Psychological profile to become and to stay obese

"Sacbe", a Comprehensive Intervention to Decrease Body Mass Index in Children with Adiposity: A Pilot Study

Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21⁻23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and their parents. Our objective was to achieve a higher percentage of success in lowering the BMI z-score in children with adiposity and their parents through a pilot program "Sacbe" based on HLS, sensitive to the sociocultural context previously explored and with the active participation of parents. This is a pilot study in children aged 8 to 18 years with adiposity according to the BMI z-score. The program consisted of two workshops on HLS and nutrition given by the pediatric endocrinologist in group sessions with 3⁻5 families and reinforcements in each visit by registered dietitians. We recorded lifestyle habits and anthropometric characteristics of children and their parents at the baseline visit and every month for 3⁻4 months. Forty-nine families, 55 children and 64 parents participated, 60% of the children were female, the average age was 13.95 ± 3.3 years, 72.7% and 86.7% lowered the z score of the BMI due to intention to treat and protocol analysis (p < 0.001), respectively; BMI z-score decreased by 0.22 ± 0.21, from 2.13 ± 0.57 to 1.91 ± 0.58 (p < 0.001). In total, 83% of the parents involved were mothers, the average age was 45.8 ± 9.4 years, 77% lost weight and body fat (p < 0.001), the frequency of unhealthy habits decreased. The results of "Sacbe" exceeded expectations by combining the active participation of parents, sessions in groups, and the education on various components of an HLS inside sociocultural context. The main challenge will be to standardize and reproduce this type of complex interventions, as well as to assure long-term success.

[What are the determinants of childhood obesity? : A literature review as part of the project "Nationwide Monitoring of Childhood Obesity Determinants"]

BACKGROUND

Obesity can impair health even in childhood and unfold negative health consequences through an individual's lifespan. In Germany, to date, a systematic and periodically updated synopsis of the multifaceted determinants of childhood obesity is lacking. In this paper, we present the results of a systematic literature review on childhood obesity determinants, which was conducted over the course of the implementation of nationwide monitoring.

METHODS

The review was carried out in three steps. Initially, a search for etiological models of childhood obesity was conducted. Based on these results, a systematic review of reviews on childhood obesity determinants was carried out. Finally, the results were verified by taking international guidelines on childhood obesity into account.

RESULTS

In total, 21 etiological models, 75 reviews and 7 guidelines were identified. Over 60 determinants were extracted from these publications and were summarized into the following categories: nutritional behavior, physical activity behavior, sleeping pattern, biological determinants and diseases, prenatal and early childhood determinants, psycho-social determinants, food environment, moveability/walkability, setting and social environment, health promotion and prevention, socioeconomic, demographic, and sociocultural determinants.

CONCLUSION

This review demonstrates the complex patterns of childhood obesity determinants in correspondence with a socio-ecological approach. The review will form the basis for the monitoring-system "Nationwide Monitoring of Childhood Obesity Determinants", which will be implemented at the Robert Koch Institute by the end of 2017.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Barriers to lose weight from the perspective of children with overweight/obesity and their parents: a sociocultural approach

INTRODUCTION

There are not enough studies about the barriers to lose weight from the perspective of children and their parents.

METHODS

Children and adolescents diagnosed with overweight/obesity in the Department of Endocrinology and their parents were invited to participate in a series of focus group discussions (FGD). Twenty-nine children 10-16 years old and 22 parents participated in 7 focus groups; 2 mothers and 2 adolescents participated in depth interviews. All interviews were recorded, transcribed, and analyzed through grounded theory.

RESULTS

Parents went to the hospital only when their children presented any obesity complication; for them, overweight was not a health problem. Parents referred to lack of time to supervise about a healthy diet and exercise; besides, the same parents, relatives, friends, and the mass media encourage the consumption of junk food. Children accepted eating a lot, not doing exercise, skipping meals, and not understanding overweight consequences. Both, parents and children, demanded support to do the time recommended for exercise inside the schools. They also suggested getting information from schools and mass media (TV) about overweight consequences, exercise, and healthy food by health workers; they recommended prohibiting announcements about junk food and its sale.

CONCLUSIONS

The barriers detected were lack of perception of being overweight, its identification as a disease and its consequences, lack of time to supervise a healthy lifestyle, and a big social influence to eat junk food.

