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Rhee KE, Corbett T, Patel S, Eichen DM, Strong DR, Anderson C, Marcus B, Boutelle KN. A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design. Contemp Clin Trials 2024; 142:107562. [PMID: 38704118 DOI: 10.1016/j.cct.2024.107562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.
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Affiliation(s)
- Kyung E Rhee
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Takisha Corbett
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Shamin Patel
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University, School of Public Health 121 South Main Street, Box G-S121-3, Providence, RI 02912-G, USA
| | - Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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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.
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Affiliation(s)
- Fionna McDarby
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Kathy Looney
- School of Psychology, University College Dublin, Dublin, Ireland.
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Cardiovascular endurance and psychosocial health predict short- and long-term BMI-SDS reduction: results from the CHILT III program. Eur J Pediatr 2023; 182:2225-2234. [PMID: 36867234 PMCID: PMC9982786 DOI: 10.1007/s00431-023-04876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 03/04/2023]
Abstract
This longitudinal study analyzes data from the Children's Health Interventional Trial (CHILT) III, an 11-month juvenile multicomponent weight management program. The objective is to identify predictors of changes in body mass index standard deviation scores (BMI-SDS), so as to further enable the advancement of existing interventions with sustained impact. This study's sample consists of 237 children and adolescents with obesity (8-17 years, 54% girls) participating in the CHILT III program between 2003 and 2021. Anthropometrics, demographics, relative cardiovascular endurance (W/kg), and psychosocial health (i.e., physical self-concept and self-worth) were assessed at program entry ([Formula: see text]), end ([Formula: see text]), and one-year follow-up ([Formula: see text]; n = 83). From [Formula: see text] to [Formula: see text], the mean BMI-SDS was reduced by -0.16 ± 0.26 units (p < 0.001). Media use and cardiovascular endurance at baseline and improvements in endurance and self-worth over the course of the program predicted changes in BMI-SDS (adj. R2 = 0.22, p < 0.001). From [Formula: see text] to [Formula: see text], mean BMI-SDS increased ([Formula: see text], p = 0.005). Changes in BMI-SDS from [Formula: see text] to [Formula: see text] were associated with parental education, improvements in cardiovascular endurance and physical self-concept, and BMI-SDS, media use, physical self-concept, and endurance level at program end (adj. R2 = 0.39, p < 0.001). Conclusions: This study highlights the need for comprehensive, sustainable weight management approaches, in order to sustain the initial treatment benefits. In this context, improvements in cardiovascular endurance and psychosocial health could be essential strategies to pursue in practice, as they significantly predicted reductions in BMI-SDS - both pre- to post-intervention and at follow-up. TRIAL REGISTRATION DRKS00026785; date of registration: 13.10.202, retrospectively registered. WHAT IS KNOWN • Childhood obesity is associated with the onset of noncommunicable diseases, many of which are likely to carry into adulthood. Thus, effective weight management strategies for affected children and their families are vital. However, achieving lasting positive health outcomes with multidisciplinary weight management programs remains challenging. WHAT IS NEW • According to this study, short- and longer-term BMI-SDS reductions are associated to cardiovascular endurance and psychosocial health. These factors should therefore be given even greater consideration in weight management strategies, as they may be important not only in themselves but also for long-term weight loss (maintenance).
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Khayutin S, Kelly AS, Fox CK, Ryder JR, Gross AC. Opinions from the experts: Experiences of adolescents with severe obesity participating in meal replacement therapy. Pediatr Obes 2023; 18:e12986. [PMID: 36263895 PMCID: PMC9851958 DOI: 10.1111/ijpo.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Meal replacement therapy (MRT) is a structured treatment that is effective for short-term weight reduction in adolescents with severe obesity. However, like other interventions, MRT response is variable. OBJECTIVE The goal of the current study was to characterize the experience of adolescents with severe obesity participating in MRT. METHODS Seventeen adolescents with severe obesity participated in semi-structured, individual interviews about their experience participating in MRT. The authors used a biopsychosocial model as the theoretical framework and data was analysed using Interpretive Phenomenological Analysis. A biopsychosocial model views an individual's health as a blend of biological characteristics, behavioural factors, and social conditions. RESULTS Results showed that adolescents with severe obesity described three biopsychosocial factors that were central to their experience with MRT: (1) scheduling and planning, (2) social support and pressure, and (3) intrapersonal factors. Specifically, adolescents with severe obesity identified that planning ahead, social support, and intrapersonal changes (e.g. self-confidence) can promote engagement in MRT. On the other hand, unplanned schedule changes, social pressures, and different intrapersonal factors (e.g., taste preference) can make engagement challenging. CONCLUSIONS Adolescents provided information on factors that supported or hindered their engagement in MRT, and themes were consistent with prior literature on health behaviour change. Overall, adolescents would recommend MRT to other teenagers who carry extra weight. Future research can use the rich information provided by adolescents with severe obesity to enhance and individualize treatment options.
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Affiliation(s)
- Sarah Khayutin
- Psychological Services, Children’s Hospitals and
Clinics of Minnesota
| | - Aaron S. Kelly
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
| | - Claudia K. Fox
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
| | - Justin R. Ryder
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
| | - Amy C. Gross
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
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Moustafa AF, Quigley KM, Wadden TA, Berkowitz RI, Chao AM. A systematic review of binge eating, loss of control eating, and weight loss in children and adolescents. Obesity (Silver Spring) 2021; 29:1259-1271. [PMID: 34227229 PMCID: PMC8319063 DOI: 10.1002/oby.23185] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This review synthesizes literature on changes in binge eating (BE) and loss of control eating (LOC) following weight loss and the association between BE/LOC and weight loss in children and adolescents. METHODS A systematic literature search was conducted in PubMed, Scopus, and PsycInfo. Eligible studies included all peer-reviewed journal articles of primary research that assessed BE/LOC and weight change following a weight-loss intervention in individuals under 18 years of age. RESULTS The 29 articles included studies on behavioral therapy, pharmacotherapy, and surgical interventions. Of the 14 studies that assessed the relationship between weight loss and BE/LOC at baseline, 4 showed that higher baseline BE/LOC was associated with less weight loss, whereas 10 showed no significant association. BE/LOC behaviors significantly decreased following weight-loss interventions in 20 of 21 studies. A greater decrease in BE/LOC was associated with improved weight loss in 4 of 9 studies that assessed this change. CONCLUSIONS Weight-loss interventions are associated with improved BE/LOC in youth with obesity. The persistence of BE/LOC symptoms may be associated with less weight loss. These results can aid in guiding future treatment for youth with BE/LOC seeking weight-loss treatment.
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Affiliation(s)
| | - Kerry M. Quigley
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, US
| | - Thomas A. Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, US
| | - Robert I. Berkowitz
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, US
- The Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA, USA
| | - Ariana M. Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, US
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
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Hayes JF, Fowler LA, Balantekin KN, Saelens BE, Stein RI, Perri MG, Welch RR, Epstein LH, Wilfley DE. Children with Severe Obesity in Family-Based Obesity Treatment Compared with Other Participants: Conclusions Depend on Metrics. Obesity (Silver Spring) 2021; 29:393-401. [PMID: 33491306 PMCID: PMC7842730 DOI: 10.1002/oby.23071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study compares children with severe obesity and children with mild obesity/overweight participating in family-based obesity treatment (FBT) on change in (1) relative weight and adiposity and (2) psychosocial distress. METHODS Children 7 to 11 years old (N = 241) and their parents participated in 12 months of behavioral treatment (FBT + maintenance treatment) and completed anthropometric, adiposity, and psychosocial assessments (psychiatric disorder symptomology, quality of life). Severe obesity was defined as a baseline BMI ≥ 120% of the 95th percentile (N = 105). RESULTS At 12 months, 40% of children with baseline severe obesity no longer had severe obesity. Percent overweight and fat mass index measurements showed similar magnitudes of change among children with severe obesity and children with mild obesity/overweight, whereas BMI z score and percent body fat change was lower in the group with severe obesity. Youth with severe obesity were higher on some measures of psychosocial distress at baseline but generally experienced improvements similar to children with mild obesity/overweight. CONCLUSIONS FBT with maintenance treatment is beneficial for children with severe obesity and is recommended for use prior to more invasive treatments in severe pediatric obesity. Future studies should assess the necessity of additional treatment, as children with severe obesity still have high relative weights post intervention.
