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Bartee RT, Heelan KA, Golden CA, Hill JL, Porter GC, Abbey BA, George K, Foster N, Estabrooks PA. Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:72-84. [PMID: 37477808 PMCID: PMC11133101 DOI: 10.1007/s11121-023-01557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 07/22/2023]
Abstract
Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.
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Affiliation(s)
- R T Bartee
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA.
| | - K A Heelan
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - C A Golden
- School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - J L Hill
- School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - G C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - B A Abbey
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - K George
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - N Foster
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - P A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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Saat JJEH, Fransen GAJ, Naumann E, van der Velden K, Assendelft WJJ. Development of a checklist to assess potentially effective components in combined lifestyle interventions for children with overweight or obesity. PLoS One 2023; 18:e0289481. [PMID: 37768922 PMCID: PMC10538710 DOI: 10.1371/journal.pone.0289481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND In the Netherlands, Combined Lifestyle Interventions (CLIs), offered in primary care, aim to reduce the number of children with overweight or obesity. CLIs are carried out by a multidisciplinary team and focus on dietary advice and guidance, exercise and behaviour change. These CLIs are not uniformly designed and vary in protocols to suit the local circumstances. Due to the variation in content of CLIs it is difficult to investigate their effectiveness. To enable a proper evaluation of CLIs, we first need to unravel the 'black boxes' of CLIs by identifying the various potentially effective components. METHODS First of all we identified potentially effective components in literature. Subsequently we organized an online consultation with experts with diverse backgrounds and asked if they could add potentially effective components. These components were then assembled into a checklist meant to determine the presence or absence of potentially effective components in CLIs for children. RESULTS 42 experts participated. We identified 65 potentially effective components for CLIs for children with overweight or obesity that we categorized into three themes: content, organisation and implementation. CONCLUSIONS Based on literature and expert opinions we developed a practical 65-item checklist to determine the presence of potentially effective components in a CLI. This checklist can be used in the development of CLIs as well as evaluation of CLIs.
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Affiliation(s)
- Jenneke J. E. H. Saat
- Department of Primary and Community Care, Academic Collaborative Centre AMPHI, ELG 117, Radboud University Medical Centre, Nijmegen, the Netherlands
- Research Group Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Gerdine A. J. Fransen
- Department of Primary and Community Care, Academic Collaborative Centre AMPHI, ELG 117, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Elke Naumann
- Research Group Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Academic Collaborative Centre AMPHI, ELG 117, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem J. J. Assendelft
- Department of Primary and Community Care, ELG 117, Radboud University Medical Centre, Nijmegen, the Netherlands
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Prinz N, Pomares-Millan H, Dannemann A, Giordano GN, Joisten C, Körner A, Weghuber D, Weihrauch-Blüher S, Wiegand S, Holl RW, Lanzinger S. Who benefits most from outpatient lifestyle intervention? An IMI-SOPHIA study on pediatric individuals living with overweight and obesity. Obesity (Silver Spring) 2023; 31:2375-2385. [PMID: 37545199 DOI: 10.1002/oby.23844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The first-line approach for childhood obesity is lifestyle intervention (LI); however, success varies. This study aimed first to identify distinct subgroups of response in children living with overweight and obesity and second to elucidate predictors for subclusters. METHODS Based on the obesity patient follow-up registry the APV (Adipositas-Patienten-Verlaufsdokumentation) initiative, a total of 12,453 children and adolescents (median age: 11.5 [IQR: 9.7-13.2] years; BMI z score [BMIz]: 2.06 [IQR: 1.79-2.34]; 52.6% girls) living with overweight/obesity and participating in outpatient LI were studied. Longitudinal k-means clustering was used to identify individual BMIz response curve for up to 2 years after treatment initiation. Multinomial logistic regression was used to elucidate predictors for cluster membership. RESULTS A total of 36.3% of children and adolescents experienced "no BMIz loss." The largest subcluster (44.8%) achieved "moderate BMIz loss," with an average delta-BMIz of -0.23 (IQR: -0.33 to -0.14) at study end. A total of 18.9% had a "pronounced BMIz loss" up to -0.61 (IQR: -0.76 to -0.49). Younger age and lower BMIz at LI initiation, larger initial BMIz loss, and less social deprivation were linked with higher likelihood for moderate or pronounced BMIz loss compared with the no BMIz loss cluster (all p < 0.05). CONCLUSIONS These results support the importance of patient-tailored intervention and earlier treatment escalation in high-risk individuals who have little chance of success.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Munich, Germany
| | - Hugo Pomares-Millan
- Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | | | - Giuseppe N Giordano
- Department of Clinical Sciences Malmö, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Christine Joisten
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - Antje Körner
- Medical Faculty, Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Daniel Weghuber
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Susann Weihrauch-Blüher
- Department for Pediatrics I, Pediatric Endocrinology, University Hospital Halle/Saale, Halle, Germany
| | - Susanna Wiegand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Berlin, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Munich, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Munich, Germany
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Obita G, Alkhatib A. Effectiveness of Lifestyle Nutrition and Physical Activity Interventions for Childhood Obesity and Associated Comorbidities among Children from Minority Ethnic Groups: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15112524. [PMID: 37299488 DOI: 10.3390/nu15112524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity-related comorbidities among adult populations but less so among children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in Western high-income countries (HICs). Our systematic review included 53 studies, involving 26,045 children from minority ethnic populations who followed lifestyle intervention programmes lasting between 8 weeks and 5 years with the aim of preventing and/or managing childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. The studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after-school settings). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body mass index (BMI) outcomes (pooled BMI mean change = -0.09 (95% CI = -0.19, 0.01); p = 0.09). This was irrespective of the intervention programme duration (<6 months vs. ≥6 months), type (PA vs. nutrition/combined intervention) and weight status (overweight or obese vs. normal weight) as all showed nonsignificant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reductions in BMI, BMI z-score and body fat percentage. However, the majority of lifestyle interventions adopting a quasi-design with combined primary and secondary obesity measures (11 out of 15 studies) were effective in reducing the obesity comorbidities of cardiometabolic risks, including metabolic syndrome, insulin sensitivity and blood pressure, in overweight and obese children. Preventing childhood obesity in high-risk ethnic minority groups is best achieved using combined PA and nutrition intervention approaches, which jointly target preventing obesity and its comorbidities, especially the outcomes of diabetes, hypertension and cardiovascular disease. Therefore, public health stakeholders should integrate cultural and lifestyle factors and contextualise obesity prevention strategies among minority ethnic groups in Western HICs.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
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Tian C, Xu J, Wang G, Yu L, Tang X. The effectiveness of web-based interventions on non-alcoholic fatty liver disease (NAFLD) in obese children: A study protocol for a randomized controlled trial. Front Public Health 2022; 10:930901. [PMID: 36339187 PMCID: PMC9632618 DOI: 10.3389/fpubh.2022.930901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
Aim Non-alcoholic fatty liver disease (NAFLD) is currently the most prevalent liver disease in the world, increasing the risk of cirrhosis and hepatocellular carcinoma, and contributing to the development of type 2 diabetes, cardiovascular disease, and chronic kidney disease. This study aims to carry out a web-based continuum of a care intervention model to provide comprehensive care interventions for obese children with NAFLD, to improve the effectiveness of treatment of children with NAFLD. Design A 1-year single-blinded randomized clinical trial in hospital in Zhejiang Province. Methods Eighty subjects will implement the program in a randomized order. The interventions for the control group mainly consisted of the routine distribution of health education materials and health education by holding health-themed lectures, and the preliminary proposed interventions including establishing management teams, regularly delivering related health knowledge, daily uploading of health intervention records, regular supervision and mutual encouragement, home visiting and psychological guidance. The primary outcomes are serum biomarkers such as alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT), aspartate aminotransferase, and imaging (liver ultrasound and magnetic resonance imaging). Second outcomes are: BMI, waist-to-hip ratio and quality of life. In addition, socio-demographic characteristics such as age, gender and ethnicity will be recorded. Children aged 7-18 years old and diagnosed with NAFLD will be included, patients will be not eligible if they do not agree to participate or are participating in other health intervention programs. This study was registered on ClinicalTrials.gov (NCT05527938). Results Over the past 30 years, NAFLD has been recognized as one of the most common liver diseases in adults and children. The current studies have focused on promoting lifestyle changes in children with NASH by providing some education and advice to children and their families to improve the histological features of NASH and lose weight. Because of the convenience and efficiency of the internet can provide some new strategies and ways for lifestyle interventions for children with NAFLD. In addition, we have designed a high-quality RCT based on the SPIRIT guidelines, which also provides strong evidence in this area.
