spinal cord dysfunction from myelomeningocele and spinal cord injury. Subjects participated in a 16-week intervention consisting of a behavioral approach to lifestyle change, exercise, and nutrition education to improve fitness (BENEfit) program. Participants were given a schedule of aerobic and strengthening exercises and attended nutrition education and behavior modification sessions every other week along with their parent(s). SUBJECTS Twenty adolescents (aged 11-18 years, mean 15.4 +/- 2.2 years) with spinal cord dysfunction. METHODS Subjects were tested immediately prior to starting and upon completion of the program. Aerobic fitness was measured using a ramp protocol with an arm ergometer. Heart rate and oxygen uptake were measured. Values at anaerobic threshold and maximum oxygen uptake were recorded. Peak isokinetic arm and shoulder strength were determined with a dynamometer. Body composition was estimated with dual-energy x-ray absorptiometry. Serum chemistry included measures of cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. RESULTS Fourteen individuals completed all testing sessions. There was no significant overall change in weight, body mass index, body mass index z-scores, or serum chemistry. Overall, there was a significant increase in whole body lean tissue without a concomitant increase in whole body fat. Fitness measures revealed a significant increase in maximum power output, work efficiency as measured by the amount of power output produced aerobically, and resting oxygen uptake. Strength measurements revealed a significant increase in shoulder extension strength and a trend towards increased shoulder flexion strength. There were no significant changes in high-density lipoprotein, low-density lipoprotein, total cholesterol, or triglycerides. CONCLUSIONS The BENEfit program shows promise as a method for improving the health and fitness of adolescents with mobility impairments who are at high risk for obesity and obesity-related health conditions.
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Affiliation(s)
| | - Lana M Widman
- University of California Davis School of Medicine, Department of Physical Medicine and Rehabilitation, Davis, California
| | - Richard Ted Abresch
- University of California Davis School of Medicine, Department of Physical Medicine and Rehabilitation, Davis, California
| | - Allan J Johnson
- Shriners Hospitals for Children Northern California, Sacramento, California
| | - Craig M McDonald
- Shriners Hospitals for Children Northern California, Sacramento, California
- University of California Davis School of Medicine, Department of Physical Medicine and Rehabilitation, Davis, California
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Stewart L, Houghton J, Hughes AR, Pearson D, Reilly JJ. Dietetic Management of Pediatric Overweight: Development and Description of a Practical and Evidence-Based Behavioral Approach. ACTA ACUST UNITED AC 2005; 105:1810-5. [PMID: 16256768 DOI: 10.1016/j.jada.2005.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Stewart
- Division of Developmental Medicine, University of Glasgow, Yorkhill Hospitals, Glasgow, Scotland
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Abstract
The increased number of children and adolescents diagnosed with type 2 diabetes presents new challenges to pediatricians, nurses, and dietitians. Treatment with medications and lifestyle changes is similar to that for adults with type 2 diabetes, but must be developmentally appropriate for children and adolescents. Registered dieticians must apply knowledge from treatment for overweight children and adolescents without diabetes with treatment for adults with type 2 diabetes to provide effective nutrition therapy for this population.
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Affiliation(s)
- Emily S Loghmani
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University Medical Center, 575 North West Drive, Room 070, Indianapolis, IN 46202, USA.
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Abstract
Obesity is one of the largest health problems facing Americans. Figures produced by the National Center for Health Statistics show that in 1999-2002, 15.8% of 6-11-year-olds were overweight as were 16.1% of adolescents aged 12-19. Some have proposed that interventions in childhood may be the best place to focus efforts to reduce the growing obesity epidemic. This paper examines several of the popular intervention strategies that have been proposed for youth and assesses the potential of these interventions for meaningful public health impacts. Findings show that most childhood obesity interventions completed to date produced only meager results, creating need for more well-designed studies that are tailored to the needs of specific age, ethnic and economic groups.
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Affiliation(s)
- Caitlin S Boon
- Department of Food Science, Chenoweth Laboratory, University of Massachusetts Amherst, 01003-1410, USA.
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