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Aman-Braaksma S, Croker H, Viner RM, Nicholls D. Exploring predictors and moderators of response to multimodal obesity treatment in children. Arch Dis Child 2023; 108:405-409. [PMID: 36746608 DOI: 10.1136/archdischild-2022-325013] [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: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether specific psychological factors influence intervention effects for children with severe obesity in a clinical setting. DESIGN Secondary analyses of data about attention deficit/hyperactivity disorder (ADHD) characteristics, body satisfaction, social and emotional functioning, and the primary outcome, change in body mass index (BMI), were available for 41 out of 72 children and their families randomised to family-based behavioural treatment over 6 months or waiting list control. Regression analyses, with an interaction term for treatment condition, were performed to explore baseline factors and moderators of outcome. RESULTS Parents reporting their child's emotional well-being as high and high maternal education significantly predicted less weight loss for the total sample, with no effect of ethnicity, age, sex or baseline BMI. Children's social functioning was a significant moderator of treatment effect; children with high social function showed a decrease in BMI after 6 months of therapy (R2=0.08-0.13), whereas an increase in BMI was observed in children with high social function who waited for treatment. For children with poor social function, no treatment effect was observed-subjects lost weight in both conditions. No significant moderation effect was found for body (dis)satisfaction, emotional status, comorbid depression or ADHD, adjusting for baseline BMI, age, sex and ethnicity. CONCLUSIONS These preliminary findings suggest directions for development of tailored obesity programmes. Professionals engaged in treatment of childhood obesity should consider a child's emotional and social functioning when considering group obesity intervention, as well as the risks of no intervention.
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Affiliation(s)
| | - Helen Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London, London, UK
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Ebbeling CB, Ludwig DS. Treatment for childhood obesity: Using a biological model to inform dietary targets. J Pediatr 2022; 255:22-29. [PMID: 36509158 DOI: 10.1016/j.jpeds.2022.12.004] [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: 07/11/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Silveira EA, Canheta AB, Noll M, Rodrigues APS, Oliveira CD. Nutritional and food education as a complementary treatment approach in severe obese individuals. Nutr Health 2022; 29:339-346. [PMID: 35293243 DOI: 10.1177/02601060221080246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The treatment for obesity, specifically severe obesity, is a challenge for health professionals and services. It requires a multidisciplinary and holistic approach covering the complexity and difficulties of incorporating healthy habits to prevent associated diseases and mortality. Individual intervention's methods are not enough to change eating habits. Objective: To describe and investigate the contribution of nutritional and food education as a complementary therapeutic approach in the treatment of individuals with severe obesity and their family members. Methods: A multidisciplinary team adopted a group approach. A different topic was addressed at each therapeutic meeting to assist in the nutritional treatment of obesity, such as diet and healthy habits i.e. barriers to lifestyle changes. The topics were developed based on different methodological and teaching approaches to facilitate adherence to non-drug treatment. Results: Overall, there was a greater understanding towards the adoption of healthy eating habits of the whole family, greater motivation to adhere to dietary changes and adoption of a more physical active lifestyle. This interventional educational support methodology had been accepted in such a positive way for patients and their relatives. Family member participation expands the possibilities of establishing necessary and lasting changes in the lifestyle of not only the patients, but their whole families. Conclusion: Health education actions constitute an important complementary therapeutic approach in promoting health and preventing complications in individuals with severe obesity. This article can be useful to enlarge the debate on the subject and face the challenges related to the effective treatment of obesity, notably severe obesity.
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Affiliation(s)
- Erika Aparecida Silveira
- Faculty of Medicine, Health Sciences Posgraduate Program, Universidade Federal Goiás, Goiania, Brazil.,66046Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Andrea Batista Canheta
- Faculty of Medicine, Health Sciences Posgraduate Program, Universidade Federal Goiás, Goiania, Brazil
| | - Matias Noll
- 509282Federal Institute Goiano, Ceres, Brazil
| | | | - Cesar de Oliveira
- 66046Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, UK
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HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood. Contemp Clin Trials 2021; 112:106644. [PMID: 34861408 DOI: 10.1016/j.cct.2021.106644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood. METHODS The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022. DISCUSSION This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses. TRIAL REGISTRATION ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.
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Campisi SC, Zasowski C, Shah S, Bradley-Ridout G, Madigan S, Szatmari P, Korczak DJ. Do Healthy Dietary Interventions Improve Pediatric Depressive Symptoms? A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:2495-2507. [PMID: 34302170 PMCID: PMC8634309 DOI: 10.1093/advances/nmab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/05/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Dietary recommendations have been proposed as a way of impacting current and future mental health. There exists a limited body of conflicting literature related to pediatric nutritional interventions and depression. This meta-analysis aims to determine the efficacy of child and adolescent dietary interventions on depression. Systematic searches in electronic databases and gray literature were conducted. After screening 6725 citations, 17 studies were included in this systematic review. Quality assessment was performed using the Cochrane risk-of-bias tool and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. A meta-analysis of Hedges g values was calculated using the Hartung-Knapp-Sidik-Jonkman method. Publication bias was assessed with funnel plots and the Egger test. The results of the meta-analysis of the RCTs (k = 7) demonstrated a nonsignificant effect of dietary intervention (g = 0.05; 95% CI: -0.25, 0.35; P = 0.70) whereas the results of the pre-post intervention studies (k = 9) demonstrated a significant small-to-medium effect favoring dietary intervention for reducing depression (g = -0.45; 95% CI: -0.64, -0.27; P = 0.001). Publication bias was not detected by the Egger test or by funnel plot asymmetry. The current meta-analysis demonstrates that "healthy" dietary interventions for children or adolescents in the community have little impact on nonclinical depression. Confusion will persist until better-designed studies in pediatric nutritional psychiatry research focusing on adolescents with depressive illness are conducted.
