1
|
Chan KM, Rahem SM, Teo HO, Curcio J, Mushiyev S, Faillace R, Bochner R, Bargman R, Raiszadeh F. Understanding family dynamics of obesity: Do parents and children lose and gain weight together? Pediatr Obes 2024; 19:e13097. [PMID: 38583983 DOI: 10.1111/ijpo.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND Obesity is prevalent among children and adults. Yet, understanding the relationship between parent and child weight trajectories is limited. OBJECTIVE (1) Examine the association between parent/child undesirable body mass index (BMI) category change. (2) Assess whether parental BMI category predicts child modified BMI z-score (mBMIz) annual change. METHODS We conducted a cross-sectional study of weight trajectories of 3821 parent-child dyads between March 2020 and December 2021 within the NYC Health + Hospitals system. Undesirability of child and parental BMI category change and the magnitude of mBMIz change by parental BMI are analysed. RESULTS Of 3821 children (mean [SD] baseline age, 9.84 [3.51]), 1889 were female. Of the 3220 parents (mean [SD] baseline age, 39.9 [8.51]), 2988 were female. Most children (53.52%) and parents (81.94%) presented with overweight and obesity. Undesirable BMI change in children was associated with concordant change in parents (adjusted OR: 1.7, 95% CI [1.45, 2.01], adjusted p < 0.001). Children of parents with obesity (adjusted coef: 0.076, 95% CI [0.004, 0.147], p < 0.038) and severe obesity (adjusted coef: 0.1317, 95% CI [0.024, 0.239], adjusted p < 0.016) demonstrated greater change in mBMIz than those of parents with normal weight or underweight. CONCLUSION Parents and children have concordant weight trajectories, and public health interventions targeting both populations are essential.
Collapse
Affiliation(s)
- Karina M Chan
- California Northstate University College of Medicine, Department of Medicine, Elk Grove, California, USA
| | - Sarra M Rahem
- Department of Data Sciences and Support, NYC Health + Hospitals, Central Office, New York, New York, USA
| | - Hugo O Teo
- Department of Data Sciences and Support, NYC Health + Hospitals, Central Office, New York, New York, USA
| | - Joan Curcio
- Division of Hospital Medicine, Department of Medicine, NYC Health + Hospitals, Elmhurst Hospital Center, Elmhurst, New York, USA
| | - Savi Mushiyev
- Division of Cardiology, Department of Medicine, NYC Health + Hospitals, Metropolitan Hospital Center, New York, New York, USA
| | - Robert Faillace
- Division of Cardiology, Department of Medicine, NYC Health + Hospitals, Jacobi Medical Center, Bronx, New York, USA
| | - Risa Bochner
- Department of Pediatrics, NYC Health + Hospitals, Harlem Hospital Center, New York, New York, USA
| | - Renee Bargman
- Department of Pediatrics, NYC Health + Hospitals, Kings County Hospital, Brooklyn, New York, USA
- Department of Pediatrics, NYC Health + Hospitals, South Brooklyn Health, Brooklyn, New York, USA
| | - Farbod Raiszadeh
- Division of Cardiology, Department of Medicine, NYC Health + Hospitals, Harlem Hospital Center, New York, New York, USA
| |
Collapse
|
2
|
Staiano AE, Button AM, Baker A, Beyl R, Conn AM, Lima A, Lindros J, Newton RL, Stein RI, Welch RR, Cook S, Wilfley DE. A pragmatic trial of a family-centered approach to childhood obesity treatment: Rationale and study design. Contemp Clin Trials 2024; 138:107459. [PMID: 38278478 PMCID: PMC10922779 DOI: 10.1016/j.cct.2024.107459] [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] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Family-based behavioral treatment (FBT) is an effective intensive health behavior and lifestyle treatment for obesity reduction in children and adolescents, but families have limited access. The purpose of this randomized, pragmatic, comparative effectiveness trial was to examine changes in child relative weight in a 12-month, enhanced standard of care (eSOC) intervention combined with FBT (eSOC+FBT) vs. eSOC alone. METHODS Children aged 6 to 15 years with obesity, and their primary caregiver, were recruited from primary care clinics. Families were randomized 1:1 to eSOC, a staged approach led by the primary care provider that gradually intensified dependent on a child's response to care and aligns with the American Medical Association guidelines, or the eSOC+FBT arm, which included regular meetings with a health coach for healthy eating, physical activity, positive parenting strategies, and managing social and environmental cues. Both treatments align with the 2023 American Academy of Pediatrics clinical practice guidelines. Assessments occurred at baseline, midpoint (month 6), end-of-intervention (month 12), and follow-up (month 18). Primary outcome was change from baseline to 12 months in child percent overweight (percentage above the median body mass index in the general US population normalized for age and sex). Secondary outcomes were parent weight, child psychosocial factors, heterogeneity of treatment effects, and cardiometabolic risk factors. Exploratory outcomes assessed reach, effectiveness, adoption, implementation, and maintenance. CONCLUSION This pragmatic trial will generate evidence for the comparative effectiveness of implementing two guidelines-based approaches in primary care for obesity reduction in children and adolescents. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843424.
Collapse
Affiliation(s)
- Amanda E Staiano
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America.
| | - Alyssa M Button
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Alison Baker
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robbie Beyl
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Anne-Marie Conn
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Angela Lima
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Jeanne Lindros
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Richard I Stein
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - R Robinson Welch
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Stephen Cook
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Denise E Wilfley
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| |
Collapse
|
3
|
McDarby F, Looney K. The effectiveness of group-based, parent-only weight management interventions for children and the factors associated with outcomes: a systematic review. Int J Obes (Lond) 2024; 48:3-21. [PMID: 37821651 DOI: 10.1038/s41366-023-01390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Obesity in Childhood is a significant public health issue, which requires both a preventative and treatment approach. International guidelines continue to recommend family-focused, multicomponent, childhood weight management programmes and many studies have investigated their effectiveness, however, findings have been mixed and primarily based on weight. Thus, the aim of this review was to assess the effectiveness of group-based parent-only interventions on a broad range of child health-related outcomes and to investigate the factors associated with intervention outcomes. METHODS An electronic database search was conducted using CINAHL, Medline, PsychINFO, Embase and the Cochrane Database of Systematic Reviews: 522 articles were identified for full text review and 15 studies were selected. The quality of studies were appraised and data were synthesised according to the review aims. RESULTS Parent-only group interventions are effective in changing children's weight status, as well as other outcomes such as health behaviours and self-esteem, although these were reported inconsistently. Parent-only interventions were generally found to be similar to parent-child interventions, and minimal contact interventions but better than a waiting list control. Factors found to be associated with treatment outcomes, included session attendance, the child's age and weight at baseline, socioeconomic status of families and modification to the home food environment. The methodological quality of the studies included in the review was low, with only six studies rated to be methodologically adequate. CONCLUSIONS Parent-only interventions may be an effective treatment for improving the health status of children and their families, particularly when compared with waitlist controls. However, results need to be interpreted with caution due to the low quality of the studies and the high rates of non-completion.
Collapse
Affiliation(s)
- Fionna McDarby
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Kathy Looney
- School of Psychology, University College Dublin, Dublin, Ireland.
| |
Collapse
|
4
|
Woo S, Song HJ, Song JK, Kim Y, Lim H, Park KH. Parent and child characteristics associated with treatment non-response to a short- versus long-term lifestyle intervention in pediatric obesity. Eur J Clin Nutr 2023; 77:127-134. [PMID: 36076070 DOI: 10.1038/s41430-022-01207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND/OBJECTIVES This study aimed to identify the factors associated with short- or long-term non-response to an obesity intervention in children and adolescents. SUBJECTS/METHODS In this observational study, a total of 242 children and adolescents (sex- and age-specific body mass index (BMI) ≥ 85th percentile) were divided into three groups according to the BMI z-score change after 6 (n = 163) and 24 months (n = 110) of participating in an obesity intervention: responders, low responders, and non-responders if the BMI z-score decrease was ≥0.25, 0 to 0.25, and if it increased, respectively. RESULTS Short-term non-response was associated with higher maternal psychosocial stress (OR = 2.34, 95% CI [1.07-5.11]) and adolescence (>11 years; OR = 2.40, 95% CI [1.10-5.22]). The odds of long-term non-response were reduced by an increased vegetable consumption of more than five dishes per week (OR = 0.21, 95% CI [0.07-0.69]) and an hour of increased sleep duration during weekends (OR = 0.14, 95% CI [0.04-0.53]). CONCLUSIONS Short-term non-response was associated with child and maternal characteristics, whereas long-term non-response was associated with actual lifestyle changes such as sleep duration and vegetable consumption. Children with obesity may benefit from an hour of weekend catch-up sleep in lowering the risk of long-term treatment non-response. An individualized approach should be considered for children of older age and mothers with a higher level of stress, as they may not benefit from a conventional short-term lifestyle intervention.