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Affiliation(s)
| | | | | | | | - Xiaoli Tang
- Shaoxing Maternity and Child Health Care Center, Shaoxing, China
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Multidisciplinary Treatment for Childhood Obesity: A Two-Year Experience in the Province of Naples, Italy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060834. [PMID: 35740771 PMCID: PMC9221826 DOI: 10.3390/children9060834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 01/22/2023]
Abstract
Childhood obesity must be faced through an integrated multi-level preventive approach. This study was aimed at assessing the adherence and the outcomes of an outpatient service for childhood obesity treatment activated in the province of Naples, Italy, throughout a 2-year follow-up period. At first visit (T0), weight, height, waist circumference, and body composition of children were assessed, together with sociodemographic features and physical activity levels of children and parents. Anthropometric and body composition parameters of children were measured at 6 ± 3 months (T1) and 12 ± 3 months (T2). A total of 451 non-related children who accessed the service were analyzed: 220 (48.7%) of them returned at least once (attrition rate 51.3%). Returner outpatients showed higher age (p = 0.046) and father’s educational level (p = 0.041) than non-returner ones. Adherence to the treatment was found to be related to father’s (Rho = 0.140, p = 0.005) and mother’s (Rho = 0.109, p = 0.026) educational level. All the outcomes improved between T0 and T1 (p < 0.001), while only body mass index (BMI) decreased significantly at T2. Changes in BMI-SDS were associated with baseline value (OR 0.158, 95%CI 0.017−0.298, p = 0.029). The multidisciplinary approach seems to be promising to treat childhood obesity in this geographic context. Lower parents’ educational level should be considered as an attrition determinant.
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Whooten RC, Horan C, Cordes J, Dartley AN, Aguirre A, Taveras EM. Evaluating the Implementation of a Before-School Physical Activity Program: A Mixed-Methods Approach in Massachusetts, 2018. Prev Chronic Dis 2020; 17:E116. [PMID: 33006544 PMCID: PMC7553220 DOI: 10.5888/pcd17.190445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose and Objectives Our aim was to evaluate the implementation of a widely available, before-school, physical activity program in a low-resource, racially/ethnically and socioeconomically diverse, urban school setting to identify adaptations needed for successful implementation. Intervention Approach We used a collaborative effort with stakeholders to implement the Build Our Kids’ Success (BOKS) program in 3 schools in Revere, Massachusetts. Program structure followed a preexisting curriculum, including 60-minute sessions, 3 mornings per week, over 2 sessions (spring and fall 2018). Programs had a capacity of 40 students per school per session and the ability to adapt as needed. Evaluation Methods We used a mixed-methods approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RE-AIM domains were assessed by use of baseline and follow-up student measures, parent interviews, and program administrative records. Results From a district of 11 schools, 3 schools (2 elementary, 1 middle) implemented the BOKS program. Program enrollment reached 82% capacity (188 of 230 potential participants). Of the 188 enrolled students, 128 (68%) had parental consent for study participation. Among the 128 study participants, 61 (48%) were male, 52 (41%) identified as Hispanic/Latino, and mean age was 9.3 years (SD, 2.2). Program duration varied by school (25–60 minutes), with a mean of 33% (SD, 16%) of the session spent in actigraphy-measured moderate-to-vigorous physical activity (MVPA), or mean 16.3 (SD, 9.3) minutes of MVPA. Participants attended a median 90% (interquartile range [IQR], 56%–97%) of sessions. We observed no change in body mass index (BMI) z score or self-reported quality of life from baseline to follow-up assessment. Parents reported positive program effects. Enrollment was sustained in elementary schools and decreased in the middle school during the study period, expanding to 3 additional schools for spring 2019. Implications for Public Health Implementation and evaluation of an evidence-based physical activity program, in a low-resource setting, are feasible and yield relevant information about program adaptations and future dissemination of similar programs.
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Affiliation(s)
- Rachel C Whooten
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114. .,Division of Endocrinology, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jack Cordes
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Anna Nicole Dartley
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Annabelle Aguirre
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Kraft Center for Community Health, Massachusetts General Hospital, Boston, Massachusetts.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Kim KW, Kim SJ, Kim H, Shin SU, Song J, Chung WS. Clinical effects of slim-diet, with lifestyle modification for childhood obesity in community-based healthcare program: A case series. Medicine (Baltimore) 2020; 99:e20817. [PMID: 32590767 PMCID: PMC7329022 DOI: 10.1097/md.0000000000020817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/23/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Although there are several reports on the effect of herbal medicine on weight loss in adults, evidence supporting its efficacy and safety in obese pediatrics is insufficient. Herein, we clinically investigated the preliminary experience of community-based healthcare program in cases of childhood obesity treated with an herbal complex, Slim-diet (SD), along with lifestyle modification. PATIENT CONCERNS Seventeen subjects with childhood obesity participated in a community-based healthcare program, which consisted of twice-a-week play type physical activity and dietary counseling program with simultaneous twice-a-day administration of SD for 4 weeks. DIAGNOSES The data of 13 obese pediatrics (body mass index [BMI] ≥ the 95th percentile for children of the same age and sex) in their 3rd to 6th grade who finally completed at least 6 visits out of a total of 8 visits of the program including baseline and endpoint assessments were analyzed. INTERVENTIONS Participants received 20 g of SD daily. Simultaneously, play-type physical activity program with an exercise therapist and dietary counseling with a dietitian for lifestyle modification were conducted at every visit. Body composition, blood chemistry, the Korean Youth Physical Activity Questionnaire (KYPAQ) score, and the preference for salt density and sugar content were assessed at baseline and endpoint. OUTCOMES After SD administration, body mass index decreased from 26.74 ± 2.11 kg/m to 26.50 ± 2.20 kg/m (P < .05) with statistically significant increases in height, weight, and skeletal muscle mass. The results of blood chemistry and the KYPAQ score showed no significant change. The preferences for salt density were improved in 8, maintained in 2, and worsened in 3 participants and those for sugar content were improved in 6 and maintained in 7 participants with no worsening. LESSONS In the present study, we showed the clinical effects of SD with lifestyle modification in patients with childhood obesity who participated in community-based healthcare program. Further clinical studies investigating the effects of SD are required.
