Management of obesity in adolescence

Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls

BACKGROUND

Childhood obesity is a major public health problem, with one third of America's children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants.

METHODS/DESIGN

Forty girls who are overweight or obese (aged 8-13 years) will be recruited from a Midwestern college town. Participants will be recruited through posted flyers, newspaper advertisements, email, and social media. The volunteer convenience sample of girls will be randomized to one of two home-based wellness coaching interventions: a general health education condition or a healthy eating physical activity skills condition. Trained female wellness coaches will conduct weekly hour-long home visits for 12 consecutive weeks. Assessments will occur at baseline, post-intervention (3 months after baseline), and follow-up (6 months after baseline) and will include height, weight, waist circumference, body composition, pulmonary function, blood pressure, systemic inflammation, physical activity (Actical accelerometer), and self-reported survey measures (relevant to fruit and vegetable consumption, physical activity, and quality of life).

DISCUSSION

This study will evaluate the feasibility of home-based wellness coaching interventions for overweight and obese girls and secondarily assess the preliminary impact on health-related psychosocial, behavioral, and biomedical outcomes. Results will provide information regarding the feasibility of this new model for use in girls as an approach to reduce the burden of overweight and obesity toward the prevention of chronic disease.

TRIAL REGISTRATION

NCT01845480.

The association of race, socioeconomic status, and health insurance status with the prevalence of overweight among children and adolescents

OBJECTIVES

We examined the effect of race, socioeconomic status, and health insurance status on the prevalence of overweight among children and adolescents.

METHODS

We studied an observational cohort from the 1996 Medical Expenditure Panel Survey Household Component.

RESULTS

In the younger group, both Black and Latino children had a greater likelihood of being overweight compared with White children. Among the adolescent group, Latinos and Asian/Pacific Islanders were more likely to be overweight. Among adolescents, lacking health insurance and having public insurance were both positively associated with the prevalence of overweight. A relationship between insurance status and overweight was not observed for younger children.

CONCLUSIONS

There are substantial racial differences in the prevalence of overweight for children and adolescents. Health insurance status is associated with the prevalence of overweight among adolescents.

Association between birthweight and body mass index at 3 years of age

BACKGROUND

Obesity in children is one of the risk factors for adulthood obesity, which then leads to the development of chronic diseases such as hypertension, hyperlipidemia and diabetes. In this study, we identified significant factors associating with the body mass index (BMI) at 3 years of age from the perinatal characteristics of children.

METHODS

A total of 588 children were included in the study. The BMI at 3 years of age was examined in conjunction with the possible variables such as parents' smoking status during pregnancy, parents' age at birth, gestational age, sibling number and live birth order, sex, birthweight, BMI at 1 month of age, weight gain during the first month of life and feeding method at 1 month of age.

RESULTS

Univariate analysis showed that birthweight (P<0.0001), weight gain during the first month of life (P=0.0012) and BMI at 1 month of age (P<0.0001) were significantly associated with the BMI at 3 years of age. Of these factors, birthweight and weight gain during the first month of life were the independent factors correlating with the BMI at 3 years by multivariate analysis (P<0.0001 and P=0.0095, respectively).

CONCLUSIONS

Infants with higher birthweight and/or greater weight gain during the first month of life may have a risk of being overweight at 3 years of age.

Tracking of body mass index in children in relation to overweight in adulthood

Body mass index (BMI; in kg/m2) values at or above the 75th percentile are associated with increased morbidity and mortality in adulthood, and there are significant correlations between BMI values in childhood and in adulthood. The present study addresses the predictive value of childhood BMI for overweight at 35 +/- 5 y, defined as BMI >28 for men and BMI >26 for women. Analyses of data from 555 white children showed that overweight at age 35 y could be predicted from BMI at younger ages. The prediction is excellent at age 18 y, good at age 13 y, but only moderate at ages <13 y. For 18-y-olds with BMIs above the 60th percentile, the probability of overweight at age 35 y is 34% for men and 37% for women. A clinically applicable method is provided to assign an overweight child to a group with a known probability of high BMI values in adulthood.

Norplant failure: an adolescent case study and review of the literature

STUDY OBJECTIVE

To alert clinicians to risk factors associated with levonorgestrel implant (Norplant; Wyeth-Ayerst Laboratories, Philadelphia, PA) failures in the adolescent population and discuss alternatives.

DATA SOURCES

Medline search of articles pertaining to the use of levonorgestrel implants in the adolescent population.

STUDY SELECTION

All articles pertaining to the use of levonorgestrel implants in adolescents.

CONCLUSIONS

Levonorgestrel subdermal implants, Norplant, have been successfully used worldwide as contraceptives. Clinical trials suggest that pregnancy rates while using levonorgestrel implants are positively correlated with increased body weight. In addition, pregnancy rates may be higher in women below age 25 years. Finally, patients who report regular menstrual cycles on levonorgestrel implants may be at greater risk for method failure. Consequently, despite its apparent success, levonorgestrel implants have some significant but little-known limitations that should be considered in initial adolescent patient selection, education, and postinsertion medical supervision.