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Affiliation(s)
| | | | | | - Brian E. Saelens
- Seattle Children’s Research Institute and the University of Washington, Seattle, WA, USA
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Lier LM, Breuer C, Ferrari N, Friesen D, Maisonave F, Schmidt N, Graf C. Individual Physical Activity Behaviour and Group Composition as Determinants of the Effectiveness of a Childhood Obesity Intervention Program. Obes Facts 2021; 14:100-107. [PMID: 33352573 PMCID: PMC7983679 DOI: 10.1159/000512293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Up to now, there is limited clarity on factors that determine the effectiveness of childhood obesity interventions. OBJECTIVE This study intends to uncover individual- and program-level predictors of BMI-SDS and fitness to achieve significant, sustainable health improvements. METHODS Data of 249 children with obesity or overweight who participated in an outpatient multidisciplinary program were analysed and compared to 54 waitlist controls. Linear regression models were used to examine associations between individual- and group-level variables and BMI-SDS and fitness. RESULTS Among intervention children, BMI-SDS decreased by 0.19 units and physical fitness increased by 11.5%, versus a BMI-SDS decrease of 0.07 and a 1.8% decrease in fitness in the control group. Participants who reported being physically active before the program start achieved greater improvements in BMI-SDS (β = -0.177, p < 0.05) and physical fitness (β = 0.174, p < 0.05) than inactive peers. BMI-SDS decreased significantly more for members of gender-heterogeneous groups (β = 0.194, p < 0.05) with a narrow age range (β = 0.152, p < 0.05). CONCLUSIONS The program under review is effective in counteracting juvenile obesity. The results give reason to believe that forming mixed-gender groups with a small age range and providing increased support for reportedly inactive children may improve program effectiveness.
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Affiliation(s)
- Liesa Marie Lier
- Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany,
| | - Christoph Breuer
- Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany
| | - Nina Ferrari
- Cologne Center for Prevention and Youth/Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - David Friesen
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - Fernanda Maisonave
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - Nikola Schmidt
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - Christine Graf
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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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.
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The Correlation Between Parental Perceptions and Readiness to Change with Participation in a Pediatric Obesity Program Serving a Predominantly Black Urban Community: A Retrospective Cohort Study. Matern Child Health J 2020; 25:606-612. [PMID: 33237508 DOI: 10.1007/s10995-020-03058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study assessed whether maternal BMI and perceptions about weight and reported level of readiness to change was correlated with compliance to a pediatric lifestyle modification program targeting a hard-to-reach urban population with a high prevalence of severe obesity. METHODS The Parental Readiness Questionnaire (PRQ) was administered to the child's mother at program entry. The PRQ consisted of forty-seven multiple-choice and 10-point Likert scale questions regarding family demographics, exercise and eating habits, attitudes about health, body image, and weight, and the desire to improve nutrition and physical activity. Analysis was performed on PRQs of participants to compare parental perceptions and readiness for change with compliance to program requirements. Analysis was conducted on 596 questionnaires and compliance was categorized into three groups based on attendance to follow-up visits. RESULTS Significant differences were found between short-term and long-term follow-up groups in regards to parental perception of one's health as well as the health, weight, and body image of their child. Differences were found in perceptions of one's own weight and body image as well as the health of one's self and child between the group with a maternal BMI < 35 and the group with a maternal BMI ≥ 35. A lower maternal BMI was associated with a better perception of one's own weight, body image, and health, as well as the health of the child. CONCLUSION Positive parental perceptions on weight were correlated with improved compliance to a pediatric lifestyle modification program.
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10
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Lier LM, Breuer C, Ferrari N, Friesen D, Maisonave F, Schmidt N, Graf C. Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany. Public Health 2020; 186:185-192. [PMID: 32858303 DOI: 10.1016/j.puhe.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs. STUDY DESIGN All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program. METHODS Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease. RESULTS On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%. CONCLUSIONS This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.
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Affiliation(s)
- L M Lier
- MA. Strategy & International Management, BSc Business Administration & Economics Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany, Eisenstraße 5, 50925, Cologne, Germany.
| | - C Breuer
- Habilitation Sport Science Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany
| | - N Ferrari
- PhD Sport Science Cologne Center for Prevention and Youth/Heart Center Cologne, University Hospital Cologne, Germany
| | - D Friesen
- MA Sports Science Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - F Maisonave
- Diploma in Sport Science Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - N Schmidt
- BA Sport Science, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - C Graf
- Habilitation Sport Science, PhD Sports Medicine Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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11
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Reinelt T, Petermann F, Bauer F, Bauer C. Emotion regulation strategies predict weight loss during an inpatient obesity treatment for adolescents. Obes Sci Pract 2020; 6:293-299. [PMID: 32523718 PMCID: PMC7278908 DOI: 10.1002/osp4.410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/09/2020] [Accepted: 02/04/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Weight loss during an inpatient obesity treatment is an important predictor of subsequent weight maintenance. However, psychological factors influencing weight loss are not well established. Psychological models suggest some importance of executive functioning and emotion regulation strategies. Therefore, this study investigated whether these factors predict weight loss during an inpatient obesity treatment and whether this effect holds after controlling for general personal and treatment characteristics. METHOD A total of 158 adolescents with diagnosed obesity underwent inpatient obesity treatment at a German rehabilitation clinic. Psychological factors (executive functioning and emotion regulation) were measured at admission and used to predict BMI reduction after treatment completion. RESULTS More frequent use of reappraisal as an emotion regulation strategy, but not suppression or executive functioning, predicted weight loss at the end of the obesity treatment, even after controlling for age, gender, treatment duration, and BMI at admission. CONCLUSION Functional emotion regulation strategies, like reappraisal, might offer an additional target for obesity treatment programmes, complementary to the more traditional components of psychoeducation, physical activity, and caloric restriction.
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Affiliation(s)
- Tilman Reinelt
- Center for Clinical Psychology and RehabilitationUniversity of BremenBremenGermany
| | - Franz Petermann
- Center for Clinical Psychology and RehabilitationUniversity of BremenBremenGermany
| | - Florian Bauer
- Clinic for Paediatrics and Adolescent Medicine at the Klinikum HarlachingKlinikum MünchenMunichGermany
| | - Carl‐Peter Bauer
- Clinic for Pediatrics at the Klinikum SchwabingTechnical University MunichMunichGermany
- Fachklinik GaißachGermany
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12
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Eichen DM, Mestre ZL, Strong DR, Rhee KE, Boutelle KN. Defining and identifying predictors of rapid response to pediatric obesity treatment. Pediatr Obes 2020; 15:e12621. [PMID: 32100412 PMCID: PMC7202991 DOI: 10.1111/ijpo.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
Early weight loss (rapid response [RR]) is associated with better outcomes in adults. Less is known about RR in children enrolled in weight-loss treatment. The aim of the current study was to establish an RR weight-loss threshold following 4 weeks of pediatric obesity treatment and identify characteristics associated with achieving RR. One hundred thirty-seven children aged 8 to 12 with overweight/obesity and parents participated in 6 months of family-based or parent-based treatment. Receiver operating characteristic curves evaluated how weight loss at week 4 related to decreases of 5% at posttreatment and 10% at 6- and 18-month follow-ups of standardized body mass index (BMIz), percentage distance of a child's BMI from the median BMI for sex and age, and percentage above the 95th percentile. Weight loss of 2.4% to 3.4% at week 4 predicted 5% change at posttreatment (AUC's = .68-.75; P's ≤ .002) and 10% change at 6-month follow-up (AUC's = .63-.70; P's ≤ .02). No model was significant at 18-month follow-up. Amount of parent weight (lbs) change at week 4 was associated with child achieving RR. Males and Non-Hispanic Whites were more likely to achieve RR. This threshold could be used to mark early significant progress and guide clinical evaluations of treatment response to paediatric obesity treatment.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA
| | - Zoe L Mestre
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA USA
| | - David R Strong
- University of California San Diego, Department of Family
Medicine and Public, San Diego, CA USA
| | - Kyung E Rhee
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA
| | - Kerri N Boutelle
- University of California San Diego, Department of
Pediatrics, San Diego, CA USA,University of California San Diego, Department of Family
Medicine and Public, San Diego, CA USA,University of California San Diego, Department of
Psychiatry, San Diego, CA USA
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13
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Kemps E, Goossens L, Petersen J, Verbeken S, Vervoort L, Braet C. Evidence for enhancing childhood obesity treatment from a dual-process perspective: A systematic literature review. Clin Psychol Rev 2020; 77:101840. [DOI: 10.1016/j.cpr.2020.101840] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/08/2019] [Accepted: 02/08/2020] [Indexed: 12/16/2022]
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14
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Adams L. Letter to the editor: Concerns regarding "Meta-analysis on pediatric obesity treatments and eating disorder risk" of Jebeile et al. Obes Rev 2020; 21:e12968. [PMID: 31709725 DOI: 10.1111/obr.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/29/2022]
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15
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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.