Collapse
Affiliation(s)
- Sarah Woo
- Department of Medical Sciences, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jung-Kook Song
- Department of Preventive Medicine, College of Medicine, Jeju National University, Jeju-si, Jeju Special Self-Governing Province, Republic of Korea
| | - YoonMyung Kim
- University College, Yonsei University International Campus, Incheon, Republic of Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
5
|
Nezami BT, Wasser HM, Tate DF. Parent and child dietary changes in a 6-month mobile-delivered weight loss intervention with tailored messaging for parents. Front Public Health 2022; 10:972109. [PMID: 36225761 PMCID: PMC9548804 DOI: 10.3389/fpubh.2022.972109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023] Open
Abstract
Objective To examine changes in parent and child dietary intake, associations between program adherence and parent dietary changes, and the association between parent and child dietary changes in a mobile-delivered weight loss intervention for parents with personalized messaging. Methods Adults with overweight or obesity and who had a child aged 2-12 in the home were recruited for a randomized controlled trial comparing two types of dietary monitoring: calorie monitoring (Standard, n = 37) or "red" food monitoring (Simplified, n = 35). Parents received an intervention delivered via a smartphone application with lessons, text messages, and weekly personalized feedback, and self-monitoring of diet, activity, and weight. To measure associations between parent and child dietary changes, two 24-h recalls for parents and children at baseline and 6 months measured average daily calories, percent of calories from fat, vegetables, fruit, protein, dairy, whole grains, refined grains, added sugars, percent of calories from added sugars, and total Healthy Eating Index-2015 score. Results Higher parent engagement was associated with lower parent percent of calories from fat, and greater days meeting the dietary goal was associated with lower parent daily calories and refined grains. Adjusting for child age, number of children in the home, parent baseline BMI, and treatment group, there were significant positive associations between parent and child daily calories, whole grains, and refined grains. Parent-child dietary associations were not moderated by treatment group. Conclusions These results suggest that parent dietary changes in an adult weight loss program may indirectly influence child diet.
Collapse
Affiliation(s)
- Brooke T. Nezami
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Heather M. Wasser
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deborah F. Tate
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
6
|
Kjetså I, Halvorsen PA, Kokkvoll AS. Age, income and sleep duration were associated with outcomes in children participating in weight management. Acta Paediatr 2022; 111:1412-1419. [PMID: 35322469 PMCID: PMC9324948 DOI: 10.1111/apa.16339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022]
Abstract
Aim To explore associations between baseline factors and weight‐related outcomes among participants enrolled in a paediatric obesity trial. Methods We included children aged 6–12 years participating in a 2‐year multidisciplinary family programme who attended a postintervention follow‐up 36 months from baseline (n = 62). Outcome measures were change in body mass index standard deviation score (BMI SDS), reduction in BMI SDS ≥0.25 and change in waist circumference (WC). Independent variables included in linear and logistic regression models were age, sex, household income, parents' education, sleep duration, screen time and physical activity. Results Altogether, 26 children (42%) attained a reduction of BMI SDS ≥0.25. Higher family income and longer sleep duration were associated with greater change in BMI SDS (−0.05 per 100.000 NOK, p = 0.02, and −0.24 per hour, p = 0.02, respectively). Higher age was associated with greater change in WC (−2.1 cm per year, p = 0.01) but lower odds of attaining a reduction in BMI SDS ≥0.25 (OR per year 0.70, p = 0.04). There was a borderline statistically significant trend towards greater increase in WC with longer daily screen time (p = 0.05). Conclusion Age, family income and sleep duration at baseline were associated with weight‐related outcomes 1‐year postintervention.
Collapse
Affiliation(s)
- Ingrid Kjetså
- Department of Radiology Helse Møre og Romsdal Molde Sjukehus Molde Norway
| | - Peder Andreas Halvorsen
- Research Unit for General Practice Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Ane Sofie Kokkvoll
- Department of Paediatrics Finnmark Hospital Trust Hammerfest Norway
- Paediatric Research Group Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| |
Collapse
|
7
|
Fowler LA, Litt MD, Rotman SA, Conlon RPK, Jakubiak J, Stein RI, Balantekin KN, Welch RR, Perri MG, Epstein LH, Wilfley DE. Relation of social network support to child health behaviors among children in treatment for overweight/obesity. Eat Weight Disord 2022; 27:1669-1678. [PMID: 34549372 PMCID: PMC8934746 DOI: 10.1007/s40519-021-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT). METHODS Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT. RESULTS Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time. CONCLUSION The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention. LEVEL OF EVIDENCE III. cohort study.
Collapse
Affiliation(s)
- Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Storrs, CT, 263 Farmington Ave., MC 3910, Farmington, CT, 06030, USA
| | - Sophia A Rotman
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 451 Newton Rd, Iowa City, IA, 52242, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Jessica Jakubiak
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, Campus Box 8031, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, 204A Kimball Tower, Buffalo, NY, 14214, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100185, Gainesville, FL, 32610, USA
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo, 3435 Main St, Buffalo, NY, 14214, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| |
Collapse
|
8
|
Parents' Reports of Children's Physical and Sedentary Behavior Engagement among Parents in Weight Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073773. [PMID: 35409456 PMCID: PMC8997835 DOI: 10.3390/ijerph19073773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023]
Abstract
Background: The purpose of this study was to explore the associations between demographics, family exercise participation, family discouragement of exercise, and the children’s physical and sedentary behaviors to identify specific areas of physical activity intervention for children with parents engaged in medical weight management (MWM). Methods: Parents (n = 294) of children aged 2−18 years old were recruited from two university MWM programs to complete a one-time survey. Bivariate analyses tested associations. Results: Parents reported that sedentary activity was higher for children who identified as racial minorities (t(141) = −2.05, p < 0.05). Mobile phone and tablet use was higher for adolescents compared to school age and young children (H(2) = 10.96, p < 01) Exercise game use was higher for racial minority children compared to white children (U = 9440.5, z = 2.47, p ≤ 0.03). Male children (t(284) = 1.83, p < 0.07), children perceived to have a healthy weight status (t(120) = 4.68, p < 0.00), and younger children (t(289) = 1.79, p < 0.08) all engaged in more strenuous physical activity. Family exercise participation (t(162) = −2.93, p < 0.01) and family discouragement of exercise (U = 7813.50, z = −2.06, p ≤ 0.04) were significantly higher for children in racial minority families. Conclusions: Future work should determine methods to engage children and their parents participating in MWM in physical activities together to ensure that the changes the parents are making with MWM are sustainable.
Collapse
|
9
|
Vermeiren E, Van Eyck A, Van De Maele K, Ysebaert M, Makhout S, De Guchtenaere A, Van Helvoirt M, Tanghe A, Naets T, Vervoort L, Braet C, Bruyndonckx L, De Winter B, Verhulst S, Van Hoorenbeeck K. The Predictive Value of Adipokines and Metabolic Risk Factors for Dropouts and Treatment Outcomes in Children With Obesity Treated in a Pediatric Rehabilitation Center. Front Endocrinol (Lausanne) 2022; 13:822962. [PMID: 35769076 PMCID: PMC9234213 DOI: 10.3389/fendo.2022.822962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inpatient pediatric obesity treatments are highly effective, although dropouts and weight regain threaten long-term results. Preliminary data indicate that leptin, adiponectin, and cardiometabolic comorbidities might predict treatment outcomes. Previous studies have mainly focused on the individual role of adipokines and comorbidities, which is counterintuitive, as these risk factors tend to cluster. This study aimed to predict the dropouts and treatment outcomes by pre-treatment patient characteristics extended with cardiometabolic comorbidities (individually and in total), leptin, and adiponectin. METHODS Children aged 8-18 years were assessed before, immediately after and 6 months after a 12-month inpatient obesity treatment. Anthropometric data were collected at each visit. Pre-treatment lipid profiles; glucose, insulin, leptin, and adiponectin levels; and blood pressure were measured. The treatment outcome was evaluated by the change in body mass index (BMI) standard deviation score (SDS) corrected for age and sex. RESULTS We recruited 144 children with a mean age of 14.3 ± 2.2 years and a mean BMI of 36.7 ± 6.2 kg/m2 corresponding to 2.7 ± 0.4 BMI SDS. The 57 patients who dropped out during treatment and the 44 patients who dropped out during aftercare had a higher pre-treatment BMI compared to the patients who completed the treatment (mean BMI, 38.3 ± 6.8 kg/m2 vs 35.7 ± 5.5 kg/m2) and those who completed aftercare (mean BMI, 34.6 ± 5.3 kg/m2 vs 37.7 ± 6.3 kg/m2) (all p<0.05). Additionally, aftercare attenders were younger than non-attenders (mean age, 13.4 ± 2.3 years vs 14.9 ± 2.0, p<0.05).Patients lost on average 1.0 ± 0.4 SDS during treatment and regained 0.4 ± 0.3 SDS post-treatment corresponding to regain of 43 ± 27% (calculated as the increase in BMI SDS post-treatment over the BMI SDS lost during treatment). A higher BMI and more comorbidities inversely predicted BMI SDS reduction in linear regression (all p<0.05).The absolute BMI SDS increase after returning home was predicted by pre-treatment leptin and systolic blood pressure, whereas the post-treatment BMI SDS regain was predicted by pre-treatment age, leptin, and adiponectin levels (all p<0.05) in multivariate linear regressions. CONCLUSION Patients who need treatment the most are at increased risk for dropouts and weight regain, emphasizing the urgent need for interventions to reduce dropout and support inpatients after discharge. Furthermore, this study is the first to report that pre-treatment leptin and adiponectin levels predict post-treatment BMI SDS regain, requiring further research.