The development and effectiveness of a health information website designed to improve parents' self-efficacy in managing risk for obesity in preschoolers

PURPOSE

To evaluate the effects of web-based information on parental self-efficacy in managing obesity risk in preschoolers.

DESIGN AND METHODS

The project included a literature review and the development and field testing of an information website that presented information on how to manage nine obesity risk factors for childhood obesity.

RESULTS

Parents stated that they had no problems using the website, and 69% reported improved self-efficacy on at least two risk factors.

PRACTICE IMPLICATIONS

Many parents access the Internet to obtain health information. A website that offers practical information on managing childhood obesity risk factors is a valuable resource for obesity prevention efforts.

Children and eating. Personality and gender are associated with obesogenic food consumption and overweight in 6- to 12-year-olds

The role of children's personality traits in the consumption of potentially obesogenic foods was investigated in a sample of Norwegian children aged 6-12 years (N=327, 170 boys, 157 girls). Mothers rated their child's personality on the traits of the Five Factor Model (i.e., extraversion, benevolence, conscientiousness, neuroticism, and imagination). Mothers also completed a food frequency questionnaire assessing their child's consumption of sweet drinks, sweet foods, and fruit and vegetables, and reported their child's height and weight. Controlling for age and mothers' education, boys and girls who were less benevolent consumed more sweet drinks, and girls who were less conscientious and more neurotic consumed more sweet drinks. Boys and girls who were more benevolent and imaginative consumed more fruits and vegetables, and boys who were more extraverted, more conscientious, and less neurotic consumed more fruits and vegetables. Controlling for maternal education, boys and girls who were less extraverted, and girls who were less benevolent, less conscientious, and more neurotic were more likely to be overweight or obese. These findings suggest that children's personality traits play an important yet understudied role in their diet. Further investigation of mechanisms that relate child traits to obesogenic eating and overweight would be valuable.

Bariatric surgery: a primer for eating disorder professionals

Obesity is a public health epidemic with medical, psychological and economic consequences. It continues to increase globally in prevalence and severity. Despite numerous behaviourally, medically or pharmacologically guided treatments, an effective non-surgical long-term treatment approach has not been identified. Bariatric surgery has surfaced as a viable option for a subset of individuals with medically complicated obesity who have failed non-surgical approaches. Pre-operative evaluation followed by post-operative, longitudinal follow-up by a multidisciplinary team specializing in surgery, medicine, psychiatry/psychology, exercise science and nutrition constitutes recognized and necessary standard of care for these complex patients. More information is needed regarding factors that interfere with successful outcomes and mechanisms of optimal follow-up for bariatric surgery patients to prevent and detect post-operative medical, psychological and social difficulties. We will review these issues with a focus on issues relevant to eating disorders professionals.

Exploratory evaluation of an obese population seeking bariatric surgery in an Italian public service

Obesity is a difficult to treat multi-problematic disease. Bariatric surgery (BS) has been regarded as the most effective therapeutic option, however the outcomes strongly depend on baseline conditions and further behavioural modifications. Our aim was to assess the characteristics of severely obese patients seeking BS in a Public Health Service in Italy. Socio-demographic characteristics, eating habits and the presence of stressful situations associated to weight increase, as well as psychiatric disorders of 111 outpatients attending our BS Program were assessed. Twenty-seven percent of patients have familiar history of obesity (FHO). Differences between patients having or not having a FHO were found for several psychiatric conditions, including lower Bulimic symptoms (p=0.025) and lower use of Alcohol (p=0.045). A total of 28.8% of the participants reported a BED; those patients do not differ in BMI (p=0.437) from non-BED patients but had higher psychological disorders associated to eating disorder, as for example Bulimic symptoms (p=0.000), higher BES scores (p=0.000) and psychological distress, such as Depression (p=0.000). Nearly 50% of patients had any psychiatric disorders and depression was the most common disturbance (32.4%); anxiety disorder was present in 15.3% of patients. Moreover, patients who have disclosed traumatic episodes (11.7%) presented higher distress associated to eating disorder variables, such as BES (p=0.001) and EDI-2 BU scores (p=0.000) and presence of BED (p=0.001), and women are more likely to be in this group (p=0.043). Our report proposes that multiple causative factors play a role in obesity, and we need to take them all into account to plan a comprehensive pre- and post-surgical treatment plan.