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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
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16
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Feldman K, Solymos GMB, de Albuquerque MP, Chawla NV. Unraveling Complexity about Childhood Obesity and Nutritional Interventions: Modeling Interactions Among Psychological Factors. Sci Rep 2019; 9:18807. [PMID: 31827160 PMCID: PMC6906362 DOI: 10.1038/s41598-019-55260-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
As the global prevalence of childhood obesity continues to rise, researchers and clinicians have sought to develop more effective and personalized intervention techniques. In doing so, obesity interventions have expanded beyond the traditional context of nutrition to address several facets of a child’s life, including their psychological state. While the consideration of psychological features has significantly advanced the view of obesity as a holistic condition, attempts to associate such features with outcomes of treatment have been inconclusive. We posit that such uncertainty may arise from the univariate manner in which features are evaluated, focusing on a particular aspect such as loneliness or insecurity, but failing to account for the impact of co-occurring psychological characteristics. Moreover, co-occurrence of psychological characteristics (both child and parent/guardian) have not been studied from the perspective of their relationship with nutritional intervention outcomes. To that end, this work looks to broaden the prevailing view: laying the foundation for the existence of complex interactions among psychological features. In collaboration with a non-profit nutritional clinic in Brazil, this paper demonstrates and models these interactions and their associations with the outcomes of a nutritional intervention.
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Affiliation(s)
- Keith Feldman
- Department of Computer Science and Engineering, Interdisciplinary Center for Network Science and Applications (iCeNSA), University of Notre Dame, Notre Dame, IN, 46556, USA.,Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Gisela M B Solymos
- Department of Computer Science and Engineering, Interdisciplinary Center for Network Science and Applications (iCeNSA), University of Notre Dame, Notre Dame, IN, 46556, USA.,Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, USA
| | - Maria Paula de Albuquerque
- Department of Physiology, Section Physiology of Nutrition, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,CREN, São Paulo, Brazil
| | - Nitesh V Chawla
- Department of Computer Science and Engineering, Interdisciplinary Center for Network Science and Applications (iCeNSA), University of Notre Dame, Notre Dame, IN, 46556, USA.
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17
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Sepúlveda AR, Solano S, Blanco M, Lacruz T, Veiga O. Feasibility, acceptability, and effectiveness of a multidisciplinary intervention in childhood obesity from primary care: Nutrition, physical activity, emotional regulation, and family. EUROPEAN EATING DISORDERS REVIEW 2019; 28:184-198. [PMID: 31802570 DOI: 10.1002/erv.2702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022]
Abstract
Childhood obesity is a growing problem with a complex aetiology, for which multidisciplinary interventions are required. Our programme describes a novel structured psychosocial family-based intervention targeting the emotional regulation in childhood obesity, using a train trip metaphor aimed at improving healthy lifestyles for the family. The aims were (a) to describe the feasibility and acceptability of this psychosocial family-based intervention among children with overweight or obesity in primary care and (b) to examine the effectiveness of the "ENTREN-F" programme (with family intervention) compared with the "ENTREN" programme (without family intervention) among Spanish children regarding anthropometric variables, physical activity, emotional well-being, and family functioning. Children were randomly allocated to either ENTREN-F programme (n = 30) or psychological intervention for children (ENTREN, n = 40), and assessments were carried out over time (T0 baseline vs. T1 post/6-month vs. T2 6-month follow-up). Both parent groups expressed high levels of satisfaction with the interventions. ENTREN-F resulted in higher adherence to treatment and was more effective in improving z-body mass index, reducing children's anxiety, and increasing family adaptability than the ENTREN programme. There were no significant changes in parents' emotional well-being and expressed emotion. Both groups improved in the children's emotional well-being and light physical activity. In summary, this multidisciplinary psychosocial family-based intervention was succesful.
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Affiliation(s)
- Ana R Sepúlveda
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Santos Solano
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Miriam Blanco
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Tatiana Lacruz
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Oscar Veiga
- Department of Physical Education, Sport & Human Motricity, Autonomous University of Madrid, Madrid, Spain
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18
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Gowey MA, Lim CS, Dutton GR, Silverstein JH, Dumont-Driscoll MC, Janicke DM. Executive Function and Dysregulated Eating Behaviors in Pediatric Obesity. J Pediatr Psychol 2019; 43:834-845. [PMID: 28595362 PMCID: PMC6093324 DOI: 10.1093/jpepsy/jsx091] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/23/2017] [Indexed: 01/12/2023] Open
Abstract
Objective To examine the association between caregiver proxy report of executive function (EF) and dysregulated eating behavior in children with obesity. Methods Participants were 195 youth with obesity aged 8-17 years, and their legal guardians. Youth height, weight, demographics, depressive symptoms, eating behaviors, and EF were assessed cross-sectionally during a medical visit. Analyses of covariance, adjusted for child age, gender, race/ethnicity, standardized BMI, depressive symptoms, and family income were used to examine differences in youth EF across caregiver and youth self-report of eating behaviors. Results Youth EF differed significantly by caregiver report of eating behavior but not youth self-report. Post hoc analyses showed that youth with overeating or binge eating had poorer EF than youth without these eating behaviors. Conclusions Executive dysfunction, as reported by caregivers, in youth with obesity may be associated with dysregulated eating behaviors predictive of poor long-term psychosocial and weight outcomes. Further consideration of EF-specific targets for assessment and intervention in youth with obesity may be warranted.
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Affiliation(s)
- Marissa A Gowey
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham
| | | | | | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida
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19
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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: 72] [Impact Index Per Article: 14.4] [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.
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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
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20
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Fox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. Curr Obes Rep 2019; 8:201-209. [PMID: 31054014 DOI: 10.1007/s13679-019-00347-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. RECENT FINDINGS Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA.
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Megan M Oberle
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
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21
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Bomberg EM, Ryder JR, Brundage RC, Straka RJ, Fox CK, Gross AC, Oberle MM, Bramante CT, Sibley SD, Kelly AS. Precision medicine in adult and pediatric obesity: a clinical perspective. Ther Adv Endocrinol Metab 2019; 10:2042018819863022. [PMID: 31384417 PMCID: PMC6661805 DOI: 10.1177/2042018819863022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual's genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.
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Affiliation(s)
- Eric M. Bomberg
- Department of Pediatrics and Center for
Pediatric Obesity Medicine, University of Minnesota, Minneapolis, 717
Delaware Street SE, Room 371, Minneapolis, MN 55414, USA
| | - Justin R. Ryder
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Richard C. Brundage
- Department of Experimental and Clinical
Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Robert J. Straka
- Department of Experimental and Clinical
Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Amy C. Gross
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Megan M. Oberle
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of
Minnesota, Minneapolis, MN, USA
| | | | - Aaron S. Kelly
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of
Minnesota, Minneapolis, MN, USA
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22
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Conlon RPK, Hurst KT, Hayes JF, Balantekin KN, Stein RI, Saelens BE, Brown ML, Sheinbein DH, Welch RR, Perri MG, Schechtman KB, Epstein LH, Wilfley DE. Child and parent reports of children's depressive symptoms in relation to children's weight loss response in family-based obesity treatment. Pediatr Obes 2019; 14:e12511. [PMID: 30664829 PMCID: PMC6546528 DOI: 10.1111/ijpo.12511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies of the association between children's depressive symptoms and obesity treatment response show mixed results. Different measurement may contribute to the inconsistent findings, as children's depressive symptoms are often based on parent-report about their child rather than child self-report. OBJECTIVES We assessed both child- and parent-report of child depressive symptoms as predictors of children's obesity treatment response. METHODS Children with overweight/obesity (body mass index [BMI] ≥ 85th percentile; N = 181) and their parents reported on children's depressive symptoms prior to family-based behavioral weight loss treatment. RESULTS Child percent overweight reduction from baseline to post-treatment was not predicted by child self-reported depressive symptoms or parent-report of child symptoms (P > 0.80), but was significantly predicted by the interaction between child self-report and parent-report on child (β = 0.14, P = 0.05). In analyses using clinical cutoffs, amongst children with high self-reported symptoms, those whose parents reported low child depressive symptoms had greater reduction in percent overweight (t = 2.67, P = 0.008), whereas amongst children with low self-reported symptoms, parent ratings were not associated with treatment outcome. CONCLUSIONS Including both child self-report and parent-report of child depressive symptoms may inform obesity care. Research is needed to examine differences amongst child and parent depressive symptom reports and strategies to address symptoms and optimize pediatric obesity treatment.