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Affiliation(s)
- Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul
| | - So-Jin Kim
- Department of Health Promotion, Public Health Center, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Hojun Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dongguk University, Goyang-si, Gyeonggi-do
| | | | - Jaechul Song
- Symphony Korean Medicine Clinic, Seoul, Republic of Korea
| | - Won-Seok Chung
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul
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Rigamonti AE, Tringali G, De Micheli R, De Col A, Tamini S, Saezza A, Cella SG, Sartorio A. Impact of a Three-Week in-Hospital Multidisciplinary Body Weight Reduction Program on Body Composition, Muscle Performance and Fatigue in a Pediatric Obese Population with or without Metabolic Syndrome. Nutrients 2020; 12:E208. [PMID: 31941135 PMCID: PMC7019212 DOI: 10.3390/nu12010208] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome is a combination of cardiometabolic risk factors, frequently detected in obese children and adolescents. To date, few clinical studies have evaluated the effectiveness of multidisciplinary body weight reduction programs on body mass index, body composition, muscle performance and fatigue in pediatric obese subjects suffering from metabolic syndrome, which might represent a sub-population that is more difficult to be treated and worthy of more intensive interventions than a population less metabolically complicated. The aim of the present study was to compare the impact of a three-week in-hospital multidisciplinary integrated body weight reduction program (BWRP) on body mass index (BMI), body composition (particularly, fat mass (FM) and fat-free mass (FFM)), motor control (evaluated by one-leg standing balance (OLSB) test), muscle performance (evaluated by the stair climbing test (SCT)) and fatigue (evaluated by fatigue severity scale (FSS)) in a pediatric obese population with or without metabolic syndrome. A pediatric population of 548 obese subjects without metabolic syndrome (F/M = 312/236; age range: 8-18 years; BMI: 36.3 ± 6.7 kg/m2) and 96 obese subjects with metabolic syndrome (F/M = 53/43; age range: 9-18 years; BMI: 38.3 ± 6.9 kg/m2) was recruited. The BWRP significantly reduced BMI, FM (expressed as %), SCT time and FSS score, and increased OLSB time in all subgroups of obese subjects, independent of sex and metabolic syndrome, with preservation of FFM. No significant differences in |ΔBMI|, |ΔFM|, |ΔOLSB| or |ΔSCT| times and |ΔFSS| score were found when comparing subjects (males and females) with or without metabolic syndrome, apart from obese females without metabolic syndrome, who exhibited a lower weight loss and FM (expressed as %) reduction when compared to the corresponding male counterpart. In conclusion, the beneficial effects of a three-week BWRP on BMI, body composition, muscle performance and fatigue in a pediatric obese population were not found to be different in patients with or without metabolic syndrome, thus indicating that the more metabolically compromised patient is as responsive to a short-term BWRP as the patient without metabolic syndrome. More prolonged follow-up studies are, however, necessary in order to verify whether the adherence to the multidisciplinary recommendations at home and the long-term maintenance of the positive effects in the two subgroups of patients will remain similar or not.
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Affiliation(s)
| | - Gabriella Tringali
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Roberta De Micheli
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Alessandra De Col
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Sofia Tamini
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Antonella Saezza
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy;
| | - Silvano G. Cella
- Department of Clinical Sciences and Community Health, University of Milan, 20129 Milan, Italy;
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy;
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White MJ, Hoffman J, Armstrong S, Skinner AC. Body Mass Index Change Between Referral to and Enrollment in Pediatric Weight Management. Clin Pediatr (Phila) 2020; 59:70-74. [PMID: 31658819 DOI: 10.1177/0009922819884587] [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] [Indexed: 11/16/2022]
Abstract
This study describes changes in body mass index z score (BMIz) and percent of 95th percentile (P95) between referral to pediatric weight management (PWM) and initial PWM visit. We conducted a prospective cohort analysis among subjects (n = 77) aged 5 to 11 years referred to PWM and compared height and weight at time of referral versus initial PWM visit. Mean BMIz decreased by 0.05, and P95 decreased by 1.48 across all age groups (both P < .01) from time of referral to initial visit. Children 5 to 8 years old experienced a greater BMIz change than older children (-0.07 vs -0.02; P < .05). Interval BMIz change was greater for non-Hispanic White and Hispanic children compared with non-Hispanic Blacks (-0.10 vs -0.01; P < .001). There were no subgroup differences in P95. Interval BMI changes between referral and treatment approach half the effect reported by some PWM programs. Referral to PWM may motivate pretreatment lifestyle changes in some patients.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Jessica Hoffman
- Departments of Pediatrics and Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke Clinical Research Institute, Duke Unversity, Durham, NC, USA
| | - Asheley C Skinner
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke Clinical Research Institute, Duke Unversity, Durham, NC, USA
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11
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Zoellner JM, You W, Hill JL, Brock DJP, Yuhas M, Alexander RC, Price B, Estabrooks PA. A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods. Contemp Clin Trials 2019; 84:105801. [PMID: 31260792 DOI: 10.1016/j.cct.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022]
Abstract
While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice - particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IDENTIFIERS: Clincialtrials.gov: NCT03245775.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 304 Hutcheson Hall, 24060, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
| | - Donna-Jean P Brock
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Maryam Yuhas
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Ramine C Alexander
- Department of Family and Consumer Sciences, North Carolina A&T State University, Benbow 202-A, Greensboro, NC 27411, USA
| | - Bryan Price
- UVA Cancer Center, Community Outreach and Education, Main Street, Unit 102, Danville, VA 24541, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
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12
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Hill JL, Zoellner JM, You W, Brock DJ, Price B, Alexander RC, Frisard M, Brito F, Hou X, Estabrooks PA. Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation. BMC Public Health 2019; 19:122. [PMID: 30696420 PMCID: PMC6352451 DOI: 10.1186/s12889-019-6450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. METHODS A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). RESULTS Bright Bodies rated highest on program characteristics and adoptability (p's < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program-iChoose-had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = - 0.047; t = - 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents. CONCLUSION The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.