Collapse
Affiliation(s)
- Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | | | - Marijke Ysebaert
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Sanae Makhout
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | | | - Tiffany Naets
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
- Department of Developmental Psychology, Radboud University, Nijmegen, Netherlands
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
- *Correspondence: Kim Van Hoorenbeeck,
| |
Collapse
|
10
|
Ruiz VMT, Lima RBDS, Lima KF, Martins MC, Barbosa LP, Oriá MOB. Autoeficácia alimentar em crianças e adolescentes com sobrepeso ou obesidade: revisão integrativa de instrumentos. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0301pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Descrever as características dos instrumentos para avaliação da autoeficácia alimentar no sobrepeso e na obesidade em crianças e adolescentes. Métodos: Revisão integrativa da literatura, realizada em maio de 2020, em seis bases de dados (PubMed; Web of Science; Scopus; CINAHL, ADOLEC e PsycINFO) com a seguinte estratégia de busca: self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Resultados: Incluíram-se 35 artigos e 21 instrumentos aplicados às crianças de 6 a 9 anos (n=2), em adolescentes de 10 a 19 anos (n=9) e em crianças e adolescentes de 7 a 18 anos (n=10). Os instrumentos têm de 4 a 30 itens e variaram de duas a cinco dimensões, sendo as mais frequentes “alimentação saudável” e “atividade física”. Conclusão: Existem diferentes instrumentos confiáveis destinados à avaliação da autoeficácia alimentar do público adolescente e infantil, o que sinaliza a importância desse construto para prevenção e controle da obesidade e sobrepeso.
Collapse
|
11
|
Ruiz VMT, Lima RBDS, Lima KF, Martins MC, Barbosa LP, Oriá MOB. Eating self- efficacy in overweight and obese children and adolescents: integrative review of instruments. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To describe the characteristics of instruments to assess eating self-efficacy in overweight and obesity in children and adolescents. Methods: Integrative literature review, conducted in May 2020, in six databases (PubMed; Web of Science; Scopus; CINAHL, ADOLEC, and PsycINFO) with the following search strategy: Self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Results: The inclusion of thirty-five articles and twenty-one instruments was applied to children 6 to 9 years old (n=2), adolescents 10 to 19 years old (n=9), and children and adolescents 7 to 18 years old (n=10). The instruments have 4 to 30 items and vary from two to five dimensions, the most frequent being “healthy eating” and “physical activity.” Conclusion: There are different reliable instruments designed to assess eating self-efficacy in adolescents and children, indicating the importance of this construct for preventing and controlling obesity and overweight.
Collapse
|
12
|
Foster BA, Reynolds K, Callejo-Black A, Polensek N, Weill BC. Weight outcomes in children with developmental disabilities from a multidisciplinary clinic. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103809. [PMID: 33220529 PMCID: PMC7775337 DOI: 10.1016/j.ridd.2020.103809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children with developmental disabilities experience disparately high rates of obesity yet there are few reports detailing clinical outcomes for this population. AIM To describe outcomes of obesity treatment for children with developmental disabilities and a comparison group of children without developmental disabilities. METHODS AND PROCEDURES We examined weight outcomes of children with and without developmental disabilities seen in a family-centered, multidisciplinary treatment center over a ten-year period. We stratified by age and developmental disability diagnosis. We assessed whether intake demographic or health behavior data was associated with successful reduction of adiposity over six and twelve month follow-up periods, using a ≥5% absolute reduction in percent over the 95th percentile body mass index (BMIp95) as the primary outcome. OUTCOMES AND RESULTS Over a ten-year period, 148 of 556 children in the obesity clinic (27 %) had a developmental disability. In children <12 years of age, 36 % of children with developmental disabilities reduced their adiposity compared with 18 % of children without developmental disabilities at six months, p = .01. This pattern continued at twelve months. Active transport to school was associated with reduced adiposity for those without a disability. Older children with disabilities rarely had a significant reduction (2 of 26 children), and they took more medications with weight-related side effects. CONCLUSIONS AND IMPLICATIONS Younger children with developmental disabilities experienced relative success in reducing their adiposity. Challenges to addressing obesity in this population include structural barriers to physical activity and medications for behavioral management with weight-related side effects.
Collapse
Affiliation(s)
- Byron Alexander Foster
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, and OHSU-PSU School of Public Health, United States.
| | - Kimberly Reynolds
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, United States
| | | | - Natasha Polensek
- Departments of Family Medicine and Pediatrics, School of Medicine, Oregon Health & Science University, United States
| | - Beau C Weill
- Metropolitan Pediatrics, Portland, United States
| |
Collapse
|
13
|
Fowler LA, Grammer AC, Ray MK, Balantekin KN, Stein RI, Kolko Conlon RP, Welch RR, Perri MG, Epstein LH, Wilfley DE. Examining the interdependence of parent-child dyads: Effects on weight loss and maintenance. Pediatr Obes 2021; 16:e12697. [PMID: 32720457 PMCID: PMC8186411 DOI: 10.1111/ijpo.12697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/05/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to further elucidate correlated weight changes in parent-child dyads enrolled in family-based treatment (FBT) by modeling the interdependence of weight changes during treatment. METHODS Parent-child dyads (n = 172) with overweight/obesity (child mean zBMI = 2.16 ± 0.39; parent mean BMI = 37.9 ± 9.4 kg/m2 ) completed 4 months of FBT and were randomized to one of three 8-month maintenance interventions (Social Facilitation Maintenance [SFM]-high dose, SFM-low dose or control). Weight/height was measured at 0, 4 and 12 months. Structural equation models simultaneously estimated the effect that an individual had on their own (actor effect) and on one another's (partner effect) weight-status across time using the actor-partner interdependence model. RESULTS Actor paths were significant over time for parent and child. Partner paths were significant for child zBMI predicting parent BMI at 4 and 12 months. Maintenance condition moderated actor/partner paths in the model. CONCLUSIONS Child weight change may motivate parents to make environmental and behavioural changes that impact their own weight. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00759746.
Collapse
Affiliation(s)
- Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary Katherine Ray
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University of Buffalo, Buffalo, New York, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael G Perri
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo, Buffalo, New York, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
14
|
Abstract
Zusammenfassung
Hintergrund
Adipositas ist im Kindes- und Jugendalter stark verbreitet. Medizinische Rehabilitationsmaßnahmen mit ihrem umfassenden Behandlungsangebot stellen eine wesentliche Säule der Versorgung dar. Da Adipositas mit vielfältigen psychosozialen Belastungen verbunden ist, stellt sich die Frage, ob psychotherapeutische Angebote noch stärker berücksichtigt werden sollten.
Fragestellung
Untersucht wurde, wie verbreitet psychische Auffälligkeiten bei Kindern und Jugendlichen mit Adipositas sind und in welchem Zusammenhang sie zum Gewichtsverlauf stehen.
Material und Methoden
Die Stichprobe bestand aus 220 Kindern und Jugendlichen mit Adipositas (8 bis 16 Jahre, M = 13,11 Jahre; SD ± 1,88 Jahre; 54,5 % weiblich), die an einer stationären Rehabilitationsmaßnahme teilnahmen. Emotionale- und Verhaltensauffälligkeiten (Strengths and Difficulties Questionnaire, SDQ) wurden zu Rehabilitationsbeginn sowie 6 und 12 Monate nach Rehabilitationsende im Elternbericht erfasst. Zudem wurden Daten zur Bestimmung des Gewichtstatus durch das medizinische Personal der Kliniken bzw. in der Katamnese von Hausärzten erhoben.
Ergebnisse
Fast die Hälfte der Kinder und Jugendlichen (48,6 %) wies auffällige Werte auf; v. a. Mädchen waren signifikant häufiger betroffen. Die deskriptive Betrachtung nach Rehabilitationsende zeigte einen vergleichbar hohen Anteil. Zudem wirkte sich das Vorliegen psychosozialer Auffälligkeiten signifikant negativ auf den Gewichtsverlauf aus.
Schlussfolgerung
Psychische Probleme sollten im Rahmen der Adipositastherapie stärker berücksichtigt werden. Zum einen sollten evtl. belastete Kinder durch Screenings identifiziert werden, zum anderen psychotherapeutische Maßnahmen zur Reduktion psychosozialer Belastungen integraler Bestandteil der Behandlung sein.