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Affiliation(s)
| | - Kelly T. Hurst
- National Center for Weight and Wellness, Washington, DC, USA
| | | | | | | | - Brian E. Saelens
- Seattle Children’s Research Institute and the University of Washington, Seattle, WA, USA
| | - Mackenzie L. Brown
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Michael G. Perri
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | | | - Leonard H. Epstein
- School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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23
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Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. WITHDRAWN: Interventions for treating obesity in children. Cochrane Database Syst Rev 2019; 3:CD001872. [PMID: 30843601 PMCID: PMC6404387 DOI: 10.1002/14651858.cd001872.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood. SEARCH METHODS We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information. MAIN RESULTS We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs. AUTHORS' CONCLUSIONS While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.
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Affiliation(s)
- Hiltje Oude Luttikhuis
- University Medical Center GroningenBeatrix Children's Hospital and Department of EpidemiologyPO Box 30.001 (CA80)9700RBGroningenNetherlands
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Hanneke Jansen
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareP.O.Box 85500UtrechtNetherlands3508 AB
| | - Vanessa A Shrewsbury
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Ronald P Stolk
- University Medical Center GroningenDepartment of EpidemiologyGroningenNetherlands
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Science42 Old ElvetDurhamUKDH13HN
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24
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Gross AC, Kaizer AM, Kelly AS, Rudser KD, Ryder JR, Borzutzky CR, Santos M, Tucker JM, Yee JK, Fox CK. Long and Short of It: Early Response Predicts Longer-Term Outcomes in Pediatric Weight Management. Obesity (Silver Spring) 2019; 27:272-279. [PMID: 30677263 PMCID: PMC6352906 DOI: 10.1002/oby.22367] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to examine whether 1-month BMI improvement is predictive of superior 6- and 12-month BMI changes in a national sample of youth in pediatric weight management treatment. METHODS Participants were 4- to 18-year-olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation. RESULTS Primary analyses were completed with 687 participants (mean age 12.2 years). One-month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, -2.05 vs. 0.05; %BMI, -5.81 vs. 0.23; P < 0.001 for all) and 12 months (BMI, -1.87 vs. 0.30; %BMI, -5.04 vs. 1.06; P < 0.001 for all). The odds of success for 1-month responders were 9.64 (95% CI: 5.85-15.87; P < 0.001) times that of nonresponders at 6 months and 5.24 (95% CI: 2.49-11.02; P < 0.001) times that of nonresponders at 12 months. CONCLUSIONS In treatment-seeking youth with obesity, early BMI reduction was significantly associated with greater long-term BMI reduction. Nonresponders may benefit from early treatment redirection or intensification.
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Affiliation(s)
- Amy C Gross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alexander M Kaizer
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Claudia R Borzutzky
- Department of Pediatrics, Keck School of Medicine of USC, Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Melissa Santos
- The Pediatric Obesity Center, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Jared M Tucker
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, USA
| | - Jennifer K Yee
- Department of Pediatrics, Division of Endocrinology, Harbor-UCLA Medical Center, The Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Claudia K Fox
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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De Giuseppe R, Di Napoli I, Porri D, Cena H. Pediatric Obesity and Eating Disorders Symptoms: The Role of the Multidisciplinary Treatment. A Systematic Review. Front Pediatr 2019; 7:123. [PMID: 31024868 PMCID: PMC6463004 DOI: 10.3389/fped.2019.00123] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
The prevalence of obesity in children/adolescents has increased worldwide during the past 30 years, becoming a significant public health concern; prevention, and management of pediatric obesity onset is one of the most critical public health goals for both industrialized and developing countries. Pediatric obesity has been identified as a risk factor for various psychopathologies, including eating disorders (ED). Although it has been demonstrated that a comprehensive multidisciplinary treatment (MT), with small steps and practical approaches to lifestyle change, can be an effective treatment for children and adolescents with obesity, to the best of our knowledge, this is the first systematic review investigating the effect of MT on the development, progression or decrease of ED symptoms (EDS) in this target population. PubMed and Web of Science databases were searched (last search on 18 February 2019) according to a predetermined search strategy, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement. Original studies published in English examining the effect of MT on pediatric overweight/obesity, paying particularly attention at the development of EDS, were eligible for inclusion. Seven hundred and forty-four records have been identified; nine articles with study quality ranging from weak to moderate have been included. MTs were heterogeneous in nature including length, number, frequency and type of sessions, parent-involvement and use of technology, besides several psychometric questionnaires were used to screen for EDS, since there are no standardized criteria. In 3 studies there was a significant decrease in external and emotional eating and in four studies a significant increase in restraint eating post MT. Two studies found a significant decrease of binge eating symptoms and other two studies showed an improvement of self-perception, weight, and shape concern. A statistical significant decrease in BMI, BMIz, BMISDS, and adjusted BMI was observed after all MTs, except one. A narrative summary of the evidences reported highlighted the positive impact of MT on the EDS. Moreover, since weight loss post MTs was not necessarily related to EDS, clinicians should also look for the presence of EDS and treat them accordingly.
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Affiliation(s)
- Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Ilaria Di Napoli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
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Albayrak Ö, Pott W, Hebebrand J, de Zwaan M, Pauli-Pott U. Baseline Dietary Restraint Predicts Negative Treatment Outcomes after 12 Months in Children and Adolescents with Obesity Participating in a Lifestyle Intervention. Obes Facts 2019; 12:179-189. [PMID: 30893684 PMCID: PMC6547296 DOI: 10.1159/000496940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Current lifestyle interventions for children and adolescents with obesity often exclude patients with an eating pathology, leaving the impact of eating pathologies on treatment outcomes largely unconsidered. We investigated the predictive value of disordered eating symptoms on BMI z-score reduction in a sample of 111 German children and adolescents with overweight (90th percentile ≤ BMI < 97th percentile) and obesity (BMI > 97th percentile) aged 7-15 years in an outpatient lifestyle intervention program. METHODS We defined a BMI z-score reduction of more than 5% after 12 months as a successful outcome. Disordered eating symptoms (i.e., dietary restraint, emotional eating, external eating, and binge eating) were assessed at baseline with the Eating Pattern Inventory (EPI-C) and the "bulimia" scale of the Eating Disorder Inventory (EDI-2). Covariates were: baseline z-BMI, age, gender, and maternal education level. RESULTS Multiple regression analysis revealed that dietary restraint significantly predicted change in BMI z-scores between baseline and T1. Higher levels of dietary restraint were associated with a lower BMI z-score reduction between T0 and T1. To compare non-completers with completers on the 4 eating behavior scales, we used MANCOVA. At baseline, children who subsequently dropped out of the program prematurely showed significantly higher dietary restraint scores than children who completed the intervention, irrespectively of their gender, age, and BMI z-score at baseline and their mother's education level. DISCUSSION Our results provide further evidence that the analysis of treatment processes in lifestyle intervention programs for children and adolescents with overweight and obesity should take into account a broader multidimensional approach including eating and dietary habits.
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Affiliation(s)
- Özgür Albayrak
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Wilfried Pott
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps University Marburg, Marburg, Germany
- Department of Psychosomatic and Psychiatry, Red Cross Children's Hospital Siegen, Siegen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany,
| | - Ursula Pauli-Pott
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps University Marburg, Marburg, Germany
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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.
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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.
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Feasibility and Effectiveness of Adding an Approach Avoidance Training With Game Elements to a Residential Childhood Obesity Treatment — A Pilot Study. BEHAVIOUR CHANGE 2018. [DOI: 10.1017/bec.2018.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Childhood obesity treatment programs only result in moderate outcomes in the short term and do not reduce risk for future weight gain. Therefore, in the current study, Approach Avoidance Training (AAT) with motivational game elements will be added to an inpatient childhood obesity program with the aim of improving outcomes. Forty-one children (10–15 years) in the final months of an inpatient treatment program were randomised to either the AAT plus care-as-usual condition group or to a care-as-usual-only control group. During the 10 sessions, the children were trained to approach healthy food stimuli and to avoid unhealthy food stimuli. Treatment outcomes were child performances on tasks of AAT, implicit attitudes and attentional bias, self-report ratings on craving symptoms, and weight loss maintenance after leaving the clinic (12-week follow-up). Changes over time were not significantly different between conditions for the measures of automatic processes, craving, and weight loss maintenance. Possible accounts for the null findings, including sample size, influence of game elements, point of time in therapeutic process, limitations of the setting, and the control group are discussed. More research is needed before firm conclusions can be drawn about the clinical usefulness of CBM for weight control in childhood obesity.