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Affiliation(s)
- Jennie L. Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Jamie M. Zoellner
- Department of Public Health Sciences, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA 24061 USA
| | - Donna J. Brock
- Department of Public Health Sciences, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Bryan Price
- Education and Outreach Specialist, University of Virginia and Cancer Center, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Ramine C. Alexander
- Department of Family and Consumer Sciences, North Carolina Agricultural and Technical State University, Benbow 202-A, Greensboro, NC 27405 USA
| | - Madlyn Frisard
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Rm 1085, Blacksburg, VA 24061 USA
| | - Fabiana Brito
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Xiaolu Hou
- Virginia Tech University, Blacksburg, USA
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075 USA
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13
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Nier A, Brandt A, Conzelmann IB, Özel Y, Bergheim I. Non-Alcoholic Fatty Liver Disease in Overweight Children: Role of Fructose Intake and Dietary Pattern. Nutrients 2018; 10:nu10091329. [PMID: 30235828 PMCID: PMC6165138 DOI: 10.3390/nu10091329] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022] Open
Abstract
The role of nutrition and diet in the development of non-alcoholic fatty liver disease (NAFLD) is still not fully understood. In the present study, we determined if dietary pattern and markers of intestinal permeability differ between overweight children with and without NAFLD. In addition, in a feasibility study, we assessed the effect of a moderate dietary intervention only focusing on nutrients identified to differ between groups on markers of intestinal barrier function and health status. Anthropometric data, dietary intake, metabolic parameters, and markers of inflammation, as well as of intestinal permeability, were assessed in overweight children (n = 89, aged 5⁻9) and normal-weight healthy controls (n = 36, aged 5⁻9). Sixteen children suffered from early signs of NAFLD, e.g., steatosis grade 1 as determined by ultrasound. Twelve children showing early signs of NAFLD were enrolled in the intervention study (n = 6 intervention, n = 6 control). Body mass index (BMI), BMI standard deviation score (BMI-SDS), and waist circumference were significantly higher in NAFLD children than in overweight children without NAFLD. Levels of bacterial endotoxin, lipopolysaccharide-binding protein (LBP), and proinflammatory markers like interleukin 6 (IL-6) and tumor necrosis factor α (TNFα) were also significantly higher in overweight children with NAFLD compared to those without. Total energy and carbohydrate intake were higher in NAFLD children than in those without. The higher carbohydrate intake mainly resulted from a higher total fructose and glucose intake derived from a significantly higher consumption of sugar-sweetened beverages. When counseling children with NAFLD regarding fructose intake (four times, 30⁻60 min within 1 year; one one-on-one counseling and three group counselings), neither alanine aminotransferase (ALT) nor aspartate aminotransferase (AST) activity in serum changed; however, diastolic blood pressure (p < 0.05) and bacterial endotoxin levels (p = 0.06) decreased markedly in the intervention group after one year. Similar changes were not found in uncounseled children. Our results suggest that a sugar-rich diet might contribute to the development of early stages of NAFLD in overweight children, and that moderate dietary counseling might improve the metabolic status of overweight children with NAFLD.
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Affiliation(s)
- Anika Nier
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, A-1090 Vienna, Austria.
| | - Annette Brandt
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, A-1090 Vienna, Austria.
| | - Ina Barbara Conzelmann
- Department of Nutritional Medicine, (180), University of Hohenheim, D-70599 Stuttgart, Germany.
| | - Yelda Özel
- Department of Nutritional Medicine, (180), University of Hohenheim, D-70599 Stuttgart, Germany.
| | - Ina Bergheim
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, A-1090 Vienna, Austria.
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14
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Rivera J, McPherson AC, Hamilton J, Birken C, Coons M, Peters M, Iyer S, George T, Nguyen C, Stinson J. User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study. JMIR Form Res 2018; 2:e7. [PMID: 30684409 PMCID: PMC6334679 DOI: 10.2196/formative.8248] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 01/14/2018] [Accepted: 01/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.
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Affiliation(s)
- Jordan Rivera
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | | | - Michael Coons
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Peters
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | - Tessy George
- The Hospital for Sick Children, Toronto, ON, Canada
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15
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care. Obes Surg 2018; 28:1149-1174. [DOI: 10.1007/s11695-018-3138-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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16
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van Hoek E, Bouwman LI, Koelen MA, Lutt MAJ, Feskens EJM, Janse AJ. Development of a Dutch intervention for obese young children. Health Promot Int 2018; 32:624-635. [PMID: 26755807 DOI: 10.1093/heapro/dav115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The objective of this article is to provide insight in the five-step development process of the best evidence, best practice intervention for obese young children 'AanTafel!'. A set of requirements for intervention development was developed to guide the data inquiry: the use of theory, influencing factors, tailoring, multi-disciplinarity, duration/frequency and evaluation and monitoring. Step I retrieved evidence from clinical guidelines, followed by a systematic review with meta-analysis (Step II) and an extended literature review (Step III). Evidence was consistent with regard to parent-focus, targeting family level, including diet, physical activity and behaviour change techniques and tailoring to age. However, no evidence or inconsistent evidence emerged from the theory-basis, group-versus-individual sessions, face-to-face contact versus Internet-mediated contact, which disciplines to involve and how to involve them, as well as intervention duration and intensity. Hence, practice-based insights from parental interviews (Step IV) and involved therapists were added and subsequently integrated to the intervention 'AanTafel!' (Step V). 'AanTafel!' is a multi-component, multi-disciplinary, family-based, parent-focused, age-specific intervention, which is tailored to individual children and families with a duration of 1 year, and using a combination of individual and group sessions as well as a Web-based learning module. Changes in scientific working principles with regard to data collection, reporting and translation to guidelines are required. Practice and science may benefit from close collaboration in designing, implementing and evaluating interventions.