Collapse
|
15
|
Rashid R, Condon L, Gluud C, Jakobsen JC, Lindschou J, Lissau I. Psychotherapy versus treatment as usual and other control interventions in children and adolescents with overweight and obesity: a protocol for systematic review with meta-analysis and Trial Sequential Analysis. BMJ Open 2020; 10:e036058. [PMID: 33154043 PMCID: PMC7646330 DOI: 10.1136/bmjopen-2019-036058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The prevalence of children with overweight and obesity is increasing worldwide. Multicomponent interventions incorporating diet, physical activity and behavioural change have shown limited improvement to body mass index (BMI). However, the impact of psychotherapy is poorly explored. This systematic review aims to assess the effects of psychotherapeutic approaches for children with all degrees of overweight. METHODS AND ANALYSIS We will include randomised clinical trials involving children and adolescents between 0 and 18 years with overweight and obesity, irrespective of publication type, year, status or language up to April 2020. Psychotherapy will be compared with no intervention; wait list control; treatment as usual; sham psychotherapy or pharmaceutical placebo. The following databases will be searched: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, Embase, PsycINFO, PubMed, Web of Science, CINAHL and LILACS. Primary outcomes will be BMI z-score, quality of life measured by a validated scale and proportion of patients with serious adverse events. Secondary outcomes will be body weight, self-esteem, anxiety, depression and proportion of patients with non-serious adverse events. Exploratory outcomes will be body fat, muscle mass and serious adverse events. Study inclusion, data extraction and bias risk assessments will be conducted independently by at least two authors. We will assess risk of bias according to Cochrane guidelines and the Cochrane Effective Practice and Organisation of Care guidance. We will use meta-analysis and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool. The systematic review will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. ETHICS AND DISSEMINATION As individual patient data will not be included, we do not require ethics approval. This review will be published in a peer review journal. PROSPERO REGISTRATION NUMBER CRD42018086458.
Collapse
Affiliation(s)
- Rajeeb Rashid
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Laura Condon
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Sygehus, Holbaek, Sjaelland, Denmark
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Inge Lissau
- Clinical Research Centre, University Hospital Copenhagen, Copenhagen, Hvidovre, Denmark
| |
Collapse
|
16
|
Pasquale E, Neshteruk CD, Howard J, Skinner AC, Story M, Frerichs LM, Armstrong SC. An Integrated Clinic-Community Model to Treat Childhood Obesity: Revisiting 2 Years Later. Clin Pediatr (Phila) 2020; 59:1092-1096. [PMID: 32506928 DOI: 10.1177/0009922820930368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
17
|
Schur EA, Melhorn SJ, Scholz K, De Leon MRB, Elfers CT, Rowland MG, Saelens BE, Roth CL. Child neurobiology impacts success in family-based behavioral treatment for children with obesity. Int J Obes (Lond) 2020; 44:2011-2022. [PMID: 32713944 PMCID: PMC7530004 DOI: 10.1038/s41366-020-0644-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Family-based behavioral treatment (FBT) is the recommended treatment for children with common obesity. However, there is a large variability in short- and long-term treatment response and mechanisms for unsuccessful treatment outcomes are not fully understood. In this study, we tested if brain response to visual food cues among children with obesity before treatment predicted weight or behavioral outcomes during a 6-mo. behavioral weight management program and/or long-term relative weight maintenance over a 1-year follow-up period. Subjects and Methods: Thirty-seven children with obesity (age 9–11y, 62% male) who entered active FBT (attended 2 or more sessions) and had outcome data. Brain activation was assessed at pre-treatment by functional magnetic resonance imaging across an a priori set of appetite-processing brain regions that included the ventral and dorsal striatum, medial orbitofrontal cortex, amygdala, substantia nigra/ventral tegmental area and insula in response to viewing food images before and after a standardized meal. Results: Children with more robust reductions in brain activation to high-calorie food cue images following a meal had greater declines in BMI z-score during FBT (r= 0.42; 95% CI: 0.09, 0.66; P=0.02) and greater improvements in Healthy Eating Index scores (r= −0.41; 95% CI: −0.67, −0.06; P=0.02). In whole-brain analyses, greater activation in the ventromedial prefrontal cortex, specifically by high-calorie food cues, was predictive of better treatment outcomes (whole-brain cluster corrected P=0.02). There were no significant predictors of relative weight maintenance and initial behavioral or hormonal measures did not predict FBT outcomes. Conclusions: Children’s brain responses to a meal prior to obesity treatment were related to treatment-based weight outcomes, suggesting that neurophysiologic factors and appetitive drive, more so than initial hormone status or behavioral characteristics, limit intervention success.
Collapse
Affiliation(s)
- Ellen A Schur
- Division of General Internal Medicine, Department of Medicine, University of Washington, 750 Republican St, Box 358062, Seattle, WA, 98109, USA.
| | - Susan J Melhorn
- Division of General Internal Medicine, Department of Medicine, University of Washington, 750 Republican St, Box 358062, Seattle, WA, 98109, USA
| | - Kelley Scholz
- Seattle Children's Research Institute, 1900 Ninth Ave, Seattle, WA, 98101, USA
| | - Mary Rosalynn B De Leon
- Division of General Internal Medicine, Department of Medicine, University of Washington, 750 Republican St, Box 358062, Seattle, WA, 98109, USA
| | - Clinton T Elfers
- Seattle Children's Research Institute, 1900 Ninth Ave, Seattle, WA, 98101, USA
| | - Maya G Rowland
- Seattle Children's Research Institute, 1900 Ninth Ave, Seattle, WA, 98101, USA
| | - Brian E Saelens
- Seattle Children's Research Institute, 1900 Ninth Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Christian L Roth
- Seattle Children's Research Institute, 1900 Ninth Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| |
Collapse
|
18
|
Gow ML, Tee MSY, Garnett SP, Baur LA, Aldwell K, Thomas S, Lister NB, Paxton SJ, Jebeile H. Pediatric obesity treatment, self-esteem, and body image: A systematic review with meta-analysis. Pediatr Obes 2020; 15:e12600. [PMID: 32020780 DOI: 10.1111/ijpo.12600] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric obesity impacts on multiple domains of psychological health, including self-esteem and body image. OBJECTIVE To determine the effect of multicomponent pediatric obesity treatment interventions on self-esteem and body image. METHODS A systematic search of published literature up to June 2019 was undertaken using electronic databases MEDLINE, EMBASE, Cochrane Library, and PsychINFO. Eligible studies implemented an obesity treatment intervention, including a dietary and physical activity component with/without a behavioral component, in children and adolescents with overweight/obesity, and assessed self-esteem and/or body image. Data were extracted by one reviewer and cross-checked. Meta-analysis was used to combine outcome data and moderator analysis conducted to identify intervention characteristics influencing outcomes. RESULTS 64 studies were identified. Meta-analysis of 49 studies (n = 10471) indicated that pediatric obesity treatment results in increased self-esteem postintervention (standardized mean difference, [SE] 0.34 [0.03], P < .001, I2 87%), maintained at follow-up (0.35 [0.05] P < .001, I2 79%, 17 studies). Similarly, meta-analysis of 40 studies (n = 2729) indicated improvements in body image postintervention (0.40 [0.03], P < .001, I2 73%), maintained at follow-up (0.41 [0.08], P < .001, I2 89%, 16 studies). CONCLUSIONS Pediatric obesity treatment improves self-esteem and body image in the short and medium term. These findings may underpin improvements in other psychological outcomes.
Collapse
Affiliation(s)
- Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Melissa S Y Tee
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Weight Management Services, The Children's Hospital at Westmead, Sydney, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Sarah Thomas
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| |
Collapse
|
19
|
Frerichs L, Smith NR, Lyden J, Gaskin K, Skinner A, Armstrong S. Weight-related quality of life and temperament as predictors and moderators of outcomes among treatment-seeking, low-income, ethnically diverse children with obesity. Transl Behav Med 2020; 10:244-253. [PMID: 30476258 DOI: 10.1093/tbm/iby115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Within any childhood obesity treatment program, some children have better outcomes than others. Little is known about predictors or moderators of more positive outcomes. We aimed to identify whether child temperament and weight-related quality of life predict or moderate childhood obesity treatment outcomes at 6 months. From 2015 to 2016, children (n = 97) ages 5-11 years old with obesity were randomized to a clinic-community (Bull City Fit) or a clinic-only treatment program. Linear regression was used to explore whether dimensions of child temperament and weight-related quality of life predicted or moderated 6-month anthropometric and physical activity outcomes. Children who had more social avoidance due to their weight at baseline had significantly better improvements in body fat percent in the clinic-community model compared with the clinic-only model at 6 months. Across programs, better baseline social quality of life predicted greater increases in waist circumference; conversely, better physical quality of life predicted a decrease in percent of the 95th percentile. Also, children with longer attention spans had greater increases in physical activity. Our findings suggest that children who have social avoidance due to their weight may benefit most from comprehensive clinic-community treatment. Weight-related quality of life may influence outcomes across all treatments, and practitioners need to carefully counsel children experiencing weight negatively.