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Krawczyk R, Kirschenbaum DS, Caraher KJ. Vast Differences in Psychotropic Prescription Rates, But Not Outcomes, for Obese Adolescents in Immersion Treatment across Geographical Regions. Child Obes 2018; 14:165-172. [PMID: 29620921 DOI: 10.1089/chi.2017.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pediatric obesity is recognized as a worldwide epidemic. Treatment of this problem has proven difficult, but many promising interventions exist, including immersion treatment. The purpose of this study is to examine the potential influence of psychotropic medications on immersion treatment outcomes in a real-world treatment setting. METHODS This study examines the prescription rates of psychotropic medications and treatment process and outcomes of 642 adolescents in ten different cognitive behavioral therapeutic immersion weight-loss camps in the United States and in the United Kingdom. RESULTS The US participants received psychotropic medications at drastically varying rates by geographical location and overall at almost ten times the rate of UK participants. Those taking psychotropic medications engaged in treatment and decreased percentage overweight at similar rates as their nonmedicated peers. The medication group reported higher initial and final rates of distress, but both groups improved their moods during camp and exhibited smaller differences in mood ratings by the end of camp. CONCLUSIONS Significantly higher prescription rates of psychotropic medication, especially evident comparing the United States to the United Kingdom, were unrelated to immersion obesity treatment process and outcomes for youth. Immersion treatment for obese adolescents appears effective regardless of psychotropic medication status of the participant. This finding supports the use of cognitive behavioral immersion treatments for adolescent obesity and leads to several possible conclusions and directions for future study.
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Affiliation(s)
- Ross Krawczyk
- 1 Department of Psychology, The College of Saint Rose , Albany, NY
| | - Daniel S Kirschenbaum
- 2 Department of Behavioral Health, Georgia Pain and Spine Care, Newnan, GA; Nortwestern University , Evanston, IL
| | - Kristen J Caraher
- 3 Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA
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Elizathe LS, Arana FG, Rutsztein G. A cross-sectional model of eating disorders in Argentinean overweight and obese children. Eat Weight Disord 2018; 23:125-132. [PMID: 27678154 DOI: 10.1007/s40519-016-0321-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022] Open
Abstract
Despite the fact that past research identified childhood obesity as an antecedent of eating disorders, not all obese children further develop this pathology. With this regard, our first purpose was to isolate which characteristics differentiate overweight children who have an eating disorder from those who have not. Second, considering that there is little evidence collected in Latin American countries, we provided overweight children data from an Argentinean sample. Specifically, we investigated if weight-teasing, perfectionism, disturbed eating attitudes and behaviors, and body image dissatisfaction are related to the occurrence of an eating disorder in 100 school-aged overweight/obese children (37 girls and 63 boys; mean age 10.85, SD 0.88). Participants completed self-report instruments and were interviewed between 1 and 2 months later to confirm the presence of eating disorders. Seventeen percent participants confirmed to have an eating disorder. Further, the multivariate logistic analysis revealed that perfectionism (Exp β = 1.19) and disturbed eating attitudes and behaviors (Exp β = 4.78) were jointly associated with the presence of an eating disorder. These results were maintained even when the overall model was adjusted for covariates such as age, gender, body mass index, and school type. Weight-teasing and body image dissatisfaction did not contribute to the multivariate model. Prevalence rates of ED and model findings were discussed.
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Affiliation(s)
- Luciana Soledad Elizathe
- Facultad de Psicología, Universidad de Buenos Aires, Hipólito Yrigoyen 3242, C1207ABQ, Buenos Aires, Argentine Republic. .,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, C1033AAJ, Buenos Aires, Argentine Republic.
| | - Fernán Guido Arana
- Facultad de Psicología, Universidad de Buenos Aires, Hipólito Yrigoyen 3242, C1207ABQ, Buenos Aires, Argentine Republic
| | - Guillermina Rutsztein
- Facultad de Psicología, Universidad de Buenos Aires, Hipólito Yrigoyen 3242, C1207ABQ, Buenos Aires, Argentine Republic
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Balantekin KN, Hayes JF, Sheinbein DH, Kolko RP, Stein RI, Saelens BE, Hurst KT, Welch RR, Perri MG, Schechtman KB, Epstein LH, Wilfley DE. Patterns of Eating Disorder Pathology are Associated with Weight Change in Family-Based Behavioral Obesity Treatment. Obesity (Silver Spring) 2017; 25:2115-2122. [PMID: 28984076 PMCID: PMC5705531 DOI: 10.1002/oby.22028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/20/2017] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Children with overweight or obesity have elevated eating disorder (ED) pathology, which may increase their risk for clinical EDs. The current study identified patterns of ED pathology in children with overweight or obesity entering family-based behavioral weight loss treatment (FBT) and examined whether children with distinct patterns differed in their ED pathology and BMI z score (zBMI) change across FBT. METHODS Before participating in a 16-session FBT, children (N = 241) completed surveys or interviews assessing ED pathology (emotional eating, shape/weight/eating concerns, restraint, and loss of control [LOC]). Shape and weight concerns (SWC) and LOC were also assessed post treatment. Child height and weight were measured at baseline and post treatment. Latent class analysis identified patterns of ED pathology. Repeated-measures ANOVA examined changes in zBMI and ED pathology. RESULTS Four patterns of ED pathology were identified: low ED pathology, SWC, only loss of control, and high ED pathology. SWC decreased across treatment, with the highest decreases in patterns characterized by high SWC. All groups experienced significant decreases in zBMI; however, children with the highest ED pathology did not achieve clinically significant weight loss. CONCLUSIONS ED pathology decreased after FBT, decreasing ED risk. While all children achieved zBMI reductions, further research is needed to enhance outcomes for children with high ED pathology.
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Affiliation(s)
- Katherine N. Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacqueline F. Hayes
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel H. Sheinbein
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Rachel P. Kolko
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard I. Stein
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Brian E. Saelens
- Seattle Children’s Research Institute and the University of Washington, Seattle, WA, USA
| | | | - R. Robinson Welch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael G. Perri
- Department of Clinical and Health Professions, University of Florida, Gainesville, FL, USA
| | | | - Leonard H. Epstein
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
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Subjective evaluation of psychosocial well-being in children and youths with overweight or obesity: the impact of multidisciplinary obesity treatment. Qual Life Res 2017; 26:3279-3288. [PMID: 28762099 DOI: 10.1007/s11136-017-1667-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the effects of a multidisciplinary childhood obesity treatment programme on subjective evaluations of psychosocial well-being and quality of life. METHODS This longitudinal observational study included 1291 children, adolescents and young adults, 6-22 years of age, with overweight or obesity. At entry and after 2-82 months of obesity treatment, the patients evaluated the following domains of psychosocial well-being on a visual analogue scale: quality of life, mood, appetite, bullying, motivation for weight loss and body image satisfaction. The degree of overweight was calculated using a body mass index (BMI) standard deviation score (SDS) at each visit. RESULTS At entry, the mean BMI SDS was 2.81 (range: 1.35-6.65, 95% confidence interval (95% CI): 2.44-3.18). After a median of 14 months of treatment, the median reduction in BMI SDS was 0.29 (95% CI: 0.26-0.31, p < 0.0001). Improvements were observed in the domains of quality of life, mood, appetite, bullying and body image satisfaction (p < 0.0001). Larger reductions in BMI SDS were associated with greater improvements in the domains of quality of life (p = 0.001), mood (p = 0.04) and body image satisfaction (p < 0.0001), independent of BMI SDS at entry. However, improvements in psychosocial well-being were also observed in those increasing their BMI SDS (n = 315). CONCLUSIONS In a large group of children and youths, psychosocial well-being improved during a multidisciplinary childhood obesity treatment programme, irrespective of the degree of obesity at treatment entry. Greater reductions in BMI SDS were associated with greater improvements in psychosocial well-being, but even in the group increasing their BMI SDS improvements were observed.
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Taylor SJA, Rennie K, Jon C. Clinical outcomes of an inpatient pediatric obesity treatment program in the USA. Int J Adolesc Med Health 2017; 31:ijamh-2016-0141. [PMID: 28598799 DOI: 10.1515/ijamh-2016-0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
Background When treating recalcitrant and severe childhood obesity, pharmaceutical options are limited and few patients qualify for bariatric surgery. A prolonged inpatient program serves as an alternative treatment. The purpose of this project was to describe the development of a medically supervised inpatient weight management program and evaluate its effectiveness. Methods This is a retrospective chart review of 18 patients [4-18 years, mean body mass index (BMI) 50.2 kg/m2] admitted to an inpatient pediatric weight management program from October 2011 through December 31, 2012 to evaluate the biometric, laboratory, sleep and behavioral changes that occurred from admission to discharge from the program. Results Average weight loss was 15% (6.9%-21.5%, p = 0.0001), the decrease in BMI was 15.1% (1.61-21.57, p = 0.0001), systolic blood pressure and diastolic blood pressure decreased by 7.2% (p = 0.003) and 10.3% (p = 0.040), respectively. The reduction in heart rate was 15% (p = 0.013). Upon admission, nine patients had obstructive sleep apnea syndrome (OSAS), of which one was treated with tonsillectomy and six were not compliant with home positive airway pressure (PAP) therapy. At discharge, three patients no longer required PAP and five required decreased PAP settings. Upon admission, seven patients met the criteria for an internalizing disorder. At discharge, symptom reduction was noted. Conclusion An intensive pediatric inpatient weight management program leads to successful weight loss, improvement in hemodynamic parameters, reduction in OSA treatment requirements and symptom improvement in anxiety and depressive disorders in obese children.