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Affiliation(s)
- Susan C Campisi
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Clare Zasowski
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Shailja Shah
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Peter Szatmari
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ochieng L, Amaugo L, Ochieng BMN. Developing healthy weight maintenance through co-creation: a partnership with Black African migrant community in East Midlands. Eur J Public Health 2021; 31:487-493. [PMID: 33532825 DOI: 10.1093/eurpub/ckaa222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obesity prevalence in the UK varies according to ethnicity, with children from minority ethnic groups experiencing higher levels, and yet, there is a scarcity of projects that involve minority ethnic groups in the design of interventions to promote healthy weight maintenance. This article presents an account of the involvement of the participants in a co-creation activity to design public health resources for the maintenance of healthy weight. METHODS The material is drawn from a study that involved Black African parents (n = 30) and Health Visitors (n = 32), residing and working in the East Midlands, UK, respectively. The participants were purposely selected according to an inclusion/exclusion criterion and invited to participate in seven focus groups (FG) conducted for parents (FG-4) and health visitors (FG-3) at a time and place convenient to the participants. Following the focus groups, the Black African parents participated in three co-creation workshops. RESULTS The co-creation activities involved the participants, the researcher and a nutritionist. The outcome was an African heritage eatwell guide and a framework to promote healthy weight, which was well-received when presented to members of the community and local health and social care practitioners. CONCLUSION The co-creation process went beyond giving the participant a voice in shaping the promotion of healthy weight within their community, as they also became active participants in the design and creation of the specific public health service. The approach offered the potential for improved levels of community satisfaction for a public health intervention.
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Affiliation(s)
- Lorraine Ochieng
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | - Lucky Amaugo
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | - Bertha M N Ochieng
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
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House ET, Gow ML, Lister NB, Baur LA, Garnett SP, Paxton SJ, Jebeile H. Pediatric weight management, dietary restraint, dieting, and eating disorder risk: a systematic review. Nutr Rev 2021; 79:1114-1133. [PMID: 33608718 DOI: 10.1093/nutrit/nuaa127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Whether dietary restraint and dieting are risk factors associated with eating disorders has not been explored in the context of pediatric weight management. OBJECTIVE To review associations between dietary pediatric weight management, dietary restraint, dieting, and eating disorder risk. DATA SOURCES, SELECTION, AND EXTRACTION Four databases - MEDLINE, EMBASE, Cochrane Library, and PsycINFO - were searched to May 2020 to identify pediatric weight management interventions with a dietary component for children and adolescents with overweight or obesity. The review was limited to studies reporting dietary restraint and/or dieting at preintervention, postintervention, and/or follow-up. Screening and quality assessment were conducted in duplicate, and data extraction was completed by 1 reviewer and cross-checked for accuracy. Data extracted included study characteristics, dietary restraint/dieting, and eating disorder-related outcomes (including disordered eating, body image, self-esteem, depression, and anxiety). RESULTS A total of 26 papers, representing 23 studies, were included. Of these, 20 studies reported on dietary restraint, which increased (10 postintervention, 6 follow-up) or remained unchanged (7 postintervention, 5 follow-up), and 5 studies reported on dieting, which increased (1 study), remained unchanged (2 studies) or decreased (2 studies) postintervention. All studies that reported on other eating disorder risk factors (eg, binge eating, body dissatisfaction, and depression) and weight-related outcomes found improvement or no change postintervention or at follow-up. CONCLUSION The results of this review suggest that current measures of dietary restraint and dieting are not associated with eating disorder risk within the context of pediatric weight management; however, long-term data is limited. In addition, those current measures may not be suitable risk markers. Concerns about dietary restraint and dieting leading to eating disorders should not prevent access to quality care for young people with obesity. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. 2017 CRD42017069488.
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Affiliation(s)
- Eve T House
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Pallan M, Griffin T, Hurley KL, Lancashire E, Blissett J, Frew E, Griffith L, Hemming K, Jolly K, McGee E, Thompson JL, Jackson L, Gill P, Parry J, Adab P. Cultural adaptation of an existing children's weight management programme: the CHANGE intervention and feasibility RCT. Health Technol Assess 2020; 23:1-166. [PMID: 31293236 DOI: 10.3310/hta23330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Excess weight in children is a continuing health issue. Community-based children's weight management programmes have had some effect in promoting weight loss. Families from minority ethnic communities are less likely to complete these programmes but, to date, no programmes have been culturally adapted to address this. OBJECTIVES We aimed to (1) culturally adapt an existing weight management programme for children aged 4-11 years and their families to make it more suited to Pakistani and Bangladeshi communities but inclusive of all families and (2) evaluate the adapted programme to assess its feasibility and acceptability, as well as the feasibility of methods, for a future full-scale trial. DESIGN In phase I, a cultural adaptation of a programme that was informed by formative research and guided by two theoretical frameworks was undertaken and in phase II this adapted programme was delivered in a cluster-randomised feasibility study (for which the clusters were the standard and adapted children's weight management programmes). SETTING Birmingham: a large, ethnically diverse UK city. PARTICIPANTS In phase I, Pakistani and Bangladeshi parents of children with excess weight, and, in phase II, children aged 4-11 years who have excess weight and their families. INTERVENTIONS A culturally adapted children's weight management programme, comprising six sessions, which was delivered to children and parents, targeting diet and physical activity and incorporating behaviour change techniques, was developed in phase I and delivered in the intervention arm to 16 groups in phase II. The eight groups in the comparator arm received the standard (unadapted) children's weight management programme. MAIN OUTCOME MEASURES The primary outcome was the proportion of Pakistani and Bangladeshi families completing (attending ≥ 60% of) the adapted programme. Secondary outcomes included the proportion of all families completing the adapted programme, the feasibility of delivery of the programme, the programme's acceptability to participants, the feasibility of trial processes and the feasibility of collection of outcome and cost data. RESULTS The proportion of Pakistani and Bangladeshi families and all families completing the adapted programme was 78.8% [95% confidence interval (CI) 64.8% to 88.2%] and 76.3% (95% CI 67.0% to 83.6%), respectively. The programme was feasible to deliver with some refinements and was well received. Ninety-two families participated in outcome data collection. Data collection was mostly feasible, but participant burden was high. Data collection on the cost of programme delivery was feasible, but costs to families were more challenging to capture. There was high attrition over the 6-month follow-up period (35%) and differential attrition in the two study arms (29% and 52% in the intervention and comparator arms, respectively). LIMITATIONS The study was not designed to address the issue of low participant uptake of children's weight management programmes. The design of a future trial may include individual randomisation and a 'minimal intervention' arm, the acceptability of which has not been evaluated in this study. CONCLUSIONS The theoretically informed, culturally adapted children's weight management programme was highly acceptable to children and families of all ethnicities. Consideration should be given to a future trial to evaluate clinical effectiveness and cost-effectiveness of the adapted programme, but the design of a future trial would need to address the logistics of data collection, participant burden and study attrition. TRIAL REGISTRATION Current Controlled Trials ISRCTN81798055. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 33. See the NIHR Journals Library website for further project information. Kate Jolly is part-funded by the Collaboration for Leadership in Applied Health Research and Care West Midlands.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiya L Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jacqueline Blissett
- School of Psychology, University of Birmingham, Birmingham, UK.,Faculty Research Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Griffith
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Nutrition, Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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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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10