Collapse
Affiliation(s)
- Leah Frerichs
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalie R Smith
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica Lyden
- School of Medicine, Duke University, Durham, NC, USA
| | - Kiah Gaskin
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Asheley Skinner
- Clinical Research Institute, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
20
|
Njardvik U, Gunnarsdottir T, Olafsdottir AS, Craighead LW, Boles RE, Bjarnason R. Incorporating Appetite Awareness Training Within Family-Based Behavioral Treatment of Pediatric Obesity: A Randomized Controlled Pilot Study. J Pediatr Psychol 2019; 43:1017-1027. [PMID: 30010923 DOI: 10.1093/jpepsy/jsy055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To assess additive effects of incorporating appetite awareness training (AAT), a strategy to encourage eating in response to hunger and satiety cues, within a family-based behavioral treatment (FBT) for childhood obesity. Methods Total 84 families with a child with obesity in the age range of 8-12 years, Body Mass Index Standard Deviation Score (BMI-SDS) ≥ 2, and a participating parent were randomly allocated to two conditions; standard FBT was compared with FBT incorporating AAT strategies (FBT-AAT). Treatment consisted of group therapy sessions (held separately for children and parents) as well as single-family (parent-child dyad) sessions (24 sessions total) delivered over 18 weeks at a tertiary care outpatient clinic. One booster session was provided 1-year posttreatment and a final follow-up assessment was conducted at 2 years. The primary outcome was change in child standardized body mass index (BMI-SDS). Results The two conditions did not differ significantly at posttest, but the FBT-AAT group was at a significantly lower weight compared with FBT at both the first-year, F(1, 82) = 4.150, p<.05, and the second-year follow-ups, F(1, 82) = 14.912, p <.001. It was notable that over the second-year of follow-up, the FBT-AAT group continued to show improvement, whereas the FBT group did not. Conclusions Incorporating specific self-regulatory training in attending to hunger and fullness signals during a standardized family-based treatment may have enhanced the long-term maintenance of treatment effects. Findings are promising and warrant further study.
Collapse
Affiliation(s)
| | | | - Anna S Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland
| | | | - Richard E Boles
- Anschutz Medical Campus School of Medicine, University of Colorado
| | - Ragnar Bjarnason
- Faculty of Medicine, University of Iceland and Children's Medical Centre, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
21
|
Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis. Obes Rev 2019; 20:1287-1298. [PMID: 31131531 PMCID: PMC6851692 DOI: 10.1111/obr.12866] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 12/20/2022]
Abstract
This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre-post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow-up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post-intervention. Meta-analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], -0.326 [0.09], P < 0.001), emotional eating (six studies, -0.149 [0.06], P = 0.008), binge eating (three studies, -0.588 [0.10], P < 0.001), and drive for thinness (three studies, -0.167 [0.06], P = 0.005) post-intervention. At follow-up, a reduction in ED risk (six studies, -0.313 [0.13], P = 0.012), emotional eating (five studies, -0.259 [0.05], P < 0.001), eating concern (three studies, -0.501 [0.06], P < 0.001), and drive for thinness (two studies, -0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.
Collapse
Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical SchoolWestmeadAustralia
- Institute of Endocrinology and Diabetes and Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| | - Megan L. Gow
- The University of Sydney, Children's Hospital Westmead Clinical SchoolWestmeadAustralia
- Institute of Endocrinology and Diabetes and Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| | - Louise A. Baur
- The University of Sydney, Children's Hospital Westmead Clinical SchoolWestmeadAustralia
- Institute of Endocrinology and Diabetes and Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| | - Sarah P. Garnett
- The University of Sydney, Children's Hospital Westmead Clinical SchoolWestmeadAustralia
- Institute of Endocrinology and Diabetes and Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Natalie B. Lister
- The University of Sydney, Children's Hospital Westmead Clinical SchoolWestmeadAustralia
- Institute of Endocrinology and Diabetes and Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| |
Collapse
|
22
|
Gorecki MC, Feinglass JM, Binns HJ. Characteristics Associated with Successful Weight Management in Youth with Obesity. J Pediatr 2019; 212:35-43. [PMID: 31230887 DOI: 10.1016/j.jpeds.2019.05.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify the medical, demographic, and behavioral factors associated with a reduction of body mass index percent of the 95th percentile (BMIp95) after 1 year for patients receiving care at a tertiary care obesity management clinic. STUDY DESIGN A retrospective review of data from first and 12 ± 3-month follow-up visits of subjects aged 8-17 years with obesity. Data included anthropometrics, demographics, medical/psychological history, reported diet patterns, and participation in moderate/vigorous physical activity. After analyzing factors associated with 1-year follow-up, we used a forward conditional logistic regression model, controlling for subject's sex, to examine associations with a BMIp95 ≥5-point decrease at 1 year. RESULTS Of 769 subjects, 184 (23.9%) had 1-year follow-up. Boys more often had follow-up (28.4% vs girls, 19.1%; P = .003). The follow-up sample was 62.0% male, 65.8% Hispanic, and 77.7% with public insurance; 33.2% achieved a ≥5-point decrease in BMIp95. In regression results, the ≥5-point decrease group was more likely to have completed an initial visit in April-September (OR 2.0, 95% CI 1.1-3.9); have increased physical activity by 1-2 d/wk (OR 3.4, 95% CI 1.4-7.8) or increased physical activity by ≥ 3 d/wk at 1 year (OR 2.7, 95% CI 1.1-6.3); and less likely to have been depressed at presentation (OR 0.4, 95% CI 0.2-0.9). Demographic and dietary factors were not significantly associated with BMIp95 group status. CONCLUSIONS Strategies improving follow-up rates, addressing mental health concerns, and promoting year-round physical activity are needed to increase the effectiveness of obesity management clinics.
Collapse
Affiliation(s)
| | - Joseph M Feinglass
- Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Helen J Binns
- Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University, Chicago, IL; Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Chicago, IL.
| |
Collapse
|
23
|
Gailite J, Apela D, Dzīvīte-Krišāne I, Gardovska D. Short-Term Predictors for Weight Correction Success of the First Paediatric Weight Correction Programme in Children's Clinical University Hospital in Riga. ACTA ACUST UNITED AC 2019; 55:medicina55030075. [PMID: 30901958 PMCID: PMC6473572 DOI: 10.3390/medicina55030075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: The efficacy of a weight correction programme can be affected by such predictors as the number of contact hours, gender, age, baseline weight, parental weight status, psycho-emotional status, insulin resistance, and socioeconomic status. The aim of this current study was to evaluate the overall efficacy of the Weight Correction Programme at Children's Clinical University Hospital, and explore the impact of the probable predictors. We evaluated the efficacy depending on gender, age, parental weight status, signs of depression, baseline body mass index z-score (z-BMI), and baseline waist circumference. Materials and Methods: The data were gathered from medical records. The inclusion criteria were as follows: Entered the programme by 13 June 2017, at least five years old, follow-up data available. All the respondents were divided into two age groups: <10 years old and ≥10 years old. Results: The study included 181 respondents. They were 5 to 17 years old on the first day of participation in the Weight Correction Programme. Results indicated that 117 (65%) patients managed to reduce z-BMI and 69 (38%) patients achieved clinically significant reduction of z-BMI. Boys had four times higher odds (odds ratio (OR) = 4,22; CI 1.37⁻13.05; p = 0.012) to reduce their z-BMI by at least 0.20 units than girls. The respondents of the older age group (≥10 years) had a better chance to reduce z-BMI than the younger ones (OR = 11,51; CI 2.04⁻64.83; p = 0.006). The odds to reduce z-BMI were lower by 7% for every extra cm of waist circumference (OR = 0.93; CI 0.88⁻0.99; p = 0.014) for reducing z-BMI. The follow-up time was also a positive predictor, and with every month the odds for clinically significant z-BMI reduction increased by 7% (OR = 1.07; CI 1.00⁻1.15; p = 0.047). The parental weight status, signs of depression, and baseline z-BMI were not significant predictors. Conclusions: More than half of the patients of the respondents managed to reduce their z-BMI. Female gender, younger age, and larger waist circumference were negative predictors.
Collapse
Affiliation(s)
- Jurgita Gailite
- Department of Pediatrics, Rīga Stradiņš University, Rīga LV-1007, Latvia.
- Children's Clinical University Hospital, Rīga LV-1004, Latvia.
| | - Dana Apela
- Children's Clinical University Hospital, Rīga LV-1004, Latvia.
| | - Iveta Dzīvīte-Krišāne
- Department of Pediatrics, Rīga Stradiņš University, Rīga LV-1007, Latvia.