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Affiliation(s)
- E van Hoek
- Department of Paediatrics, Gelderse Vallei Hospital, PO Box 9025, Ede 6710 HN, The Netherlands.,Department of Paediatrics, Radboudumc, Nijmegen, The Netherlands
| | - L I Bouwman
- Department of Social Sciences, Health and Society, Wageningen University, Wageningen, The Netherlands
| | - M A Koelen
- Department of Social Sciences, Health and Society, Wageningen University, Wageningen, The Netherlands
| | - M A J Lutt
- Department of Medical Psychology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - A J Janse
- Department of Paediatrics, Gelderse Vallei Hospital, PO Box 9025, Ede 6710 HN, The Netherlands
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17
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Perez AJ, Ball GDC. Paradoxically speaking about engagement in pediatric weight management. Pediatr Obes 2018; 13:127-129. [PMID: 28207196 DOI: 10.1111/ijpo.12207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 01/19/2023]
Affiliation(s)
- A J Perez
- Faculty of Medicine and Dentistry, Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
| | - G D C Ball
- Faculty of Medicine and Dentistry, Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
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18
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Akgul Gundogdu N, Sevig EU, Guler N. The effect of the solution-focused approach on nutrition-exercise attitudes and behaviours of overweight and obese adolescents: Randomised controlled trial. J Clin Nurs 2018; 27:e1660-e1672. [DOI: 10.1111/jocn.14246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nurcan Akgul Gundogdu
- Department of Public Health Nursing; Faculty of Health Science; University of Cumhuriyet; Sivas Turkey
| | - Emine Umit Sevig
- Department of Nursing; Faculty of Health Science; University of Near East Turkish Republic of Northern Cyprus
| | - Nuran Guler
- Department of Public Health Nursing; Faculty of Health Science; University of Cumhuriyet; Sivas Turkey
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19
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Chaplais E, Naughton G, Greene D, Dutheil F, Pereira B, Thivel D, Courteix D. Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis. J Bone Miner Metab 2018; 36:12-30. [PMID: 28779404 DOI: 10.1007/s00774-017-0858-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 06/27/2017] [Indexed: 12/11/2022]
Abstract
Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship are needed. This systematic review and meta-analysis investigated the effect of obesity on bone health and assessed the effect of structured intervention in children and adolescents with obesity. Medline complete, OVID, CINAHL, EMBASE and PubMed databases were searched for studies on obesity and bone health variables up to September 2016, then an update occurred in March 2016. Search items included obesity, childhood, dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Twenty-three studies (14 cross-sectional and nine longitudinal) matched the inclusion criteria. Results from the meta-analysis (cross-sectional studies) confirmed that children and adolescents with obesity have higher bone content and density than their normal weight peers. Results from longitudinal studies remain inconclusive as only 50% of the included studies reported a positive effect of a structured intervention program on bone health. As such, the meta-analysis reported that structured intervention did not influence bone markers despite having beneficial effects on general health in youth with obesity.
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Affiliation(s)
- Elodie Chaplais
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France.
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia.
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia.
- Clermont University, Clermont-Ferrand, France.
| | - Geraldine Naughton
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
| | - David Greene
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
| | - Frederic Dutheil
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- CRNH-Auvergne, Clermont-Ferrand, France
- Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
- Clermont University, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital CHU G. Montpied, 63000, Clermont-Ferrand, France
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France
- CRNH-Auvergne, Clermont-Ferrand, France
- Clermont University, Clermont-Ferrand, France
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- CRNH-Auvergne, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
- Clermont University, Clermont-Ferrand, France
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20
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Serodio KJ, Berall GB, Flanders DI, Kuk JL. Effectiveness of a publicly funded clinical paediatric weight management program on obesity outcomes. Paediatr Child Health 2015; 20:425-8. [PMID: 26744553 PMCID: PMC4699521 DOI: 10.1093/pch/20.8.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of a publicly funded, paediatric weight management clinic in decreasing obesity. METHODS A retrospective chart review of patients four to 16 years of age, from 2006 to 2009, was performed at a medically supervised weight management clinic (n=121). Patients participated in monthly visits and were educated about the cognitive behavioural and nutritional aspects of weight management. RESULTS The sample included 51 male and 70 female patients with a mean (± SD) initial age of 11.7±3.0 years. Patients participated in 6.4±6.5 visits (range one to 31 visits) over 13.7±15.5 months and 7.4% of patients discontinued treatment after their initial visit. Of the patients who attended the clinic >1 time, 66.1% attended for at least four months, 48.2% attended for >8 months and 33.0% attended for >1 year. Over the course of their treatment, patients experienced a weight gain of 3.8±9.5 kg, but a reduction in body mass index (BMI) percentile (-1.1±3.6%). Post-treatment, the prevalence of obesity decreased from 96.7% to 87.5%. Patients with longer treatment times (>12 months) attained significantly lower final BMI percentiles than patients with shorter treatment times; however, there was no difference in the rate of reduction. Initial treatment age, sex and medical conditions were not related to BMI percentile change. CONCLUSIONS This paediatric weight management program effectively reduced the prevalence of obesity. Patients who had longer treatment times experienced greater reductions in obesity. Overall, the present study highlights that long-term patient attendance may be needed to better support paediatric weight management patients.
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Affiliation(s)
| | - Glenn B Berall
- Kinesiology and Health Science, Faculty of Health, York University
- Infant Child and Adolescent Nutrition Clinic, Toronto, Ontario
| | | | - Jennifer L Kuk
- Kinesiology and Health Science, Faculty of Health, York University
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21
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McTigue KM, Stepp SD, Moore CG, Cohen ED, Hipwell AE, Loeber R, Kuller LH. The development of youth-onset severe obesity in urban US girls. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2015; 2:150-156. [PMID: 26509122 PMCID: PMC4617672 DOI: 10.1016/j.jcte.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Youth-onset severe obesity warrants particular concern in urban female populations. Among 2226 girls, prevalence was 8.3% at age 7–10, 10.8% at age 12–15 and fairly stable over teen years. Severe obesity prevalence increased more rapidly with age for girls born in 1995 versus 1992. Severely obese girls' BMI grew 2.6 times as fast as normal-BMI peers in the transition to adolescence. Late childhood and early adolescence is a key developmental window for prevention and treatment.
Objective To understand the incidence and persistence of severe obesity (≥1.2 × 95th BMI percentile-for-age) in girls across the transition to adolescence, and map developmental trajectories of adolescent severe obesity in a high-risk sample. Methods We examined ten years of prospectively collected data from a population sample of urban girls (n = 2226; 53% African American, aged 7–10 in 2003–2004). We determined severe obesity prevalence and incidence by age. Logistic regression evaluated for secular trend in the association between age and severe obesity prevalence. Unconditional latent growth curve models (LGCMs) compared BMI development through the adolescence transition between girls with severe obesity versus healthy BMI. Results Severe obesity prevalence was 8.3% at age 7–10 and 10.1% at age 16–19 (white: 5.9%; African American: 13.2%; p < 0.001). Age-specific prevalence increased more rapidly among the latest-born, versus earliest-born, girls (p = 0.034). Incidence was 1.3% to 2.4% annually. When we compared 12–15 year-old girls with severe obesity versus healthy BMI, average body weight was already distinct 5 years earlier (16.5 kg versus 25.7 kg; p < 0.001) and the BMI difference between groups increased annually. LGCMs between ages 7–10 and 11–14 indicated an increase of 3.32 kg/m2 in the healthy-BMI group and 8.50 kg/m2 in the severe obesity group, a 2.6-fold difference. Conclusions Youth-onset severe obesity warrants particular concern in urban girls due to high prevalence and an increasing secular prevalence trend. Late childhood and early adolescence may represent a key developmental window for prevention and treatment, but is too late to prevent youth-onset severe obesity entirely.
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Affiliation(s)
- Kathleen M. McTigue
- Department of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
- Department of Epidemiology, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
- Corresponding author. Tel.: +1 412 692 2940; fax: + 1 412 692 4838.
| | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
| | - Charity G. Moore
- Department of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
- Department of Biostatistics, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
| | - Elan D. Cohen
- Department of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
| | - Rolf Loeber
- Department of Psychiatry, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA
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Perez A, Holt N, Gokiert R, Chanoine JP, Legault L, Morrison K, Sharma A, Ball G. Why don't families initiate treatment? A qualitative multicentre study investigating parents' reasons for declining paediatric weight management. Paediatr Child Health 2015; 20:179-84. [PMID: 26038633 DOI: 10.1093/pch/20.4.179] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. OBJECTIVE To understand parents' reasons for declining tertiary-level health services for paediatric weight management. METHOD Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents' responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. RESULTS Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents' reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children's lack of motivation); and situational factors (eg, weather). CONCLUSION Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents' intention to initiate treatment and address reasons for noninitiation that are within their control.