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Beets MW, Weaver RG, Ioannidis JPA, Geraci M, Brazendale K, Decker L, Okely AD, Lubans D, van Sluijs E, Jago R, Turner-McGrievy G, Thrasher J, Li X, Milat AJ. Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:19. [PMID: 32046735 PMCID: PMC7014944 DOI: 10.1186/s12966-020-0918-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity. METHODS We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes. RESULTS A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively. CONCLUSIONS Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Marco Geraci
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Keith Brazendale
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lindsay Decker
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - David Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - Esther van Sluijs
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Russell Jago
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - James Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Andrew J Milat
- New South Wales (NSW) Ministry of Health, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. Association of Pediatric Obesity Treatment, Including a Dietary Component, With Change in Depression and Anxiety: A Systematic Review and Meta-analysis. JAMA Pediatr 2019; 173:e192841. [PMID: 31524933 PMCID: PMC6749546 DOI: 10.1001/jamapediatrics.2019.2841] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Children and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider. OBJECTIVE To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity. DATA SOURCES Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies. STUDY SELECTION Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019. MAIN OUTCOMES AND MEASURES Change in symptoms of depression and anxiety postintervention and at the latest follow-up. RESULTS Of 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], -0.31 [0.04]; P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], -0.25 [0.07]; P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], -0.38 [0.10]; P < .001) and at follow-up (4 studies; standardized mean difference [SE], -0.32 [0.15]; P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R2 = 0.82; P < .001). Higher body mass index z score at baseline was associated with a greater reduction in depression (R2 = 0.19; P = .03). CONCLUSIONS AND RELEVANCE Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L. Gow
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A. Baur
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P. Garnett
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan J. Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Natalie B. Lister
- The University of Sydney, Children’s Hospital Westmead Clinical School, Westmead, New South Wales, Australia,Institute of Endocrinology and Diabetes and Weight Management Services, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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12
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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: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 12/20/2022]
Abstract
This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre-post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow-up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post-intervention. Meta-analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], -0.326 [0.09], P < 0.001), emotional eating (six studies, -0.149 [0.06], P = 0.008), binge eating (three studies, -0.588 [0.10], P < 0.001), and drive for thinness (three studies, -0.167 [0.06], P = 0.005) post-intervention. At follow-up, a reduction in ED risk (six studies, -0.313 [0.13], P = 0.012), emotional eating (five studies, -0.259 [0.05], P < 0.001), eating concern (three studies, -0.501 [0.06], P < 0.001), and drive for thinness (two studies, -0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.
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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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13
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Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, Kang KS, Hong J, Shim JO, Lee Y, Kang B, Lee YJ, Kim MJ, Moon JS, Koh H, You J, Kwak YS, Lim H, Yang HR. Clinical Practice Guideline for the Diagnosis and Treatment of Pediatric Obesity: Recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. Pediatr Gastroenterol Hepatol Nutr 2019; 22:1-27. [PMID: 30671370 PMCID: PMC6333581 DOI: 10.5223/pghn.2019.22.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University, College of Medicine, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Chungju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea.,Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - JeongAe You
- Department of Physical Education, College of Education, Chung-Ang University, Seoul, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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14
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Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, Kang KS, Hong J, Shim JO, Lee Y, Kang B, Lee YJ, Kim MJ, Moon JS, Koh H, You J, Kwak YS, Lim H, Yang HR. Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. KOREAN JOURNAL OF PEDIATRICS 2018; 62:3-21. [PMID: 30589999 PMCID: PMC6351800 DOI: 10.3345/kjp.2018.07360] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022]
Abstract
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Chungju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Eulji University School of Medicine, Nowon Eulji Medical Hospital, Seoul, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea
| | - JeongAe You
- Department of Physical Education, College of Education, Chung-Ang University, Seoul, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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15
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Brown T, O'Malley C, Blackshaw J, Coulton V, Tedstone A, Summerbell C, Ells LJ. Exploring the evidence base for Tier 3 specialist weight management interventions for children aged 2-18 years in the UK: a rapid systematic review. J Public Health (Oxf) 2018; 40:835-847. [PMID: 29228233 DOI: 10.1093/pubmed/fdx166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background The impact of specialist weight management services (Tier 3) for children with severe and complex obesity in the UK is unclear. This review aims to examine the impact of child Tier 3 services in the UK, exploring service characteristics and implications for practice. Methods Rapid systematic review of any study examining specialist weight management interventions in any UK setting including children (2-18 years) with a body mass index >99.6th centile or >98th centile with comorbidity. Results Twelve studies (five RCTs and seven uncontrolled) were included in a variety of settings. Study quality was moderate or low and mean baseline body mass index z-score ranged from 2.7 to 3.6 units. Study samples were small and children were predominantly older (10-14 years), female and white. Multidisciplinary team composition and eligibility criteria varied; dropout ranged from 5 to 43%. Improvements in zBMI over 1-24 months ranged from -0.13 to -0.41 units. Conclusions Specialist weight management interventions for children with severe obesity demonstrated a reduction in zBMI, across a variety of UK settings. Studies were heterogeneous in content and thus conclusions on service design cannot be drawn. There is a paucity of evidence for Tier 3 services for children, and further research is required.
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Affiliation(s)
- Tamara Brown
- School of Social Sciences, Durham University, Durham, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Claire O'Malley
- School of Social Sciences, Durham University, Durham, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jamie Blackshaw
- Health and Wellbeing, Public Health England, 2nd Floor, Skipton House, 80 London Road, London, UK
| | - Vicki Coulton
- Health and Wellbeing, Public Health England, 2nd Floor, Skipton House, 80 London Road, London, UK
| | - Alison Tedstone
- Health and Wellbeing, Public Health England, 2nd Floor, Skipton House, 80 London Road, London, UK
| | - Carolyn Summerbell
- School of Social Sciences, Durham University, Durham, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK
| | - Louisa J Ells
- FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle Upon Tyne, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
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16
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Croker H, Beeken RJ. Applied Interventions in the Prevention and Treatment of Obesity Through the Research of Professor Jane Wardle. Curr Obes Rep 2017; 6:57-62. [PMID: 28265868 PMCID: PMC5359372 DOI: 10.1007/s13679-017-0249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE OF REVIEW Obesity presents a challenge for practitioners, policy makers, researchers and for those with obesity themselves. This review focuses on psychological approaches to its management and prevention in children and adults. RECENT FINDINGS Through exploring the work of the late Professor Jane Wardle, we look at the earliest behavioural treatment approaches and how psychological theory has been used to develop more contemporary approaches, for example incorporating genetic feedback and habit formation theory into interventions. We also explore how Jane has challenged thinking about the causal pathways of obesity in relation to eating behaviour. Beyond academic work, Jane was an advocate of developing interventions which had real-world applications. Therefore, we discuss how she not only developed new interventions but also made these widely available and the charity that she established.