- Children's Clinical University Hospital, Rīga LV-1004, Latvia.
| | - Dace Gardovska
- Department of Pediatrics, Rīga Stradiņš University, Rīga LV-1007, Latvia.
- Children's Clinical University Hospital, Rīga LV-1004, Latvia.
| |
Collapse
|
24
|
Byrne JLS, O'Connor K, Peng C, Morash CL, Ball GDC. Weight up? Changes in children's anthropometry from time of referral to baseline assessment for paediatric weight management. Paediatr Child Health 2018; 23:377-382. [PMID: 30455574 DOI: 10.1093/pch/pxx191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine children's wait time to access a multidisciplinary, tertiary-level weight management clinic and assess anthropometric changes from time of referral to baseline assessment. Method A retrospective medical record review was completed of children (5 to 17 years) enrolled in a multidisciplinary, tertiary-level paediatric weight management clinic from 2006 to 2015. Children's demographic and anthropometric data from their referral to and baseline assessment at the clinic were retrieved from medical records. Based on changes in body mass index (BMI) z-score from the time of referral to baseline assessment, children were categorized as decreasers (>0.05 unit decrease), increasers (>0.05 unit increase) or stabilizers (-0.05 to 0.05 unit change). The proportion of children with a ≥0.25 unit BMI z-score reduction was calculated. Analysis of variance and chi-squared tests were performed. Results Children (n=400) were 11.7 ± 2.9 years old at the time of referral, 52.8% (n=211) female, and had an average wait time of 4.5 ± 3.9 months. By 3 and 6 months postreferral, 44.0% (n=176) and 80.8% (n=323), respectively, had attended baseline assessments. Based on BMI z-score change, children were classified as decreasers (n=183; 45.8%), increasers (n=118; 29.5%) or stabilizers (n=99; 24.8%). One-fifth of children (n=86; 21.5%) experienced a BMI z-score reduction ≥0.25 units, a subgroup that was younger, had a higher BMI z-score at referral, and had a longer wait time between referral and baseline assessment (all P<0.05). Conclusions Most children who enrolled in paediatric weight management initiated treatment within six months and experienced a modest decrease or stabilization in BMI z-score during their wait time.
Collapse
Affiliation(s)
- Jillian L S Byrne
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Kathleen O'Connor
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Chenhui Peng
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Edmonton, Alberta
| | - Cailyn L Morash
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Pediatric Centre for Weight and Health, Stollery Children's Hospital, Edmonton, Alberta
| |
Collapse
|
25
|
Wilfley DE, Hayes JF, Balantekin KN, Van Buren DJ, Epstein LH. Behavioral interventions for obesity in children and adults: Evidence base, novel approaches, and translation into practice. AMERICAN PSYCHOLOGIST 2018; 73:981-993. [PMID: 30394777 PMCID: PMC6220709 DOI: 10.1037/amp0000293] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obesity in adults has nearly doubled in the past 30 years and has risen similarly in children and adolescents. Obesity affects all systems of the body, and the serious health consequences of obesity include an increased risk for cardiovascular disease, such as Type 2 diabetes or high blood pressure, which are occurring at ever younger ages. The present article introduces traditional behavioral weight loss strategies designed to change energy-balance behaviors (i.e., dietary and physical activity behaviors) and the contexts within which these interventions have typically been delivered. The applicability of findings from behavioral economics, cognitive processing, and clinical research that may lead to more potent weight loss and weight loss maintenance interventions are also considered. Given the pervasiveness of obesity, this article concludes with a discussion of efforts toward wider scale dissemination and implementation of behavioral treatments designed to address obesity and to reduce the risk of cardiovascular disease. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine
| | - Jacqueline F Hayes
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | | | | | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo
| |
Collapse
|
26
|
Hayes JF, Fitzsimmons-Craft EE, Karam AM, Jakubiak J, Brown ML, Wilfley DE. Disordered Eating Attitudes and Behaviors in Youth with Overweight and Obesity: Implications for Treatment. Curr Obes Rep 2018; 7:235-246. [PMID: 30069717 PMCID: PMC6098715 DOI: 10.1007/s13679-018-0316-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF THE REVIEW Children with obesity experience disordered eating attitudes and behaviors at high rates, which increases their risk for adult obesity and eating disorder development. As such, it is imperative to screen for disordered eating symptoms and identify appropriate treatments. RECENT FINDINGS Family-based multicomponent behavioral weight loss treatment (FBT) is effective at treating childhood obesity and demonstrates positive outcomes on psychosocial outcomes, including disordered eating. FBT utilizes a socio-ecological treatment approach that focuses on the development of individual and family healthy energy-balance behaviors as well as positive self- and body esteem, supportive family relationships, richer social networks, and the creation of a broader environment and community that facilitates overall physical and mental health. Existing literature suggests FBT is an effective treatment option for disordered eating and obesity in children. Future work is needed to confirm this conclusion and to examine the progression and interaction of obesity and disordered eating across development to identify the optimal time for intervention.
Collapse
Affiliation(s)
- Jacqueline F Hayes
- Psychiatry Department, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Psychiatry Department, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Anna M Karam
- Psychiatry Department, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Jessica Jakubiak
- Psychiatry Department, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Mackenzie L Brown
- Psychiatry Department, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Denise E Wilfley
- Psychiatry Department, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| |
Collapse
|
27
|
Cassidy O, Eichen DM, Burke NL, Patmore J, Shore A, Radin RM, Sbrocco T, Shomaker LB, Mirza N, Young JF, Wilfley DE, Tanofsky-Kraff M. Engaging African American Adolescents and Stakeholders to Adapt Interpersonal Psychotherapy for Weight Gain Prevention. JOURNAL OF BLACK PSYCHOLOGY 2017. [DOI: 10.1177/0095798417747142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Developing culturally appropriate obesity prevention programs for African American (AA) adolescent girls that account for psychological risk factors is paramount to addressing health disparities. The current study was part of an investigation utilizing a community-based participatory research framework to gather qualitative data from urban AA girls, their caregivers, and community health liaisons to develop a novel obesity prevention program based on interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). In the current study with urban AAs, data from seven focus groups (total sample size, N = 40) were analyzed using thematic analysis. Participants identified problematic eating behaviors, including binge or loss of control eating; highlighted the importance of interpersonal relationships, mood functioning, and eating; and supported the tenets of IPT-WG. While features of IPT-WG generally resonated with participants, culturally based modifications were suggested. These data will be used to inform the development of a culturally relevant IPT-WG program.
Collapse
Affiliation(s)
- Omni Cassidy
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Dawn M. Eichen
- Washington University School of Medicine, St. Louis, MO, USA
| | - Natasha L. Burke
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Allison Shore
- Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel M. Radin
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Nazrat Mirza
- Children’s National Health System, Washington, DC, USA
| | | | | | | |
Collapse
|
28
|
Burke NL, Shomaker LB, Brady S, Reynolds JC, Young JF, Wilfley DE, Sbrocco T, Stephens M, Olsen CH, Yanovski JA, Tanofsky-Kraff M. Impact of Age and Race on Outcomes of a Program to Prevent Excess Weight Gain and Disordered Eating in Adolescent Girls. Nutrients 2017; 9:nu9090947. [PMID: 28846646 PMCID: PMC5622707 DOI: 10.3390/nu9090947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 01/23/2023] Open
Abstract
Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.
Collapse
Affiliation(s)
- Natasha L Burke
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, 303 Behavioral Sciences Building, 1570 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Sheila Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - James C Reynolds
- Radiology and Imaging Sciences Department, Warren Grant Magnuson Clinical Center, National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA.
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Campus Box 8134, St. Louis, MO 63110, USA.
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Mark Stephens
- Department of Family and Community Medicine, Pennsylvania State University, 1850 E. Park Avenue, Suite 207, State College, PA 16803, USA.
| | - Cara H Olsen
- Department of Preventative Medicine & Biometrics, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), US Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
29
|
Alulis S, Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: A qualitative meta-synthesis. Obes Res Clin Pract 2017; 11:627-639. [PMID: 28844833 DOI: 10.1016/j.orcp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child and adolescent obesity trends are rising throughout the world, revealing treatment difficulties and a lack of consensus about treatment. The family system is broadly viewed as a potential setting for facilitation of behaviour change. Therefore, family-based interventions have come into focus. However, the use of theoretical frameworks to strengthen these interventions is rare and very uneven. OBJECTIVE AND METHOD To conduct a qualitative meta-synthesis of family-based interventions for child and adolescent obesity to identify the theoretical frameworks applied, thus understanding how theory is used in practice. A literature review was conducted between January and March 2016. A total of 35 family-based interventions were selected for analysis. RESULTS Eleven interventions explicitly stated that theory guided the development and were classified as theory-inspired. The social cognitive, self-efficacy and Family Systems Theory appeared most frequently. The remaining 24 were classified as theory-related as theoretical elements of self-monitoring; stimulus control, reinforcement and modelling were used. CONCLUSION The designs of family-based interventions reveal numerous inconsistencies and a significant void between research results and health care practice. Based on the analysis, this article proposes three themes to be used as focus points when designing future interventions and when selecting theories for the development of solid, theory-based frameworks for application. The themes are: (1) age of target group, (2) intervention objective, and (3) self-efficacy and readiness for change.