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Affiliation(s)
- Arnaldo Perez
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Nicholas Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Alberta
| | | | - Laurent Legault
- Endocrinology and Metabolism, McGill Unviversity, Montreal, Quebec
| | - Katherine Morrison
- Pediatrics and Population Health Research Institute, McMaster University, Hamilton, Ontario
| | - Arya Sharma
- Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta
| | - Geoff Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
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23
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Herbst A, Kapellen T, Schober E, Graf C, Meissner T, Holl RW. Impact of regular physical activity on blood glucose control and cardiovascular risk factors in adolescents with type 2 diabetes mellitus--a multicenter study of 578 patients from 225 centres. Pediatr Diabetes 2015; 16:204-10. [PMID: 24888254 DOI: 10.1111/pedi.12144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Regular physical activity (RPA) is a major therapeutic recommendation in children and adolescents with type 2 diabetes mellitus (T2DM). We evaluated the association between frequency of RPA and metabolic control, cardiovascular risk factors, and treatment regimes. METHODS The Pediatric Quality Initiative (DPV), including data from 225 centers in Germany and Austria, provided anonymous data of 578 patients (10-20 yr; mean 15.7 ± 2.1 yr; 61.9% girls) with T2DM. Patients were grouped by the frequency of their self-reported RPA per week: RPA 0, none; RPA 1, 1-2×/wk; RPA 2, >2×/wk. RESULTS The frequency of RPA ranged from 0 to 9×/wk (mean 1.1×/wk ±1.5). 55.7% of the patients reported no RPA (58.1% of the girls). Hemoglobin A1c (HbA1c) differed significantly among RPA groups (p < 0.002), being approximately 0.8 percentage points lower in RPA 2 compared to RPA 0. Body mass index (BMI-SDS) was higher in the groups with less frequent RPA (p < 0.00001). Multiple regression analysis revealed a negative association between RPA and HbA1c (p < 0.0001) and between RPA and BMI-SDS (p < 0.01). The association between RPA and high density lipoprotein (HDL)-cholesterol was positive (p < 0.05), while there was no association to total cholesterol, low density lipoprotein (LDL)-cholesterol or triglycerides. Approximately 80% of the patients received pharmacological treatment (oral antidiabetic drugs and/or insulin) without differences between RPA groups. CONCLUSION More than half of the adolescents with T2DM did not perform RPA. Increasing physical activity was associated with a lower HbA1c, a lower BMI-SDS, a higher HDL-cholesterol, but not with a difference in treatment regime. These results suggest that regular exercise is a justified therapeutic recommendation for children and adolescents with T2DM.
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Affiliation(s)
- A Herbst
- Department of Pediatrics, Hospital of Leverkusen, Leverkusen 51375, Germany
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24
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McCann JC, Shigenaga MK, Mietus-Snyder ML, Lal A, Suh JH, Krauss RM, Gildengorin GL, Goldrich AM, Block DS, Shenvi SV, McHugh TH, Olson DA, Ames BN. A multicomponent nutrient bar promotes weight loss and improves dyslipidemia and insulin resistance in the overweight/obese: chronic inflammation blunts these improvements. FASEB J 2015; 29:3287-301. [PMID: 25900806 DOI: 10.1096/fj.15-271833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022]
Abstract
This study determined if twice-daily consumption of a nutrient-dense bar intended to fill gaps in Western diets, without other dietary/lifestyle requirements, favorably shifted metabolic/anthropometric indicators of dysregulation in a healthy direction. Three 8-wk clinical trials in 43 healthy lean and overweight/obese (OW/OB) adults, who served as their own controls, were pooled for analysis. In less inflamed OW/OB [high-sensitivity C-reactive protein (hsCRP) <1.5], statistically significant decreases occurred in weight (-1.1 ± 0.5 kg), waist circumference (-3.1 ± 1.4 cm), diastolic blood pressure (-4.1 ± 1.6 mmHg), heart rate [HR; -4.0 ± 1.7 beats per minute (bpm)], triglycerides (-72 ± 38.2 mg/dl), insulin resistance (homeostatic model of insulin resistance) (-0.72 ± 0.3), and insulin (-2.8 ± 1.3 mU/L); an increase in HDL-2b (+303 ± 116 nM) and realignment of LDL lipid subfractions toward a less atherogenic profile [decreased small LDL IIIb (-44 ± 23.5 nM), LDL IIIa (-99 ± 43.7 nM), and increased large LDL I (+66 ± 28.0 nM)]. In the more inflamed OW/OB (hsCRP >1.5), inflammation was reduced at 2 wk (-0.66 mg/L), and HR at 8 wk (-3.4 ± 1.3 bpm). The large HDL subfraction (10.5-14.5 nm) increased at 8 wk (+346 ± 126 nM). Metabolic improvements were also observed in lean participants. Thus, favorable changes in measures of cardiovascular health, insulin resistance, inflammation, and obesity were initiated within 8 wk in the OW/OB by replacing deficiencies in Western diets without requiring other dietary or lifestyle modifications; chronic inflammation blunted most improvements.
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Affiliation(s)
- Joyce C McCann
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Mark K Shigenaga
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Michele L Mietus-Snyder
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Ashutosh Lal
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Jung H Suh
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Ronald M Krauss
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Ginny L Gildengorin
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Alisa M Goldrich
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Devan S Block
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Swapna V Shenvi
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Tara H McHugh
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Don A Olson
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
| | - Bruce N Ames
- *Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, California, USA; Children's National Medical Center, Washington, DC, USA; and Processed Foods Research Unit, U.S. Department of Agriculture-Agricultural Research Service-Western Regional Research Center, Albany, California, USA
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Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes 2015; 10:7-14. [PMID: 24347523 DOI: 10.1111/j.2047-6310.2013.00212.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/15/2013] [Accepted: 10/20/2013] [Indexed: 01/28/2023]
Abstract
UNLABELLED What is already known about this subject Lifestyle intervention is regarded as therapy of choice in obese children and adolescents. It is unclear whether extremely obese children and adolescents respond to lifestyle intervention. What this study adds Extremely obese children respond better than obese children to a lifestyle intervention. In contrast, most extremely obese adolescents achieved no weight loss in lifestyle intervention suggesting that other treatment approaches are needed for them. BACKGROUND There are conflicting results of treating extreme obesity in childhood by lifestyle interventions in the literature. METHODS We analysed the outcome of a 1-year lifestyle intervention in an intention-to-treat approach in 1291 children (mean age 11.0 ± 2.5 years, mean body mass index [BMI] 27.5 ± 4.7 kg m(-2), 55.8% female, 62.4% obese, 37.6% extremely obese (defined by BMI-SDS >2.3) at end of intervention and 1 year later. RESULTS The mean BMI-SDS reduction was -0.20 ± 0.32 at end of intervention and -0.14 ± 0.37 1 year after end of intervention compared to baseline (comparing intervention vs. 1 year later P = 0.010). Extremely obese children ≤10 years demonstrated a significantly greater BMI-SDS reduction than obese children ≤10 years (-0.24 ± 0.38 vs. -0.16 ± 0.38, P = 0.021). Extremely obese adolescents >10 years demonstrated a significantly lower BMI-SDS reduction compared to obese adolescents >10 years (-0.05 ± 0.30 vs. -0.15 ± 0.39, P < 0.001). Comparing the BMI-SDS reduction between obese children <10 years and >10 years revealed no significant difference (P = 0.195) in contrast to the comparison between extremely obese children <10 years and >10 years (P < 0.001). The same findings were observed in the follow-up period after the end of intervention. CONCLUSIONS Our study demonstrated an encouraging effect of lifestyle intervention in extremely obese children ≤10 years at the end of intervention and 1 year later, but only a limited effect in extremely obese adolescents >10 years.