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Affiliation(s)
- Sharonda J Alston Taylor
- Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St. Suite 1710.00, Houston 77030, TX, USA
| | | | - Cindy Jon
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Texas Medical School - Houston, Houston 77030, TX, USA
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Carriere C, Cabaussel C, Bader C, Barberger-Gateau P, Barat P, Thibault H. Multidisciplinary care management has a positive effect on paediatric obesity and social and individual factors are associated with better outcomes. Acta Paediatr 2016; 105:e536-e542. [PMID: 27564716 DOI: 10.1111/apa.13560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/05/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
Abstract
AIM The RePPOP Aquitaine network, which was established in south-west France to prevent and treat paediatric obesity, has developed a multidisciplinary approach based on multicomponent lifestyle interventions and family-based actions. This study assessed the impact of its care management programme and investigated the factors associated with better outcomes. METHODS The impact of the RePPOP care management programme was assessed by changes in the body mass index (BMI) Z score, between baseline and the end-of-care management. We focused on 982 overweight or obese children (59.9% girls) with a mean age of 10.64 years and a range of 2.4-17.9 years. A multivariate analysis examined the independent factors associated with better outcomes. RESULTS At the end-of-care management programme, 75.5% of children had decreased their BMI Z score. Initial characteristics significantly associated with better outcomes were as follows: the age at baseline between five years and 15 years of age, playing sport at a club, being followed up by RePPOP for longer than 10 months, no parental obesity and no academic difficulties. CONCLUSION This study confirmed that multidisciplinary treatment had a significant positive effect on paediatric obesity and that social and individual factors affected the efficiency of the care management.
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Affiliation(s)
- C. Carriere
- Université Bordeaux; Bordeaux France
- INSERM; ISPED; Centre INSERM U897-Epidémiologie-Biostatistique; Bordeaux France
- RePPOP of Aquitaine; Bordeaux France
| | - C. Cabaussel
- RePPOP of Aquitaine; Bordeaux France
- CHU de Bordeaux; Unité d'endocrinologie et de diabétologie pédiatrique; Hôpital des Enfants; Bordeaux France
| | - C. Bader
- Université Bordeaux; Bordeaux France
| | - P. Barberger-Gateau
- Université Bordeaux; Bordeaux France
- INSERM; ISPED; Centre INSERM U897-Epidémiologie-Biostatistique; Bordeaux France
| | - P. Barat
- Université Bordeaux; Bordeaux France
- RePPOP of Aquitaine; Bordeaux France
- CHU de Bordeaux; Unité d'endocrinologie et de diabétologie pédiatrique; Hôpital des Enfants; Bordeaux France
| | - H. Thibault
- Université Bordeaux; Bordeaux France
- INSERM; ISPED; Centre INSERM U897-Epidémiologie-Biostatistique; Bordeaux France
- RePPOP of Aquitaine; Bordeaux France
- CHU de Bordeaux; Unité d'endocrinologie et de diabétologie pédiatrique; Hôpital des Enfants; Bordeaux France
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35
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Skjåkødegård HF, Danielsen YS, Morken M, Linde SRF, Kolko RP, Balantekin KN, Wilfley DE, Júlíusson PB. Study Protocol: A randomized controlled trial evaluating the effect of family-based behavioral treatment of childhood and adolescent obesity-The FABO-study. BMC Public Health 2016; 16:1106. [PMID: 27769209 PMCID: PMC5073413 DOI: 10.1186/s12889-016-3755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children’s family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice. Methods Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6–18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m2), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires. Discussion This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity. Trial registration ClinicalTrails.gov NCT02687516. Registered 16th of February, 2016 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3755-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanna F Skjåkødegård
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.
| | | | - Mette Morken
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Sara-Rebekka F Linde
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Rachel P Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine N Balantekin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychology, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychology, Washington University School of Medicine, St. Louis, MO, USA
| | - Pétur B Júlíusson
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Abstract
BACKGROUND Juvenile obesity is associated with multiple cardiometabolic comorbidities, which may culminate in the metabolic syndrome (MetS). METHODS Based on a narrative review, the current knowledge of prevalence and the underlying metabolic principles regarding juvenile obesity and MetS are summarized to compile up-to-date information. In addition, the role of lifestyle as well as positive and negative influencing factors are focused on. RESULTS The prevalence of MetS occurs between 1 and up to 23% in the total pediatric population and in up to 60% amongst the obese and overweight. It can be considered as the consequence of multiple processes in terms of lifestyle, perinatal programming, and (epi-)genetic pathways; however, the complex underlying mechanisms and their interplay are not completely understood. CONCLUSION Besides preventive approaches, the growing number of obese children and youth as well as its consequences call for effective and lasting therapeutic measures.
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Affiliation(s)
- Christine Graf
- Department for Physical Activity in Public Health, Institute for Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Nina Ferrari
- Department for Physical Activity in Public Health, Institute for Movement and Neuroscience, German Sport University, Cologne, Germany
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Gow ML, Baur LA, Ho M, Chisholm K, Noakes M, Cowell CT, Garnett SP. Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial? Int J Behav Nutr Phys Act 2016; 13:43. [PMID: 27036113 PMCID: PMC4818484 DOI: 10.1186/s12966-016-0367-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle interventions in adolescents with obesity can result in weight loss following active intervention but individual responses vary widely. This study aimed to identify predictors of weight loss at 12- and 24-months in adolescents with obesity and clinical features of insulin resistance. METHODS Adolescents (n = 111, 66 girls, aged 10-17 years) were participants in a randomised controlled trial, the RESIST study, examining the effects of two diets differing in macronutrient content on insulin sensitivity. Eighty-five completed the 12-month program and 24-month follow-up data were available for 42 adolescents. Change in weight was determined by BMI expressed as a percentage of the 95th percentile (BMI95). The study physician collected socioeconomic data at baseline. Physical activity and screen time, and psychological dimensions of eating behavior were self-reported using the validated CLASS and EPI-C questionnaires, respectively. Stepwise multiple regressions were conducted to identify models that best predicted change in BMI95 at 12- and 24-months. RESULTS Mean BMI95 was reduced at 12-months compared with baseline (mean difference [MD] ± SE: -6.9 ± 1.0, P < 0.001) but adolescents had significant re-gain from 12- to 24-months (MD ± SE: 3.7 ± 1.5, P = 0.017). Participants who achieved greater 12-month weight loss had: greater 3-month weight loss, a father with a higher education, lower baseline external eating and parental pressure to eat scores and two parents living at home. Participants who achieved greater 24-month weight loss had: greater 12-month weight loss and a lower baseline emotional eating score. CONCLUSIONS Early weight loss is consistently identified as a strong predictor of long-term weight loss. This could be because early weight loss identifies those more motivated and engaged individuals. Patients who have baseline factors predictive of long-term weight loss failure may benefit from additional support during the intervention. Additionally, if a patient does not achieve early weight loss, further support or transition to an alternate intervention where they may have increased success may be considered. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071.
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Affiliation(s)
- Megan L. Gow
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Louise A. Baur
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Mandy Ho
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Kerryn Chisholm
- />Nutrition and Dietetics and Weight Management Services, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Manny Noakes
- />CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide BC, SA 5000 Australia
| | - Chris T. Cowell
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Sarah P. Garnett
- />Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
- />The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
- />Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
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The association of eating styles with weight change after an intensive combined lifestyle intervention for children and adolescents with severe obesity. Appetite 2016; 99:82-90. [PMID: 26752600 DOI: 10.1016/j.appet.2015.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/21/2015] [Accepted: 12/31/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED The main purpose of this prospective intervention study was to determine whether eating styles after an intensive, partly inpatient, one year combined lifestyle intervention are associated with weight change in the following year in severely obese children and adolescents. A total of 120 participants (8-19 years) with an average SDS-BMI of 3.41 (SD = 0.38) was included. Measurements were conducted at baseline (T0), at the end of treatment (T12) and at the end of follow up two years after baseline (T24). The primary outcome measurement was the ΔSDS-BMI between T12 and T24. As primary determinant of weight change after treatment, the participants eating styles were evaluated with the Dutch Eating Behavior Questionnaire - child report that measures external, emotional and restraint eating. The association between outcome and determinant was assessed in linear regression analyses. Complete data were available for 76 of the 120 participants. This study shows that for girls a higher score on restraint eating at T12 and a higher score on external eating at T12 were associated with more weight (re)gain in the year after treatment. No statistically significant association with emotional eating at T12 was found. In addition for girls a higher score on external eating at T0 was associated with more weight (re)gain in the year after treatment. Furthermore, the observed changes in eating styles suggest that on average it is possible to influence these with treatment, although the detected changes were different for girls and boys and for the different eating styles. More generally, this study indicates that for girls the levels of restraint and external eating after treatment were associated with the weight change during the following year. TRIAL REGISTRATION Netherlands Trial Register (NTR1678, registered 20-Feb-2009).