Collapse
Affiliation(s)
- Sarah Alulis
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark; Lund University, Paradisgatan 2, 221 00 Lund, Sweden.
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark.
| |
Collapse
|
30
|
Linder DE, Sacheck JM, Noubary F, Nelson ME, Freeman LM. Dog attachment and perceived social support in overweight/obese and healthy weight children. Prev Med Rep 2017; 6:352-354. [PMID: 28491488 PMCID: PMC5423301 DOI: 10.1016/j.pmedr.2017.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/10/2017] [Accepted: 04/23/2017] [Indexed: 11/28/2022] Open
Abstract
The development of effective and sustainable interventions to treat childhood obesity remains both a priority and a challenge. Previous studies support that dogs provide social support in overweight adults in obesity interventions, but the child-dog relationship is not as well understood. The goal of the study was to examine the child-dog relationship among children to inform novel childhood obesity interventions including dogs. A cross-sectional study was conducted in the Living Laboratory® at the Museum of Science, Boston in 2015. Children aged 8-13, with a dog in the household, answered surveys on pet attachment (Pet Relationship Scale), perceived social support from parents and close friends (Child and Adolescent Social Support Scale), and had a height and weight measurement taken for calculation of body mass index percentile. Overweight and obese children (≥ 85th body mass index percentile) had greater mean attachment score to their dog and less mean perceived social support from their parents and friends combined compared to healthy weight children (73.1 ± 5.6 vs. 68.5 ± 7.2, p = 0.037; 110.5 ± 13.5 vs. 122.9 ± 14.8, p = 0.015, respectively; n = 43). In conclusions, children who are overweight/obese report greater mean dog attachment and lower mean perceived social support, supporting the concept that pet dogs are considered part of overweight/obese children's social support networks. Future studies are warranted to evaluate the impact of including pet dogs as additional health support in child obesity interventions.
Collapse
Affiliation(s)
- Deborah E. Linder
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Jennifer M. Sacheck
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Farzad Noubary
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Institute, Tufts University, Boston, MA, USA
| | - Miriam E. Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Sustainability Institute, University of New Hampshire, Durham, NH, USA
| | - Lisa M. Freeman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| |
Collapse
|
31
|
Kass AE, Wilfley DE, Eddy KT, Boutelle KN, Zucker N, Peterson CB, Le Grange D, Celio-Doyle A, Goldschmidt AB. Secretive eating among youth with overweight or obesity. Appetite 2017; 114:275-281. [PMID: 28365476 DOI: 10.1016/j.appet.2017.03.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Secretive eating, characterized by eating privately to conceal being seen, may reflect eating- and/or body-related shame, be associated with depression, and correlate with binge eating, which predicts weight gain and eating disorder onset. Increasing understanding of secretive eating in youth may improve weight status and reduce eating disorder risk. This study evaluated the prevalence and correlates of secretive eating in youth with overweight or obesity. METHODS Youth (N = 577) presented to five research/clinical institutions. Using a cross-sectional design, secretive eating was evaluated in relation to eating-related and general psychopathology via linear and logistic regression analyses. RESULTS Secretive eating was endorsed by 111 youth, who were, on average, older than youth who denied secretive eating (mean age = 12.07 ± 2.83 versus 10.97 ± 2.31). Controlling for study site and age, youth who endorsed secretive eating had higher eating-related psychopathology and were more likely to endorse loss of control eating and purging than their counterparts who did not endorse secretive eating. Groups did not differ in excessive exercise or behavioral problems. Dietary restraint and purging were elevated among adolescents (≥13y) but not children (<13y) who endorsed secretive eating; depression was elevated among children, but not adolescents, who endorsed secretive eating. CONCLUSIONS Secretive eating may portend heightened risk for eating disorders, and correlates of secretive eating may differ across pediatric development. Screening for secretive eating may inform identification of problematic eating behaviors, and understanding factors motivating secretive eating may improve intervention tailoring.
Collapse
Affiliation(s)
- Andrea E Kass
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, MC 1000, Chicago, IL, 60637, USA.
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Kamryn T Eddy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kerri N Boutelle
- Department of Pediatrics and Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA, 92093, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, P.O. Box 3842, Durham, NC, 27710, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118, USA
| | - Angela Celio-Doyle
- Eating Disorders Center at the Evidence Based Treatment Centers of Seattle, 1200 5th Avenue, Suite 800, Seattle, WA, 98101, USA; Department of Psychology, University of Washington, Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA, 98105, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Weight Control and Diabetes Research Center/The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
| |
Collapse
|
32
|
Williams AN, Konopken YP, Keller CS, Castro FG, Arcoleo KJ, Barraza E, Patrick DL, Olson ML, Shaibi GQ. Culturally-grounded diabetes prevention program for obese Latino youth: Rationale, design, and methods. Contemp Clin Trials 2017; 54:68-76. [PMID: 28104469 DOI: 10.1016/j.cct.2017.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 2 diabetes (T2D) disproportionately impacts Latino youth yet few diabetes prevention programs address this important source of health disparities. OBJECTIVES To address this knowledge gap, we describe the rationale, design, and methodology underpinning a culturally-grounded T2D prevention program for obese Latino youth. The study aims to: 1) to test the efficacy of the intervention for reducing T2D risk, 2) explore potential mediators and moderators of changes in health behaviors and health outcomes and, 3) examine the incremental cost-effectiveness for reducing T2D risk. Latino adolescents (N=160, age 14-16) will be randomized to either a 3-month intensive lifestyle intervention or a control condition. The intervention consists of weekly health education delivered by bilingual/bicultural promotores and 3 moderate-to-vigorous physical activity (PA) sessions/week. Control youth receive health information and results from their laboratory testing. Insulin sensitivity, glucose tolerance, and weight-specific quality of life are assessed at baseline, 3-months, 6-months, and 12-months. We will explore whether enhanced self-efficacy and/or social support mediate improvements in nutrition/PA behaviors and T2D outcomes. We will also explore whether effects are moderated by sex and/or acculturation. Cost-effectiveness from the health system perspective will be estimated by the incremental cost-effectiveness ratio using changes in insulin sensitivity at 12-months. CONCLUSIONS The results of this study will provide much needed information on how T2D prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent T2D in this and other high-risk populations.
Collapse
Affiliation(s)
- Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Southwest Interdisciplinary Research Center, Arizona State University, United States
| | - Yolanda P Konopken
- Family Wellness Program, Virginia G. Piper, St. Vincent de Paul Medical and Dental Clinic, United States
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | - Felipe Gonzalez Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | | | - Estela Barraza
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | - Donald L Patrick
- Seattle Quality of Life Group, Department of Health Services, School of Public Health and Community Medicine, University of Washington, United States
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Division of Endocrinology and Diabetes, Phoenix Children's Hospital, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Southwest Interdisciplinary Research Center, Arizona State University, United States; Division of Endocrinology and Diabetes, Phoenix Children's Hospital, United States.
| |
Collapse
|
33
|
Hilbert A. Social facilitation maintenance treatment for adults with obesity: study protocol for a randomised-controlled feasibility study (SFM study). BMJ Open 2016; 6:e010845. [PMID: 27580827 PMCID: PMC5013413 DOI: 10.1136/bmjopen-2015-010845] [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: 12/11/2015] [Revised: 04/27/2016] [Accepted: 06/16/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The long-term success of non-surgical weight loss treatment in adults with obesity is limited by substantial relapse, and only a few evidence-based weight loss maintenance treatments exist. This clinical trial investigates the feasibility and efficacy of a social facilitation maintenance programme for weight loss maintenance, tailored to meet the needs of obese adults who have undergone a lifestyle weight loss intervention. METHODS AND ANALYSIS In a single-centre, open feasibility trial, 72 adults currently or previously obese or overweight who have undergone a lifestyle weight loss intervention are centrally randomised to 4 months of social facilitation maintenance treatment or treatment as a usual control condition. In 16 outpatient group sessions, the social facilitation maintenance treatment, based on a socioecological model and on evidence supporting social facilitation as a key process in maintaining weight loss, focuses on promoting interpersonal relationships to build up a healthy lifestyle for long-term weight loss maintenance. Primary outcome is the amount of weight regain at 6-month follow-up, compared with pre-treatment weight, derived from measured body weight. Secondary outcomes address feasibility, including recruitment, attrition, assessment non-completion, compliance and patients' programme evaluation; and in comparison with pre-weight loss maintenance, social and interpersonal functioning, eating behaviour and physical activity, psychological and physical symptoms, body composition and risk of comorbidity, and quality of life at post-treatment and follow-up assessments. ETHICS AND DISSEMINATION The study was approved by the Ethical Committee at the University of Leipzig (165-13-15072013). The study results will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER DRKS00005182.