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Affiliation(s)
- Helen Croker
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Rebecca J. Beeken
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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17
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Kolko RP, Kass AE, Hayes JF, Levine MD, Garbutt JM, Proctor EK, Wilfley DE. Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial. J Pediatr Health Care 2017; 31:16-28. [PMID: 26873293 PMCID: PMC4980292 DOI: 10.1016/j.pedhc.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. METHOD Participants (N = 63) were randomized to live interactive training or Web-facilitated self-study training. Pretraining, post-training, and 1-month follow-up assessments evaluated training feasibility, acceptability, and impact (knowledge and skill via simulation). Moderator (previous experience) and predictor (content engagement) analyses were conducted. RESULTS Nearly all participants (98%) completed assessments. Both types of training were acceptable, with higher ratings for live training and participants with previous experience (ps < .05). Knowledge and skill improved from pretraining to post-training and follow-up in both conditions (ps < .001). Live training demonstrated greater content engagement (p < .01). CONCLUSIONS The training package was feasible, acceptable, and efficacious among nursing students. Given that live training had higher acceptability and engagement and online training offers greater scalability, integrating interactive live training components within Web-based training may optimize outcomes, which may enhance practitioners' delivery of pediatric obesity services.
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Affiliation(s)
- Rachel P. Kolko
- Department of Psychiatry, University of Pittsburgh
- Department of Psychology, Washington University in St. Louis
| | - Andrea E. Kass
- Department of Psychology, Washington University in St. Louis
- Department of Medicine, The University of Chicago
| | | | | | - Jane M. Garbutt
- Department of Medicine, Washington University School of Medicine
- Department of Pediatrics, Washington University School of Medicine
| | | | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine
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18
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Pallan M, Griffin T, Lancashire E, Hurley K, Blissett J, Frew E, Gill P, Griffith L, Hemming K, Jolly K, McGee E, Mulhern C, Parry J, Thompson JL, Adab P. Cultural adaptation of a children's weight management programme for Bangladeshi and Pakistani families in the UK: a cluster-randomised feasibility study protocol. Pilot Feasibility Stud 2016; 2:48. [PMID: 27965865 PMCID: PMC5154082 DOI: 10.1186/s40814-016-0089-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Group-based children's weight management programmes are widely available in the UK and evidence shows that these are effective in the short-term. No programmes have been specifically developed to meet the cultural requirements of UK minority ethnic communities. South Asian children are a high-risk group for obesity and its consequences; therefore, the study aim is to adapt an existing weight management programme for children aged 4-11 years and their families to ensure cultural relevance to Pakistani and Bangladeshi communities, and undertake a feasibility study of the adapted programme. METHODS/DESIGN Pakistani and Bangladeshi families of overweight children who have been offered the existing children's weight management programme in Birmingham, UK, will be invited to interviews and focus groups to explore their experiences and views of the programme. These data, together with existing literature and service provider information, will inform adaptation of the programme to be more culturally relevant to these families. The feasibility study will employ a cluster-randomised design, and will assess success of programme adaptation and feasibility of programme delivery. Planned programmes will be randomised to be delivered as the adapted programme (intervention) or the standard programme (comparator) with a 2:1 ratio. The primary outcome will be the proportion of Pakistani and Bangladeshi families completing the adapted programme. To assess recruitment, retention and data collection methods to inform a future trial, we aim to recruit 80 participants. A range of assessments will be undertaken with participants pre-, post- and 6-months post-intervention. DISCUSSION This study addresses the identified need to provide children's weight management programmes that are suitable for minority ethnic communities. Whilst the focus of the intervention adaptation is on Pakistani and Bangladeshi communities, the programme will be developed to be flexibly delivered to meet the cultural needs of communities of all ethnic compositions. The feasibility study will directly compare the adapted and existing weight management programmes, and will enable a comprehensive evaluation of the success of the adaptation. Essential information will also be gathered to inform the design and sample size calculation of a future trial to evaluate intervention effectiveness. TRIAL REGISTRATION ISRCTN81798055, registered: 13/05/2014.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Jacqueline Blissett
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Laura Griffith
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Eleanor McGee
- Birmingham Community Healthcare NHS Trust, St. Patrick's Centre, Frank St, Birmingham, B12 0YA UK
| | - Charlene Mulhern
- Birmingham Public Health, Birmingham City Council, 10 Woodcock St, Birmingham, B7 4BL UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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19
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Randall J, Slater M, Stewart A, Pugh G, Lewis K, Levy C, Alessandri-Gray P. The Effectiveness of Non-Surgical Weight Management Interventions for Obesity in the UK: A Review and Meta-Regression Analysis. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojmp.2014.33025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Mårild S, Gronowitz E, Forsell C, Dahlgren J, Friberg P. A controlled study of lifestyle treatment in primary care for children with obesity. Pediatr Obes 2013; 8:207-17. [PMID: 23172847 DOI: 10.1111/j.2047-6310.2012.00105.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 08/22/2012] [Accepted: 08/31/2012] [Indexed: 11/28/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Lifestyle intervention is the most common treatment strategy for children with obesity. Specialized units for the care of children with obesity report significant effects of lifestyle treatment. In children, the physical activity component in lifestyle treatment is often well accepted. WHAT THIS STUDY ADDS Two lifestyle treatment programmes in primary care for children with obesity both gave a reduction of body mass index significantly greater than the change observed in a non-intervention comparison group of children with obesity. Substituting one-third of nurse-led treatment sessions with sessions led by physiotherapists in one of the programmes did not improve the outcome. The efficacy of treatment in primary care seems to be comparable to that reported in the literature. OBJECTIVE To evaluate the efficacy of lifestyle treatment in primary care for children with obesity. METHODS In a multicentre study, sixty-four 9- to 13-year-old children with obesity were randomized to one of two 12-month lifestyle treatment programmes. The only difference between the programmes was that a physiotherapist substituted the nurse in one-third of the sessions in an attempt to stimulate physical activity. For comparison, children with normal weight and overweight, and an age-, sex- and body mass index-matched non-intervention group of children with obesity were used. RESULTS Anthropometry and laboratory data differed significantly between children with obesity and normal weight at baseline. The follow-up at the end of treatment was attended by 55 children with obesity, 28 and 27 in each treatment arm. The mean (standard deviation) body mass standard deviation score changed by -0.36 (0.3) in the arm involving a physiotherapist and by -0.33 (0.2) in the other arm. These outcomes were not significantly different. Both reductions were significantly greater than the change of -0.14 (0.3) observed in the non-intervention comparison group of children with obesity CONCLUSION The efficacy of treatment in primary care for children with obesity seems to be comparable to that reported in the literature. ISRCTN44919688.