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Bambra CL, Hillier FC, Cairns JM, Kasim A, Moore HJ, Summerbell CD. How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BackgroundTackling obesity is one of the major contemporary public health policy challenges and is vital in terms of addressing health inequalities.ObjectivesTo systematically review the effectiveness of interventions (individual, community and societal) in reducing socioeconomic inequalities in obesity among (1) children aged 0–18 years (including prenatal) and (2) adults aged ≥18 years, in any setting, in any country, and (3) to establish how such interventions are organised, implemented and delivered.Data sourcesNine electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and NHS Economic Evaluation Database were searched from database start date to 10 October 2011 (child review) and to 11 October 2012 (adult review). We did not exclude papers on the basis of language, country or publication date. We supplemented these searches with website and grey literature searches.Review methodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Experimental studies and observational studies with a duration of at least 12 weeks were included. The reviews considered strategies that might reduce existing inequalities in the prevalence of obesity [i.e. effective targeted interventions or universal interventions that work more effectively in low socioeconomic status (SES) groups] as well as those interventions that might prevent the development of inequalities in obesity (i.e. universal interventions that work equally along the SES gradient). Interventions that involved drugs or surgery and laboratory-based studies were excluded from the reviews. The initial screening of titles and abstracts was conducted by one reviewer with a random 10% of the sample checked by a second reviewer. Data extraction was conducted by one reviewer and independently checked by a second reviewer. The methodological quality of the included studies was appraised independently by two reviewers. Meta-analysis and narrative synthesis were conducted focusing on the ‘best-available’ evidence for each intervention type (defined in terms of study design and quality).ResultsOf 56,967 papers of inequalities in obesity in children, 76 studies (85 papers) were included, and of 70,730 papers of inequalities in obesity in adults, 103 studies (103 papers) were included. These studies suggested that interventions that aim to prevent, reduce or manage obesity do not increase inequalities. For children, there was most evidence of effectiveness for targeted school-delivered, environmental and empowerment interventions. For adults, there was most evidence of effectiveness for primary care-delivered tailored weight loss and community-based weight loss interventions, at least in the short term among low-income women. There were few studies of appropriate design that could be included on societal-level interventions, a clear limitation of the evidence base found.LimitationsThe reviews located few evaluations of societal-level interventions and this was probably because they included only experimental study designs. The quality assessment tool, although described as a tool for public health interventions, seemed to favour those that followed a more clinical model. The implementation tool was practical but enabled only a brief summary of implementation factors to be made. Most of the studies synthesised in the reviews were from outside the UK and related to women.ConclusionsThe reviews have found some evidence of interventions with the potential to reduce SES inequalities in obesity and that obesity management interventions do not increase health inequalities. More experimental studies of the effectiveness and cost-effectiveness of interventions (particularly at the societal level) to reduce inequalities in obesity, particularly among adolescents and adult men in the UK, are needed.Study registrationThe studies are registered as PROSPERO CRD42011001740 and CRD42013003612.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Clare L Bambra
- Department of Geography, Durham University, Durham, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Frances C Hillier
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Joanne-Marie Cairns
- Department of Geography, Durham University, Durham, UK
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Helen J Moore
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
| | - Carolyn D Summerbell
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, UK
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Altman M, Wilfley DE. Evidence update on the treatment of overweight and obesity in children and adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:521-37. [PMID: 25496471 DOI: 10.1080/15374416.2014.963854] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Childhood obesity is associated with increased medical and psychosocial consequences and mortality and effective interventions are urgently needed. Effective interventions are urgently needed. This article reviews the evidence for psychological treatments of overweight and obesity in child and adolescent populations. Studies were identified through searches of online databases and reference sections of relevant review articles and meta-analyses. Treatment efficacy was assessed using established criteria, and treatments were categorized as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy. Well-established treatments included family-based behavioral treatment (FBT) and Parent-Only Behavioral Treatment for children. Possibly efficacious treatments include Parent-Only Behavioral Treatment for adolescents, FBT-Guided Self-Help for children, and Behavioral Weight Loss treatment with family involvement for toddlers, children, and adolescents. Appetite awareness training and regulation of cues treatments are considered experimental. No treatments are considered probably efficacious, or of questionable efficacy. All treatments considered efficacious are multicomponent interventions that include dietary and physical activity modifications and utilize behavioral strategies. Treatment is optimized if family members are specifically targeted in treatment. Research supports the use of multicomponent lifestyle interventions, with FBT and Parent-Only Behavioral Treatment being the most widely supported treatment types. Additional research is needed to test a stepped care model for treatment and to establish the ideal dosage (i.e., number and length of sessions), duration, and intensity of treatments for long-term sustainability of healthy weight management. To improve access to care, the optimal methods to enhance the scalability and implementability of treatments into community and clinical settings need to be established.
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Affiliation(s)
- Myra Altman
- a Department of Psychology , Washington University in St. Louis
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Sampat S, Kirschenbaum DS, Gierut KJ, Germann JN, Krawczyk R. Ya gotta have friends: social support and self-efficacy predict success following immersion treatment. Obesity (Silver Spring) 2014; 22:2579-85. [PMID: 25297702 DOI: 10.1002/oby.20863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the impact of perceived social support and self-efficacy on predicting success in weight management following immersion treatment of adolescent obesity. METHODS 198 overweight and obese adolescents (M% overweight = 81.4%; M BMI = 36.0) participated in Wellspring's cognitive-behavioral therapeutic camps for 3-10 weeks during the summer of 2011. The campers and one of their caretakers completed a series of questionnaires at the halfway point during immersion. One year following camp, campers and their parents provided follow-up heights and weights. RESULTS Multiple regression intent to treat analyses indicated that campers who perceived their friends as supportive, reported confidence in their ability to succeed, and believed that their families functioned well achieved relatively more substantial reductions in percent overweight 1 year after immersion. Perceptions of support anticipated from parents failed to predict success. Campers who more fully engaged in the process of change at camp also achieved somewhat greater success in the long run. CONCLUSIONS These results suggest that participants in cognitive-behavioral immersion treatment may improve outcomes by nurturing support from their friends, increasing self-efficacy, and having their families consider family therapy if warranted.
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Chirita-Emandi A, Puiu M. Outcomes of Neurofeedback Training in Childhood Obesity Management: A Pilot Study. J Altern Complement Med 2014; 20:831-7. [DOI: 10.1089/acm.2014.0040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Adela Chirita-Emandi
- Genetics Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
- Pediatrics Department, Emergency Hospital for Children “Louis Turcanu” Timisoara, Romania
| | - Maria Puiu
- Genetics Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
- Pediatrics Department, Emergency Hospital for Children “Louis Turcanu” Timisoara, Romania
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Rank M, Wilks DC, Foley L, Jiang Y, Langhof H, Siegrist M, Halle M. Health-related quality of life and physical activity in children and adolescents 2 years after an inpatient weight-loss program. J Pediatr 2014; 165:732-7.e2. [PMID: 25039048 DOI: 10.1016/j.jpeds.2014.05.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/22/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate changes in health-related quality of life (HRQOL), body mass index (BMI), physical activity, and sedentary behavior at 24 months after an inpatient weight-loss program and to examine correlations between changes in HRQOL and BMI or physical activity. STUDY DESIGN This prospective study included 707 overweight and obese individuals (mean age, 14 ± 2 years; 57% girls) participating in a 4- to 6-week inpatient weight-loss program, 381 of whom completed a 24-month follow-up. HRQOL, physical activity, sedentary behavior, and BMI were assessed at baseline, at discharge, and at 6, 12, and 24 months after starting therapy. Longitudinal analyses were conducted using repeated-measures mixed models, adjusted for age, sex, and baseline outcome and accounting for attrition over time. RESULTS All variables improved over treatment and 6-month follow-up (P < .05). At 24 months, overall HRQOL indicated improvements relative to baseline (3 points on a scale of 0-100; 95% CI, 1.68-4.47; P < .001). Of the 6 HRQOL domains, the greatest improvement was observed for self-esteem (11 points; 95% CI, 8.40-13.14; P < .001). BMI was 0.5 kg/m(2) lower than at baseline (95% CI, -0.92 to -0.02; P = .04). Long-term changes in physical activity explained 30% of the variation in overall HRQOL (P = .01), and change in BMI was not associated with a change in HRQOL. CONCLUSIONS This inpatient weight-loss program was associated with positive changes in HRQOL over the long term, with particular improvements in self-esteem. The results indicate the potential role of physical activity in improving HRQOL without a substantial change in body composition.