Social implications of overweight and obesity in children

PURPOSE

To elucidate some of the social impacts that overweight and obesity in children has on families. Healthcare practitioners may be unaware of these impacts if not similarly affected.

DESIGN

Qualitative semistructured, interview-based study.

METHODS

A purposive sample of parents (n = 58) with overweight and obese children (n = 48) from three areas in the United Kingdom was used. Analysis was thematic and iterative, underpinned by Grounded Theory.

RESULTS

There are many social situations that have an impact on the child directly (stigmatization), on parents (blame), and on the family in general (being ostracized).

PRACTICE IMPLICATIONS

Seeing the child and his/her family in a broader context with improved understanding of the complexity of raising an overweight child.

Association between family divorce and children's BMI and meal patterns: the GENDAI Study

The aim of this work was to explore the associations between family factors, including divorce, and children's overweight as well as eating and physical activity patterns in a population-based sample of healthy school-aged children. In this cross-sectional study, 1,138 children (53% girls; age: 11.2 +/- 0.7 years) from elementary schools in the Attica region participated. Their parents provided sociodemographic information, including their marital status. Overweight status classification was based on weight and height measurements and BMI evaluation. Children completed a physical activity checklist and a questionnaire on meal patterns and eating behaviors. The Eating Style score was calculated: the higher the score, the more frequent a child was engaged in less-structured feeding practices promoting food intake for reasons other than hunger. Analysis revealed significant association between family divorce and children's overweight: compared with children of married parents, those of divorced had significantly higher BMI levels (20.0 +/- 3.6 kg/m(2) vs. 21.3 +/- 3.4 kg/m(2), respectively, P = 0.007). Controlling for socioeconomic and physical activity factors, divorce remains a significant predictor of a higher BMI, along with older age, higher father's and mother's BMI, less children in the family, and more minutes of daily screen time. Children who had experienced a divorce in their family also reported higher Eating Style score, even after adjusting for potential confounders. In conclusion, in this sample of fifth and sixth graders, unfavorable family circumstances have been associated with children's overweight, as well as with aspects of their eating behavior, namely eating style in relation to conditions around food consumption and hunger, independent of other socioeconomic factors.

The role of implicit attitudes towards food and physical activity in the treatment of youth obesity

This study investigated whether implicit and self-reported food and exercise attitudes changed during a residential six month treatment period in youngsters with obesity (n=19). Moreover, it was examined whether this attitudinal change explained their decrease in overweight during the program and at a one year follow up. Two Extrinsic Affective Simon Tasks (EAST) were conducted to investigate implicit attitudes towards exercise and food, respectively. Self-reported attitudes were assessed using a questionnaire. The results revealed that the obese youngsters lost weight during the treatment, that was not regained at follow up. Mean self-reported and implicit attitudes did not change markedly. Moreover, changes in self-reported attitudes were not predictive for decrease in overweight during and after the treatment. In contrast, some small effects were found for the change in implicit attitudes towards food and exercise. Several possible explanations are discussed.

From birth to adolescence: Vienna 2005 European Childhood Obesity Group International Workshop

BACKGROUND

In the last 15 y there has been a tremendous increase in the number of studies on pediatric obesity looking at epidemiology, health-related risks, etiology, methodology and treatment. During the early 1990s, the European Childhood Obesity Group (ECOG) was born as a group of scientists' expert in the field of pediatric obesity. ECOG this year celebrates the approach to early maturity with an excited and omni-comprehensive program developing through eight different tracks.

METHODS

Comments on different 'key' papers in each of the eight tracks.

RESULTS

The eight tracks were (1) Nutrition requirements and food habits, (2) physical activity, (3) prevention and political actions/strategies, (4) diabetes, (5) metabolism, (6) psychology, (7) pathology, and (8) treatment with emphasis on drugs.

CONCLUSION

Looking at the overall picture of the ECOG workshop we could conclude that despite the fact that childhood obesity is a crisis facing worldwide youth, it is necessary that action to control it must be taken now. All the six relevant levels (ie, family, schools, health professionals, government, industry and media) could be involved in prevention of child and adolescent obesity.