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Affiliation(s)
- S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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21
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Moraes PM, Dias CMDSB. Nem só de pão se vive: a voz das mães na obesidade infantil. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2013. [DOI: 10.1590/s1414-98932013000100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A obesidade infantil tornou-se uma preocupação mundial e de saúde pública. Sabe-se que existem diversos fatores que predispõem à doença (biológicos, econômicos, pessoais, socioculturais e familiares), porém, nesta pesquisa, o objetivo geral foi compreender os elementos presentes na história familiar de crianças com obesidade. Participaram seis mães e uma avó de crianças, na faixa etária entre oito a dez anos incompletos, que se encontravam em atendimento em um ambulatório de referência para obesidade infantil. Foi utilizada uma entrevista com roteiro previamente estabelecido e, posteriormente, os resultados foram analisados com base na análise de conteúdo temática. Pode-se concluir que as famílias apresentaram falta de coesão acerca das normas alimentares e de limites à criança, conflitos conjugais e familiares e dificuldades em adequar o ambiente às recomendações solicitadas pelos profissionais.
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Ball GDC, Ambler KA, Keaschuk RA, Rosychuk RJ, Holt NL, Spence JC, Jetha MM, Sharma AM, Newton AS. Parents as agents of change (PAC) in pediatric weight management: the protocol for the PAC randomized clinical trial. BMC Pediatr 2012; 12:114. [PMID: 22866998 PMCID: PMC3469386 DOI: 10.1186/1471-2431-12-114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/25/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is an urgent need to develop and evaluate weight management interventions to address childhood obesity. Recent research suggests that interventions designed for parents exclusively, which have been named parents as agents of change (PAC) approaches, have yielded positive outcomes for managing pediatric obesity. To date, no research has combined a PAC intervention approach with cognitive behavioural therapy (CBT) to examine whether these combined elements enhance intervention effectiveness. This paper describes the protocol our team is using to examine two PAC-based interventions for pediatric weight management. We hypothesize that children with obesity whose parents complete a CBT-based PAC intervention will achieve greater reductions in adiposity and improvements in cardiometabolic risk factors, lifestyle behaviours, and psychosocial outcomes than children whose parents complete a psycho-education-based PAC intervention (PEP). METHODS/DESIGN This study is a pragmatic, two-armed, parallel, single-blinded, superiority, randomized clinical trial. The primary objective is to examine the differential effects of a CBT-based PAC vs PEP-based PAC intervention on children's BMI z-score (primary outcome). Secondary objectives are to assess intervention-mediated changes in cardiometabolic, lifestyle, and psychosocial variables in children and parents. Both interventions are similar in frequency of contact, session duration, group facilitation, lifestyle behaviour goals, and educational content. However, the interventions differ insofar as the CBT-based intervention incorporates theory-based concepts to help parents link their thoughts, feelings, and behaviours; these cognitive activities are enabled by group leaders who possess formal training in CBT. Mothers and fathers of children (8-12 years of age; BMI ≥85th percentile) are eligible to participate if they are proficient in English (written and spoken) and agree for at least one parent to attend group-based sessions on a weekly basis. Anthropometry, cardiometabolic risk factors, lifestyle behaviours, and psychosocial health of children and parents are assessed at pre-intervention, post-intervention, 6-, and 12-months follow-up. DISCUSSION This study is designed to extend findings from earlier efficacy studies and provide data on the effect of a CBT-based PAC intervention for managing pediatric obesity in a real-world, outpatient clinical setting. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01267097.
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Affiliation(s)
- Geoff D C Ball
- 8B, Pediatric Centre for Weight and Health, Edmonton General Continuing Care Centre, 11111 Jasper Ave, Edmonton, AB, CANADA, T5K0L4
| | - Kathryn A Ambler
- 8B, Pediatric Centre for Weight and Health, Edmonton General Continuing Care Centre, 11111 Jasper Ave, Edmonton, AB, CANADA, T5K0L4
| | - Rachel A Keaschuk
- Community Programs East, Alberta Health Services, Northgate Health Centre, Edmonton, AB, CANADA
| | - Rhonda J Rosychuk
- Edmonton Clinic Health Academy, Department of Pediatrics, University of Alberta, Rm 3-524, 11405 87 Avenue, Edmonton, AB, CANADA, T6G1C9
| | - Nicholas L Holt
- P3-20 S Van Vliet Centre, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, CANADA, T6G2H9
| | - John C Spence
- W1-16 H Van Vliet Centre, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, CANADA, T6G2H9
| | - Mary M Jetha
- 8B, Pediatric Centre for Weight and Health, Edmonton General Continuing Care Centre, 11111 Jasper Ave, Edmonton, AB, CANADA, T5K0L4
| | - Arya M Sharma
- 406 CSC Royal Alexandra Hospital, Edmonton, AB, CANADA, T5H3V9
| | - Amanda S Newton
- 3-526 Edmonton Clinic Health Academy, Department of Pediatrics, University of Alberta, 11405 87 Avenue, Edmonton, AB, CANADA, T6G1C9
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Gunnarsdottir T, Sigurdardottir ZG, Njardvik U, Olafsdottir AS, Bjarnason R. A randomized-controlled pilot study of Epstein’s family-based behavioural treatment for childhood obesity in a clinical setting in Iceland. NORDIC PSYCHOLOGY 2012. [DOI: 10.1027/1901-2276/a000024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gunnarsdottir T, Njardvik U, Olafsdottir AS, Craighead L, Bjarnason R. Childhood obesity and co-morbid problems: effects of Epstein's family-based behavioural treatment in an Icelandic sample. J Eval Clin Pract 2012; 18:465-72. [PMID: 21210895 DOI: 10.1111/j.1365-2753.2010.01603.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study assessed the effects of Epstein's family-based behavioural treatment in a clinical sample of obese children in Iceland. Also, it explored whether co-morbid concerns affect treatment outcome. METHODS Eighty-four obese children [mean body-mass-index standard-deviation-scores (BMI-SDS) = 3.11, aged 7.5-13.6 years] and a participating parent initiated treatment in response to a school-based screening. Sixty-one families completed treatment and were followed for 1 year post treatment. Measurements included height, weight, reports of psychological well-being (Strengths and Difficulties Questionnaire, Multidimensional Anxiety Scale for Children, Children's Depression Inventory, Piers-Harris Self Concept Scale, Social Skills Rating System) and academic competencies. RESULTS Among treatment completers a large effect size was obtained for change in BMI-SDS during treatment (mean difference = -0.40, SD = 0.29). Psychological well-being improved and treatment effects were maintained at 1-year follow-up. At baseline, 69% of the children presented with one or more co-morbid concerns. Children who scored above cut-off for concern on parent-reported hyperactivity (Strengths and Difficulties Questionnaire subscale T-score ≥ 65) reduced their BMI-SDS less during treatment than children with lower hyperactivity scores whereas children who scored in the clinical range for social anxiety (Multidimensional Anxiety Scale for Children subscale T-score ≥ 65) reduced their BMI-SDS significantly more than children with lower social anxiety scores. The social anxiety effect was still present at 1-year follow-up, but not the hyperactivity effect (P > 0.05). No differential response was shown for children with higher depression scores, lower self-concept or low academic competencies. CONCLUSIONS Epstein's family-based behavioural treatment produced promising effects in both the short and the longer term in a clinical sample of Icelandic children with substantial rates of co-morbid concerns. Co-morbid problems affect outcome and tailoring treatment to address co-morbid concerns might improve outcomes for certain subgroups.