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Affiliation(s)
- Melanie Rank
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Germany.
| | - Desiree C Wilks
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Germany; Sports Center, University of Passau, Germany
| | - Louise Foley
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - Helmut Langhof
- Rehabilitation Clinic Schoensicht, Berchtesgaden, Germany
| | - Monika Siegrist
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; Else-Kröner-Fresenius-Zentrum, Klinikum rechts der Isar, Munich, Germany
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Van Allen J, Borner KB, Gayes LA, Steele RG. Weighing physical activity: the impact of a family-based group lifestyle intervention for pediatric obesity on participants' physical activity. J Pediatr Psychol 2014; 40:193-202. [PMID: 25241402 DOI: 10.1093/jpepsy/jsu077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. METHODS Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. RESULTS Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. CONCLUSIONS Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.
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Affiliation(s)
- Jason Van Allen
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
| | - Kelsey B Borner
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
| | - Laurie A Gayes
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
| | - Ric G Steele
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
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Coppock JH, Ridolfi DR, Hayes JF, St Paul M, Wilfley DE. Current approaches to the management of pediatric overweight and obesity. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:343. [PMID: 25205083 DOI: 10.1007/s11936-014-0343-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OPINION STATEMENT Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers have an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. Key aspects of effective treatment include: early intervention, moderate intensity to high intensity intervention of sufficient duration, multicomponent intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multicomponent behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management.
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Affiliation(s)
- Jackson H Coppock
- Washington University in Saint Louis, School of Medicine, St. Louis, MO, USA,
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Predicting success: factors associated with weight change in obese youth undertaking a weight management program. Obes Res Clin Pract 2014; 7:e147-e154. [PMID: 24331776 DOI: 10.1016/j.orcp.2011.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/27/2011] [Accepted: 09/29/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore which baseline physiological and psychosocial variables predict change in body mass index (BMI) z-score in obese youth after 12 weeks of a dietary weight management study. METHODS Participants were obese young people participating in a dietary intervention trial in Brisbane Australia. The outcome variable was change in BMI z-score. Potential predictors considered included demographic, physiological and psychosocial parameters of the young person, and demographic characteristics of their parents. A multivariable regression model was constructed to examine the effect of potential predictive variables. RESULTS Participants (n = 88) were predominantly female (69.3%), and had a mean(standard deviation) age of 13.1(1.9) years and BMI z-score of 2.2(0.4) on presentation. Lower BMI z-score (p < 0.001) and insulin resistance (p = 0.04) at baseline, referral from a paediatrician (p = 0.02) and being more socially advantaged (p = 0.046) were significantly associated with weight loss. Macronutrient distribution of diet and physical activity level did not contribute. CONCLUSIONS Early intervention in obesity treatment in young people improves likelihood of success. Other factors such as degree of insulin resistance, social advantage and referral source also appear to play a role. Assessing presenting characteristics and factors associated with treatment outcome may allow practicing clinicians to individualise a weight management program or determine the 'best-fit' treatment for an obese adolescent.
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Salawi HA, Ambler KA, Padwal RS, Mager DR, Chan CB, Ball GDC. Characterizing severe obesity in children and youth referred for weight management. BMC Pediatr 2014; 14:154. [PMID: 24947311 PMCID: PMC4074846 DOI: 10.1186/1471-2431-14-154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background Severe obesity (SO) in pediatrics has become increasing prevalent in recent decades. The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers. Methods A retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99th percentile) and OW/OB (BMI ≥85th and <99th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved. Results Of the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > $50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05). Conclusion Children and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years.
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Affiliation(s)
| | | | | | | | | | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, AB T5K0L4, CANADA.
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Goldschmidt AB, Best JR, Stein RI, Saelens BE, Epstein LH, Wilfley DE. Predictors of child weight loss and maintenance among family-based treatment completers. J Consult Clin Psychol 2014; 82:1140-1150. [PMID: 24932567 DOI: 10.1037/a0037169] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine general and treatment-specific predictors of children's weight outcomes during a pediatric weight management trial. METHOD One hundred fifty overweight children-69.3% female; M body mass index (BMI) z score (z-BMI) = 2.21 ± 0.30-completed family-based behavioral weight loss treatment (FBT), followed by randomization to social facilitation maintenance (SFM) treatment addressing social support and body image; behavioral skills maintenance treatment (BSM), which extended FBT skills to maintenance; or a control condition with no maintenance treatment. Regression and mixed-effects repeated-measures analysis of covariance (ANCOVA) examined child and parent anthropometric, demographic, and psychosocial variables in predicting relative weight outcomes over short- and long-term follow-ups. RESULTS Among FBT completers, lower child baseline z-BMI and age, and greater parent BMI reductions during FBT and baseline self-efficacy, predicted better child relative weight loss following FBT, F(6, 137) = 7.77, p < .001. Higher child-reported post-FBT eating pathology predicted greater relative weight loss in SFM than BSM or control from post-FBT to 2-year follow-up, F(4,255.88) = 3.48, p = .009, whereas higher parent-reported post-FBT social support predicted greater relative weight loss in BSM than control, F(2,141.65) = 3.28, p = .04. Lower parent-reported post-FBT behavioral problems predicted greater relative weight loss in SFM and BSM versus control, F(2,147.84) = 7.37, p < .001; higher problems predicted equivalent outcome across treatments. CONCLUSION SFM may improve weight outcomes for FBT completers with initially higher eating pathology, whereas extending FBT skills may be effective for those with higher familial support. These results suggest that certain pretreatment variables moderate the effectiveness of different pediatric weight control interventions. Further understanding these findings may help optimally match families to treatments.
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Affiliation(s)
| | - John R Best
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brian E Saelens
- Department of Pediatrics, Seattle Children's Hospital Research Institute and University of Washington, Seattle, Washington, 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.,Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Gerke CK, Mazzeo SE, Stern M, Palmberg AA, Evans RK, Wickham EP. The stress process and eating pathology among racially diverse adolescents seeking treatment for obesity. J Pediatr Psychol 2013; 38:785-93. [PMID: 23853156 DOI: 10.1093/jpepsy/jst042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examined the associations of weight-related teasing and daily hassles with eating pathology, as well as potential mediators of these relations, among a racially diverse sample of adolescents. METHODS Participants were 92 primarily African American 11-17-year-olds seeking treatment for obesity. Data were collected at baseline. RESULTS Both daily hassles and weight-related teasing were significantly correlated with eating pathology at r = .22 and r = .25, respectively. Feeling upset about teasing mediated the associations of daily hassles (PE = .0093, SE = .0054, 95% BCa bootstrap CI of .0001-.0217) and teasing (PE = .0476, SE = .0198, 95% BCa bootstrap CI of .0093-.0873) with eating pathology. CONCLUSIONS These results highlight the importance of psychological interventions in the treatment of weight-loss among adolescents, as stressors may impact eating behaviors.
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Affiliation(s)
- Clarice K Gerke
- Departments of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA
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50
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van Egmond-Froehlich A, Claußnitzer G, Dammann D, Eckstein E, Bräuer W, de Zwaan M. Parent reported inattention and hyperactivity/impulsivity as predictor of long-term weight loss after inpatient treatment in obese adolescents. Int J Eat Disord 2013; 46:39-46. [PMID: 22821768 DOI: 10.1002/eat.22043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The long-term success of treatment for pediatric obesity is often unsatisfactory and variable. We aim to elucidate the influence of inattention and hyperactivity/impulsivity on weight loss after inpatient treatment for adolescent obesity. METHOD We included 13-17 year old obese participants treated in three inpatient multidisciplinary treatment centers. At the beginning and end of treatment and at one year follow-up weight and height were measured. Inattention and hyperactivity/impulsivity was assessed with the hyperactivity/inattention (HI) subscale of the parent-rated Strengths and Difficulties Questionnaire. General linear models were used with the standard deviation scores of the body mass index (BMI-SDS) as dependent variable. RESULTS Totally, 253 participants were included (65% female, age: 15.3 ± 1.4 years, baseline BMI-SDS: 3.13 ± 0.38 kg/m(2)). HI scores were associated with long-term (p < .001) but not short term (ns) weight loss. DISCUSSION This indicates that inattention and hyperactivity/impulsivity is associated with reduced long-term weight loss success in adolescent inpatients.
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