Collapse
Affiliation(s)
- Anja Hilbert
- Department of Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig Medical Center, Leipzig, Germany
| |
Collapse
|
34
|
Nicol GE, Kolko RP, Mills M, Gunnarsdottir T, Yingling MD, Schweiger JA, Lenze EJ, Newcomer JW, Wilfley D. Behavioral Weight Loss Treatment in Antipsychotic Treated Youth. Scand J Child Adolesc Psychiatr Psychol 2016; 4:96-104. [PMID: 27347489 PMCID: PMC4916921 DOI: 10.21307/sjcapp-2016-014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Antipsychotic-treated youth have increased risk for the development of obesity and type 2 diabetes. Behavioral weight loss treatments show promise in reducing obesity and diabetes risk in antipsychotic treated adults, but have received no study in antipsychotic treated youth. OBJECTIVE We describe a rationale for behavioral weight loss interventions in high-weight antipsychotic treated youth, and report behavioral, anthropomorphic, and metabolic findings from a case series of obese antipsychotic-treated adolescents participating in a short-term, family-based behavioral weight loss intervention. METHODS We adapted the Traffic Light Plan, a 16-week family-based weight loss intervention that promotes healthy energy balance using the colors of the traffic light to categorize the nutritional value of foods and intensity of physical activity, adapting a social ecological framework to address health behavior change in multiple social contexts. The intervention was administered to three obese adolescents with long-term antipsychotic medication exposure. Efficacy of the intervention was evaluated with a battery of anthropomorphic and metabolic assessments including weight, body mass index percentile, whole body adiposity, liver fat content, and fasting plasma glucose and lipids. Participants and their parents also filled out a treatment satisfaction questionnaire upon study completion. RESULTS Two males and 1 female (all aged 14 years) participated. All 3 participants attended all 16 sessions, and experienced beneficial changes in adiposity, fasting lipids and liver fat content associated with weight stabilization or weight loss. Adolescents and their parents all reported a high level of satisfaction with the treatment. CONCLUSIONS Family-based behavioral weight loss treatment can be feasibly delivered and is acceptable to antipsychotic-treated youth and their families. Randomized controlled trials are needed to fully evaluate the effectiveness and acceptability of behavioral weight loss interventions in antipsychotic treated youth and their families.
Collapse
Affiliation(s)
- Ginger E Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis MO
| | - Rachel P Kolko
- Department of Psychiatry, Western Psychiatric Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Monica Mills
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis MO
| | | | - Michael D Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis MO
| | - Julia A Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis MO
| | - Eric J Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis MO
| | - John W Newcomer
- Weight Management & Eating Disorders Program, Department of Psychiatry, Washington University School of Medicine, St. Louis MO
| | - Denise Wilfley
- Weight Management & Eating Disorders Program, Department of Psychiatry, Washington University School of Medicine, St. Louis MO; Department of Psychology, Washington University School of Medicine, St. Louis, MO; Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO; Department of Pediatrics, Washington University School of Medicine, St. Louis MO
| |
Collapse
|
35
|
Broccoli S, Davoli AM, Bonvicini L, Fabbri A, Ferrari E, Montagna G, Panza C, Pinotti M, Storani S, Tamelli M, Candela S, Bellocchio E, Giorgi Rossi P. Motivational Interviewing to Treat Overweight Children: 24-Month Follow-Up of a Randomized Controlled Trial. Pediatrics 2016; 137:peds.2015-1979. [PMID: 26702030 DOI: 10.1542/peds.2015-1979] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatrician-led motivational interviewing can be an effective way of controlling BMI in overweight children in the short term. Its long-term efficacy is unknown. The primary aim was to determine whether the short-term (12-month) impact of family pediatrician-led motivational interviews on the BMI of overweight children could be sustained in the long term (24 months), in the absence of any other intervention. METHODS Children were recruited in 2011 by family pediatricians working in the province of Reggio Emilia, Italy, and randomly allocated to receive either 5 interviews delivered over a 12-month period or usual care. Eligible participants were all 4- to 7-year-old overweight children resident in the province of Reggio Emilia who had been receiving care from the pediatrician for ≥ 12 months. The primary outcome of this study was individual variation in BMI between the baseline visit and the 24-month follow-up, assessed by pediatricians not blinded to treatment group allocation. RESULTS Of 419 eligible families, 372 (89%) participated; 187 children were randomized to receive intervention and 185 to usual care. Ninety-five percent of the children attended the 12-month follow-up, and 91% attended the 24-month follow-up. After the 12-month intervention period, BMI in the intervention group increased less than in the control group (0.46 and 0.78, respectively; difference -0.32; P = .005). At the 24-month follow-up, the difference had disappeared (1.52 and 1.56, respectively; difference -0.04; P = .986). CONCLUSIONS The intervention lost its effectiveness within 1 year of cessation. Sustainable boosters are required for weight control and obesity prevention.
Collapse
Affiliation(s)
- Serena Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy;
| | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| | | | | | | | | | - Mirco Pinotti
- Primary Health Care, Local Health Authority, Reggio Emilia, Italy
| | - Simone Storani
- Promotion Health Researchers, League Against Cancer, Reggio Emilia, Italy
| | - Marco Tamelli
- Promotion Health Researchers, League Against Cancer, Reggio Emilia, Italy
| | - Silvia Candela
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| |
Collapse
|
36
|
Han E, Jones-Smith J, Surkan PJ, Kharmats AY, Vedovato GM, Trude ACB, Anderson Steeves E, Gittelsohn J. Low-income African-American adults share weight status, food-related psychosocial factors and behaviours with their children. Obes Sci Pract 2015; 1:78-87. [PMID: 27774251 PMCID: PMC5064723 DOI: 10.1002/osp4.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/28/2015] [Accepted: 09/04/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aims to examine the extent to which low-income African-American children's weight status, psychosocial characteristics and food-related behaviours are associated with that of their adult caregivers. METHODS Cross-sectional data from baseline evaluation of B'More Healthy Communities for Kids obesity prevention trial were used. Outcomes of interest were children's overweight and/or obesity status, food-related self-efficacy, knowledge, intentions and healthier/less healthy food acquisition scores. The primary exposures were adult caregiver's overweight and/or obesity status, their psychosocial factors and food acquisition scores. Multiple logistic regression analyses were used to assess associations. RESULTS Children had higher odds of overweight or obesity if they had an overweight/obese caregiver (odds ratio [OR] 4.04, 95% confidence interval [95%CI] 1.59-10.28) or an obese caregiver (OR 2.50, 95%CI 1.39-4.51). Having a caregiver in the highest quartile of self-efficacy, food intentions and healthy food acquisition patterns was associated with higher odds of their child also having a higher score on these factors (self-efficacy: OR 3.77 [95%CI 1.76-8.04]; food intentions: OR 1.13 [95%CI 1.01-1.27]; and healthy food acquisition: OR 2.19 [95%CI 1.05-4.54]). CONCLUSIONS Child and adult caregiver weight status and psychosocial characteristics were positively associated in this low-income, urban population. These findings may help inform obesity treatment or prevention programmes and interventions aimed at parents and families.
Collapse
Affiliation(s)
- E Han
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - J Jones-Smith
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - P J Surkan
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - A Y Kharmats
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - G M Vedovato
- Health and Society Institute Federal University of São Paulo Santos SP Brazil
| | - A C B Trude
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - E Anderson Steeves
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - J Gittelsohn
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| |
Collapse
|
37
|
Hayes JF, Altman M, Coppock JH, Wilfley DE, Goldschmidt AB. Recent Updates on the Efficacy of Group Based Treatments for Pediatric Obesity. CURRENT CARDIOVASCULAR RISK REPORTS 2015; 9:16. [PMID: 25866596 DOI: 10.1007/s12170-015-0443-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is limited research on optimal treatment formats for childhood obesity. Group-based interventions are popular, but it is unclear whether outcomes can be obtained without an additional individual component. AIM To examine statistically and clinically significant outcomes of recent group-based and mixed-format (group + Individual) pediatric obesity interventions. METHODS Effect sizes and magnitudes of weight change were calculated for studies published between January 2013 and September 2014. RESULTS Approximately half of the group-based studies reviewed produced significant results compared to control, and effect sizes were small. Mixed-format studies were less likely to include a control group, but those that did evidenced medium to large effects. Magnitudes of weight change post-intervention were generally greater in mixed-format studies than group-only studies. CONCLUSIONS Recent studies in pediatric obesity interventions suggest including an individual component in a group-based intervention produces optimal outcomes. Future research should directly compare group-only and mixed formats to confirm this observation.
Collapse
Affiliation(s)
- Jacqueline F Hayes
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | - Myra Altman
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | - Jackson H Coppock
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | - Denise E Wilfley
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | | |
Collapse
|