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Croker H, Cooke L, Wardle J. Appetitive behaviours of children attending obesity treatment. Appetite 2011; 57:525-9. [DOI: 10.1016/j.appet.2011.05.320] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/19/2011] [Accepted: 05/22/2011] [Indexed: 10/18/2022]
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Croker H, Viner RM, Nicholls D, Haroun D, Chadwick P, Edwards C, Wells JCK, Wardle J. Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial. Int J Obes (Lond) 2011; 36:16-26. [PMID: 21931327 PMCID: PMC3272466 DOI: 10.1038/ijo.2011.182] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The best outcomes for treating childhood obesity have come from comprehensive family-based programmes. However there are questions over their generalisability. Objective To examine the acceptability and effectiveness of ‘family-based behavioural treatment’ (FBBT) for childhood obesity in an ethnically and socially diverse sample of families in a UK National Health Service (NHS) setting. Methods In this parallel group, randomised controlled trial, 72 obese children were randomised to FBBT or waiting list control. Primary outcomes were body mass index (BMI) and BMI standard deviation scores (SDS). Secondary outcomes were weight, weight SDS, height, height SDS, waist, waist SDS, fat mass index, fat free mass index, blood pressure, and psychosocial measures. Outcomes were assessed at baseline and post-treatment, with analyses on the 6 month data done on an intent-to-treat (ITT) basis. Follow-up anthropometric data were collected at twelve months for the treatment group. Results ITT analyses included all children with baseline data (n=60). There were significant BMI SDS changes (p<0.01) for the treatment and control groups of −0.11 (0.16) and −0.10 (1.6). The treatment group showed a significant reduction in systolic blood pressure (−0.24 (0.7), p<0.05) and improvements in quality of life and eating attitudes (p<0.05), with no significant changes for the control group. However the between-group treatment effects for BMI, body composition, blood pressure and psychosocial outcomes were not significant. There was no overall change in BMI or BMI SDS from 0-12 months for the treatment group. No adverse effects were reported. Conclusions Both treatment and control groups experienced significant reductions in level of overweight, but with no significant difference between them. There were no significant group differences for any of the secondary outcomes.
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Affiliation(s)
- H Croker
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK.
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Rosnov DL, Roberts MC, Kessler ED, Pendley JS, Datto G, Hassink S. Acceptability of Weight-Loss Interventions Among Adolescents Who Are Overweight and Their Caregivers. CHILDRENS HEALTH CARE 2011. [DOI: 10.1080/02739615.2011.590386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Watson PM, Dugdill L, Pickering K, Bostock S, Hargreaves J, Staniford L, Cable NT. A whole family approach to childhood obesity management (GOALS): Relationship between adult and child BMI change. Ann Hum Biol 2011; 38:445-52. [DOI: 10.3109/03014460.2011.590531] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Paula M. Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lindsey Dugdill
- College of Health and Social Care, University of Salford, Salford, UK
| | - Katie Pickering
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Stephanie Bostock
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jackie Hargreaves
- Physical Activity, Sport and Exercise Sciences, Leeds Metropolitan University, Leeds, UK
| | - Leanne Staniford
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Nigel T. Cable
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Murdoch M, Payne N, Samani-Radia D, Rosen-Webb J, Walker L, Howe M, Lewis P. Family-based behavioural management of childhood obesity: service evaluation of a group programme run in a community setting in the United Kingdom. Eur J Clin Nutr 2011; 65:764-7. [PMID: 21427740 DOI: 10.1038/ejcn.2011.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A service evaluation of a pilot of a family-based behavioural management group programme for childhood obesity was conducted in a community setting in the United Kingdom. A total of 17 families with children aged 7.5-14 years completed the programme, which was delivered in 15 sessions over 6 months. Behavioural and psychological measures and age- and sex-adjusted z-body mass index (BMI) were assessed before and after programme. z-BMI was maintained. There was a significant increase in the amount of high-fibre foods and a decrease in the amount of low-fibre foods consumed and in sedentary behaviours. There were significant decreases in depression, abnormal dieting behaviour and bulimia and food preoccupation, and an increase in self-worth related to physical appearance. These positive behavioural and psychological changes suggest that this is a promising programme.