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Affiliation(s)
- C Knop
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten, Herdecke, Germany
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26
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Brown RE, Kuk JL. Consequences of obesity and weight loss: a devil's advocate position. Obes Rev 2015; 16:77-87. [PMID: 25410935 PMCID: PMC4312481 DOI: 10.1111/obr.12232] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/18/2014] [Accepted: 10/03/2014] [Indexed: 12/22/2022]
Abstract
Obesity is associated with multiple negative health consequences and current weight management guidelines recommend all obese persons to lose weight. However, recent evidence suggests that not all obese persons are negatively affected by their weight and that weight loss does not necessarily always improve health. The purpose of this review is not to trivialize the significant health risks associated with obesity, but to discuss subpopulations of obese people who are not adversely affected, or may even benefit from higher adiposity, and in who weight loss per se may not always be the most appropriate recommendation. More specifically, this review will take a devil's advocate position when discussing the consequences of obesity and weight loss for adults with established cardiovascular disease and type 2 diabetes, weight cyclers, metabolically healthy obese adults, youth, older adults and obese individuals who are highly fit.
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Affiliation(s)
- R E Brown
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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27
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van Hoek E, Feskens EJM, Bouwman LI, Janse AJ. Effective interventions in overweight or obese young children: systematic review and meta-analysis. Child Obes 2014; 10:448-60. [PMID: 25333421 DOI: 10.1089/chi.2013.0149] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment programs for overweight and obese young children are of variable effectiveness, and the characteristics of effective programs are unknown. In this systematic review with meta-analysis, the effectiveness of treatment programs for these children is summarized. METHODS PubMed, Embase, Web of Science, and PsycINFO databases were searched up to April 2012. Articles reporting the effect of treatment on the body weight of overweight or obese children with a mean age in the range of 3-<8 years are included. Studies reporting the change in BMI z-score with standard error were included in a meta-analysis. For this purpose, a random-effects model was used. RESULTS The search identified 11,250 articles, of which 27 were included in this review. Eleven studies, including 20 treatment programs with 1015 participants, were eligible for the meta-analysis. The pooled intervention effect showed high heterogeneity; therefore, subgroup analysis was performed. Subgroup analysis showed that program intensity and used components partly explained the heterogeneity. The subgroup with two studies using multicomponent treatment programs (combining dietary and physical activity education and behavioral therapy) of moderate or high intensity showed the largest pooled change in BMI z-score (-0.46; I2, 0%). CONCLUSION Although the subgroup multicomponent treatment programs of moderate to high intensity contained only two studies, these treatment programs appeared to be most effective in treating overweight young children.
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Affiliation(s)
- Esther van Hoek
- 1 Department of Pediatrics, Gelderse Vallei Hospital , Ede, The Netherlands
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28
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Böhler T, Goldapp C, Mann R, Reinehr T, Bullinger M, Holl R, Hoffmeister U, van Egmond-Fröhlich A, Ravens-Sieberer U, Wille N, Westenhöfer J, Bengel J. Sensitivity analysis of weight reduction results of an observational cohort study in overweight and obese children and adolescents in Germany: the evakuj study. Pediatr Rep 2013; 5:e16. [PMID: 24198928 PMCID: PMC3812533 DOI: 10.4081/pr.2013.e16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/30/2013] [Indexed: 11/23/2022] Open
Abstract
In the German EvAKuJ observational cohort study, changes in the body mass index standard deviation score (BMI-SDS) of overweight and obese children and adolescents as primary outcome of multimodal (short, inpatient or long, outpatient) weight-loss interventions are difficult to interpret. Published intention-to-treat (ITT) and per protocol data obtained at the end of the intervention (T1), one year (T2), and two years (T3) after its end were used for sensitivity analysis of treatment success rates. The odds ratio and the number needed to treat (NNT) for BMI-SDS reduction of at least -0.2 (successful treatment) and at least -0.5 (good treatment success) were related to spontaneous BMI-SDS reduction rates in a hypothetical control group (control event rate, CER). At T1, treatment seems to be effective up to a CER of 10% in inpatients and of 5% in outpatients. ITT analysis, compromised by a loss to follow-up of 81 to 90% (inpatients) and 57 to 66% (outpatients), indicated that treatment may become less effective at a CER above 1% in inpatients (e.g., successful treatment at T2: NNT=106, at T3: NNT=51), and above 5% in outpatients (successful treatment at T2: NNT=7, at T3: NNT=8; good treatment success at T2 and T3: NNT=25). Positive short-term effects of inpatient treatment of overweight and obese children and adolescents may not be maintained in the long term. Long-term effectiveness of outpatient treatment may depend on age and the degree of overweight.