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Affiliation(s)
- M Murdoch
- Public Health, NHS Islington, London, UK
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Nowicka P, Flodmark CE. Family therapy as a model for treating childhood obesity: useful tools for clinicians. Clin Child Psychol Psychiatry 2011; 16:129-45. [PMID: 20650975 DOI: 10.1177/1359104509355020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than 15 percent of children in Europe are overweight; another 5 percent are obese. The high prevalence of obesity emphasizes the necessity of developing evidence-based treatment programs that are useful in a clinical setting. Management of childhood obesity is commonly based on lifestyle interventions where nutrition, physical activity, and behavior modification are the main targets. To incorporate lifestyle interventions, many childhood obesity treatment models use different psychological models, such as behavior modification or cognitive behavior therapy. This paper presents the key lessons from a research program on an empirically supported family-therapy-based treatment, Standardized Obesity Family Therapy (SOFT). SOFT is based on systemic and solution-focused theories and has shown positive effects on the child with respect to degree of obesity, physical fitness, self-esteem, and family functioning in several studies. The distinguishing features of SOFT are the focus on family interactions as an important source for implementing and maintaining lifestyle changes, the multidisciplinary team approach, and a limited number of sessions (three to four per year). The main aim of this paper is to provide tools for clinicians in the field of obesity who work with families, alone or in a multidisciplinary team.
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Affiliation(s)
- Paulina Nowicka
- Childhood Obesity Unit, Skåne University Hospital and Department of Pediatrics, Lund University, Malmö, Sweden.
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Haroun D, Croker H, Viner RM, Williams JE, Darch TS, Fewtrell MS, Eaton S, Wells JCK. Validation of BIA in obese children and adolescents and re-evaluation in a longitudinal study. Obesity (Silver Spring) 2009; 17:2245-50. [PMID: 19373222 DOI: 10.1038/oby.2009.98] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Decrease in fat mass (FM) is a one of the aims of pediatric obesity treatment; however, measurement techniques suitable for routine clinical assessment are lacking. The objective of this study was to validate whole-body bioelectrical impedance analysis (BIA; TANITA BC-418MA) against the three-component (3C) model of body composition in obese children and adolescents, and to test the accuracy of our new equations in an independent sample studied longitudinally. A total of 77 white obese subjects (30 males) aged 5-22 years, BMI-standard deviation score (SDS) 1.6-3.9, had measurements of weight, height (HT), body volume, total body water (TBW), and impedance (Z). FM and fat-free mass (FFM) were calculated using the 3C model or predicted from TANITA. FFM was predicted from HT(2)/Z. This equation was then evaluated in 17 other obese children (5 males) aged 9-13 years. Compared to the 3C model, TANITA manufacturer's equations overestimated FFM by 2.7 kg (P < 0.001). We derived a new equation: FFM = -2.211 + 1.115 (HT(2)/Z), with r(2) of 0.96, standard error of the estimate 2.3 kg. Use of this equation in the independent sample showed no significant bias in FM or FFM (mean bias 0.5 +/- 2.4 kg; P = 0.4), and no significant bias in change in FM or FFM (mean bias 0.2 +/- 1.8 kg; P = 0.7), accounting for 58% (P < 0.001) and 55% (P = 0.001) of the change in FM and FFM, respectively. Our derived BIA equation, shown to be reliable for longitudinal assessment in white obese children, will aid routine clinical monitoring of body composition in this population.
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Affiliation(s)
- Dalia Haroun
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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Family involvement in the treatment of childhood obesity: the Copenhagen approach. Eur J Pediatr 2009; 168:1437-47. [PMID: 19234719 DOI: 10.1007/s00431-009-0944-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 02/04/2009] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The objective of this study was to assess the impacts of a family-based childhood obesity treatment on anthropometry and predictors of dropout and successful weight loss. MATERIALS AND METHODS The 18-month treatment consisted of a intensive period (IP) including physical exercise, nutritional guidance, family psychotherapy, child group sessions and a 1-year follow-up (FU). RESULTS One hundred children (10-12 years old, >140% of median weight-for-height) participated. The 81 children completing the IP decreased significantly from 2.9 to 2.6 body mass index (BMI) standard deviation score (SDS) units (p < 0.001). Furthermore, mean body fat percentage decreased significantly from 33.7 to 31.9 during IP. The 49 children completing the FU had a further decrease of 0.2 BMI SDS units (p = 0.003). Weight loss was less in children from immigrant families. Drop-out was higher if the mother had limited education and in immigrant families. CONCLUSIONS This treatment with a psychological approach is feasible and results in significant weight loss during the programme. Future research should focus on how to improve the results of families with limited education and immigrants with non-European origin.
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Stewart L, Reilly JJ, Hughes AR. Evidence-based behavioral treatment of obesity in children and adolescents. Child Adolesc Psychiatr Clin N Am 2009; 18:189-98. [PMID: 19014866 DOI: 10.1016/j.chc.2008.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity is the most common childhood disease and is widely acknowledged as having become a global epidemic. Well-recognized health consequences of childhood obesity exist, both during childhood and adulthood, affecting health and psychological and economic welfare. The importance of finding effective strategies for the management of childhood obesity has international significance with the publication of various expert reports and evidence-based guidelines in recent years.
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Affiliation(s)
- Laura Stewart
- The Children's Weight Clinic PO Box 28533, Edinburgh EH4 2WW, Scotland, UK
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Raynor HA, Osterholt KM, Hart CN, Jelalian E, Vivier P, Wing RR. Evaluation of active and passive recruitment methods used in randomized controlled trials targeting pediatric obesity. INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY : IJPO : AN OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF OBESITY 2009; 4:224-32. [PMID: 19922036 PMCID: PMC4828141 DOI: 10.3109/17477160802596189] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluate enrollment numbers, randomization rates, costs, and cost-effectiveness of active versus passive recruitment methods for parent-child dyads into two pediatric obesity intervention trials. METHODS Recruitment methods were categorized into active (pediatrician referral and targeted mailings, with participants identified by researcher/health care provider) versus passive methods (newspaper, bus, internet, television, and earning statements; fairs/community centers/schools; and word of mouth; with participants self-identified). Numbers of enrolled and randomized families and costs/recruitment method were monitored throughout the 22-month recruitment period. Costs (in USD) per recruitment method included staff time, mileage, and targeted costs of each method. RESULTS A total of 940 families were referred or made contact, with 164 families randomized (child: 7.2+/-1.6 years, 2.27+/-0.61 standardized body mass index [zBMI], 86.6% obese, 61.7% female, 83.5% Caucasian; parent: 38.0+/-5.8 years, 32.9+/-8.4 BMI, 55.2% obese, 92.7% female, 89.6% caucasian). Pediatrician referral, followed by targeted mailings, produced the largest number of enrolled and randomized families (both methods combined producing 87.2% of randomized families). Passive recruitment methods yielded better retention from enrollment to randomization (p<0.05), but produced few families (21 in total). Approximately $91,000 was spent on recruitment, with cost per randomized family at $554.77. Pediatrician referral was the most cost-effective method, $145.95/randomized family, but yielded only 91 randomized families over 22-months of continuous recruitment. CONCLUSION Pediatrician referral and targeted mailings, which are active recruitment methods, were the most successful strategies. However, recruitment demanded significant resources. Successful recruitment for pediatric trials should use several strategies. CLINICAL TRIALS REGISTRATION NCT00259324, NCT00200265.