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Affiliation(s)
- Thomas Böhler
- Medical Service of Statutory Health Insurance Baden-Württemberg, Karlsruhe, Germany
| | | | | | - Thomas Reinehr
- Vestische Kinder- und Jugendklinik, University of Witten-Herdecke, Datteln, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Ulrike Hoffmeister
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | - Ulrike Ravens-Sieberer
- Research Section Child Public Health, Department of Psychosomatics in Children and Adolescents, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Nora Wille
- Research Section Child Public Health, Department of Psychosomatics in Children and Adolescents, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Westenhöfer
- Department for Health Sciences, University of Applied Sciences, Hamburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
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29
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Rendo-Urteaga T, García-Calzón S, Martínez-Ansó E, Chueca M, Oyarzabal M, Azcona-Sanjulián MC, Bustos M, Moreno-Aliaga MJ, Martínez JA, Marti A. Decreased cardiotrophin-1 levels are associated with a lower risk of developing the metabolic syndrome in overweight/obese children after a weight loss program. Metabolism 2013; 62:1429-36. [PMID: 23856329 DOI: 10.1016/j.metabol.2013.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiotrophin-1 (CT-1) shares some similarities with other cytokines, and participates in the control of energy metabolism. Higher circulating levels are observed in obese humans, but little information is gathered in weight loss (WL) programs. Therefore, we aimed to investigate the association of serum CT-1 levels with metabolic variables and the risk of developing metabolic syndrome (MetS) after a WL program in overweight/obese children. SUBJECTS AND METHODS Forty-four overweight/obese children (mean age 11.5 y; 50% males) undergoing a 10-week WL program were enrolled. Subjects were dichotomized at the median of Body Mass Index-Standard Deviation Score (BMI-SDS) change, as high and low responders after intervention. RESULTS CT-1 levels were significantly reduced (-48 fmol/mL, p=0.043) in the high responder group after the WL program. They had significantly lower body weight (-3.7 kg, p<0.001), body fat mass (-8%, p<0.001), BMI-SDS (-0.78, p<0.001) and waist circumference (-5.4 cm, p<0.001), and a significant improvement in lipid and glucose profiles (p<0.05). Interestingly, decreased CT-1 levels significantly predicted changes in total cholesterol (41%) and LDL-cholesterol (28%). Moreover, in our participants the lower the CT-1 levels, the higher the reduction in MetS risk components, after the 10-week intervention, (p-ANCOVA=0.040, p-trend=0.024). CONCLUSION We showed, for the first time, a reduction in serum CT-1 levels after a WL program and this decrease in CT-1 was strongly associated with a reduction in cholesterol levels and in MetS risk factors in overweight/obese children. Our findings may suggest that CT-1 could be an indirect marker for the diagnosis of MetS in this population.
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Affiliation(s)
- Tara Rendo-Urteaga
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain
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Myer GD, Faigenbaum AD, Stracciolini A, Hewett TE, Micheli LJ, Best TM. Exercise deficit disorder in youth: a paradigm shift toward disease prevention and comprehensive care. Curr Sports Med Rep 2013; 12:248-55. [PMID: 23851413 PMCID: PMC4137789 DOI: 10.1249/jsr.0b013e31829a74cd] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite the widely recognized benefits of daily play, recreation, sports, and physical education on the physical and psychosocial well-being of children and adolescents, many contemporary children and adolescents worldwide do not meet the recommendations for daily physical activity (PA). The decline in PA seems to start early in life, which leads to conditions characterized by reduced levels of PA in the pediatric population that are inconsistent with current public health recommendations. Unlike many other diseases and disorders in pediatrics, physical inactivity in youth is unique in that it currently lacks a clinical gold standard for diagnosis. This makes the diagnosis and treatment medically challenging, though no less important, as the resultant ramifications of a missed diagnosis are of significant detriment. Exercise-deficient children need to be identified early in life and treated with developmentally appropriate exercise programs designed to target movement deficiencies and physical weaknesses in a supportive environment. Without such interventions early in life, children are more likely to become resistant to our interventions later in life and consequently experience adverse health consequences. Integrative approaches that link health care professionals, pediatric exercise specialists, school administrators, community leaders, and policy makers may provide the best opportunity to promote daily PA, reinforce desirable behaviors, and educate parents about the exercise-health link.
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Affiliation(s)
- Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Nobili V, Svegliati-Baroni G, Alisi A, Miele L, Valenti L, Vajro P. A 360-degree overview of paediatric NAFLD: recent insights. J Hepatol 2013; 58:1218-29. [PMID: 23238106 DOI: 10.1016/j.jhep.2012.12.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/14/2012] [Accepted: 12/04/2012] [Indexed: 02/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a multi-faceted disorder, which ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) with/without fibrosis. The effects of specific risk factors, such as obesity and sedentary lifestyle, on predisposing genetic settings eventually lead to the development of NAFLD in children. The complex interplay between genes and environment in NAFLD pathogenesis is sustained by multiple mechanisms that involve liver crosstalk with other organs and tissues, especially gut and adipose tissue. Unfortunately, natural history of paediatric NAFLD is lacking, and the etiopathogenesis is still in the process of being defined. Potential early predictors and suitable non-invasive diagnostic tools can be discovered based on the pathogenetic mechanisms and histological patterns. This will also help design novel treatments and a comprehensive and successful management strategy for patients. In this review, we discuss the recent advances made in genetics, etiopathogenesis, diagnosis, and therapeutic management of NAFLD, focusing especially on the obesity-related steatotic liver condition.
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Affiliation(s)
- Valerio Nobili
- Hepato-metabolic Disease Unit and Liver Research Unit, "Bambino Gesù" Children's Hospital, IRCCS, P.le S. Onofrio 4, 00165 Rome, Italy.
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Hartmann A, Hilbert A. Psychosoziale Folgen von Adipositas im Kindes- und Jugendalter und Strategien zu deren Behandlung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:532-8. [DOI: 10.1007/s00103-012-1637-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kreier F, Genco ŞM, Boreel M, Langkemper MP, Nugteren IC, Rijnveld V, Thissen V, Deden S, Keessen M. An individual, community-based treatment for obese children and their families: the solution-focused approach. Obes Facts 2013; 6:424-32. [PMID: 24107796 PMCID: PMC5644677 DOI: 10.1159/000355909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 06/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluates an individual, community-based treatment for obese children and their families. In this program, a treatment team applied solution-focused techniques to develop a custom-made treatment plan in collaboration with the participants. The treatment plan consisted of community-based lifestyle activities. METHODS 559 obese children with an average BMI z-score of 2.76 ± 0.54 took part in the 12-month study, and 372 children with an average BMI z-score of 2.75 ± 0.52 took part in the 24-month study. At the start of the study, ethnicity and special school needs were recorded. Before, after 12 months, and after 24 months of the treatment, body weight and height were measured. The effect of the treatment on body weight was evaluated using BMI z-scores. RESULTS 291 children (52%) completed 12 months of treatment, whereas 22 children (4%) were dismissed earlier due to a good response. After 12 months, the children showed a significant decrease in BMI z-score by 0.16 (95% confidence interval (CI) 0.11-0.20; p < 0.005). After 24 months, 103 children (28%) were participating in the program, with a significant decrease in BMI z-score of 0.15 (95% CI 0.07-0.22; p < 0.005). 50 children (13%) were dismissed before the end of the second year due to significant weight loss (standard deviation z-score reduction -0.38; 95% CI 0.30-0.46; p < 0.005; with an average treatment duration of 12.9 ± 6.4 months). There was a negative correlation of age and reduction in BMI z-score: children younger than 6 years showed a decrease in BMI z-score of 0.45 (95% CI 0.26-0.65) and 0.31 (95% CI 0.11-0.53) after 12 and after 24 months, respectively. CONCLUSIONS Children showed a significant decrease in BMI z-score after the treatment. We found a negative correlation of age and weight loss. Special attention to patients with a high risk of drop-out might further improve these results. We advise a referral to obesity treatment as early as possible since a 'wait and see' policy might have adverse results in obese children.
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Affiliation(s)
- Felix Kreier
- *Dr. Felix Kreier, Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, Postbus 95500, 1090 HM Amsterdam (The Netherlands),
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