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Affiliation(s)
- Hollie A Raynor
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Larnkjaer A, Høj AR, Bendtsen KM, Mølgaard C, Michaelsen KF. Weight loss and the effect on stature in children during a residential intervention program. Obesity (Silver Spring) 2008; 16:2652-7. [PMID: 18927551 DOI: 10.1038/oby.2008.436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Weight loss is generally high in residential weight-loss programs but the effect of a large weight loss on linear growth is not known. We report the weight loss and the influence on linear growth in a large group of children during a residential weight-loss program focusing on nutrition and physical activity. In a longitudinal noncontrolled intervention study of 990 overweight children (540 girls) attending the weight reduction program from 1990 to 2001 for about 11 weeks (age: 10-14 years, mean BMI-standard deviation score (SDS) at enrollment: 2.83) weight and height were measured initially and after end of treatment. Weekly measurements of height and weight were performed on 138 children. The children lost on average 9.4 kg, reduced their BMI by 4.5 kg/m(2) and BMI-SDS by 0.98. In a multiple regression analysis (P < or = 0.001) weight loss was higher in boys than girls (1.7 kg), higher if the weight was higher at admission (-0.192 kg/kg at baseline) and was positively associated with duration of stay (-80 g/day). Initially the boys' BMI-SDS was higher than the girls' BMI-SDS (P < or = 0.05) but after 8 weeks of treatment the boys had lower BMI-SDS than the girls. There was no negative effect on linear growth during the treatment; on the contrary, linear growth accelerated during the stay as the average increase in height was 2.38 cm corresponding to 11.4 cm/year. In conclusion the children lost close to 1 kg/week during the stay without any negative effect on linear growth. The cause of the linear growth acceleration needs further investigation.
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Affiliation(s)
- Anni Larnkjaer
- Department of Human Nutrition, Centre for Advanced Food Studies, Faculty of Life Sciences, University of Copenhagen, Frederiksberg C, Denmark.
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Laroche HH, Davis MM, Forman J, Palmisano G, Heisler M. What about the children? The experience of families involved in an adult-focused diabetes intervention. Public Health Nutr 2007; 11:427-36. [PMID: 17686202 DOI: 10.1017/s1368980007000791] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Among adults with diabetes attempting to change their own diets, we explored how these adults approached providing food for their children and how their children reacted to dietary changes in the household. DESIGN The research design used semi-structured parallel individual interviews of adults and a child (aged 10-17 years) in their home. Interviews were audio-taped, transcribed, coded and analysed for themes. SUBJECTS Subjects included families in which one inner-city African American or Latino adult with diabetes had completed a diabetes intervention promoting healthy dietary behaviours. RESULTS We completed 29 interviews (14 adult-child pairs and one child). Adults approached making dietary changes for themselves and also providing food for their family in different ways, ranging from expecting everyone to eat the same thing to preparing two separate meals. Many children resisted dietary changes while fewer acquiesced. Among children who went along with changes, some reported resisting initially then adjusting, while others did not resist because the food still tasted good or they could obtain preferred foods outside the house. The intersection of adults' meal strategies and children's reactions to the changes can be used to categorise families into different patterns. These patterns highlight the tension between an adult who must make dietary changes to control diabetes and a child who is not necessarily motivated to change. CONCLUSION From this framework we suggest hypotheses about how these patterns might influence dietary behaviour in adults and children. Understanding these patterns could guide interventions to assist parents in successfully including children in their dietary changes.
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Affiliation(s)
- Helena H Laroche
- Division of General Medicine, Department of Internal Medicine, University of Iowa, VA Medical Center mailstop 152, Iowa City, IA 52246, USA.
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Lowry KW, Sallinen BJ, Janicke DM. The Effects of Weight Management Programs on Self-Esteem in Pediatric Overweight Populations. J Pediatr Psychol 2007; 32:1179-95. [PMID: 17584780 DOI: 10.1093/jpepsy/jsm048] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Review published findings on self-esteem and pediatric overweight, and changes in self-esteem subsequent to weight management programs. METHODS We used PsycInfo and MedLine searches to identify peer-reviewed journal articles examining self-esteem changes following participation in weight management programs. RESULTS Data regarding the relationship between self-esteem and obesity is mixed. Factors that place overweight children "at-risk" for low self-esteem include early adolescence, female gender, identification with majority cultural standards of body shape, exposure to teasing and peer victimization, a history of greater parental control over feeding, and internal attributions about weight status. Data from intervention studies suggest positive effects on self-esteem across settings. Components related to self-esteem improvements include weight change, parent involvement, and group intervention format. CONCLUSIONS Well-designed, longitudinal studies using multidimensional measures of self-esteem, and following CONSORT guidelines are needed to confirm and expand these findings. Emphasis should be placed on examining mediators and moderators of self-esteem change.
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Affiliation(s)
- Kelly Walker Lowry
- Department of Clinical and Health Psychology, University of Florida, 101 South Newell Dr., Room #3151, Gainesville, FL 32610, USA
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Abstract
Global increases in childhood obesity rates demand that we tackle the problem from many directions. One promising avenue is to explore the impact of parental feeding practices, particularly those related to parental control over children's intake. In this paper, we review studies of parent feeding and child adiposity covering a range of research methodologies (case-control studies, high risk studies, cross-sectional community studies and longitudinal cohort studies). We also present results from a cross-sectional community study of pre-schoolers (n = 439) and a longitudinal study of twins from ages of 4 to 7 years (n = 3175 pairs). We conclude that parents are more likely to encourage leaner than heavier children to eat, but relationships between adiposity and other parental feeding strategies are unclear. We suggest that future research should: (i) explore the impact of a comprehensive range of authoritative and authoritarian parental feeding behaviours, preferably using the same validated scales consistently across studies; (ii) test the generalisation of existing findings to diverse socio-economic and ethnic groups and (iii) utilise experimental, prospective and genetic methodologies to explore the causal relationships between parental feeding and child weight. We describe current projects in our own group that are designed to take forward these recommendations.
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Affiliation(s)
- Jane Wardle
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, UK.
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