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Skelton JA, Vitolins M, Pratt KJ, DeWitt LH, Eagleton SG, Brown C. Rethinking family-based obesity treatment. Clin Obes 2023; 13:e12614. [PMID: 37532265 DOI: 10.1111/cob.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
Emerging research in paediatric obesity has demonstrated that parental involvement in the weight management process can improve weight outcomes in children. Recent guidelines by the American Academy of Pediatrics note the importance of parent and family involvement in treatment. However, it is currently unknown if including the entire family in obesity treatment can supersede outcomes associated with participation of only one parent. Family Systems Theory (FST) provides the theoretical foundation for examining one's healthy behaviours as they exist within the context of their family, defined by family dynamics. This narrative review aims to reconsider prior definitions of paediatric family-based management using the FST framework to be inclusive of family and household diversity and in doing so, inform research not only within weight management but also other domains of clinical care requiring family support or change. Applying FST to paediatric weight management highlights the link between family dynamics and paediatric obesity, demonstrating the association of dysfunctional family dynamics with more severe obesity. While family-based weight management remains the gold standard for treatment of paediatric obesity, more investigation is needed in expanding family-based interventions to impact entire families and potentially improve outcomes more broadly for overall family health and wellbeing.
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mara Vitolins
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development & Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sally G Eagleton
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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2
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Meek CL. An unwelcome inheritance: childhood obesity after diabetes in pregnancy. Diabetologia 2023; 66:1961-1970. [PMID: 37442824 PMCID: PMC10541526 DOI: 10.1007/s00125-023-05965-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023]
Abstract
Diabetes in pregnancy affects 20 million women per year and is associated with increased risk of obesity in offspring, leading to insulin resistance and cardiometabolic disease. Despite the substantial public health ramifications, relatively little is known about the pathophysiological mechanisms underlying obesity in these high-risk children, which creates a barrier to successful intervention. While maternal glucose itself is undeniably a major stimulus upon intrauterine growth, the degree of offspring hyperinsulinism and disturbed lipid metabolism in mothers and offspring are also likely to be implicated in the disease process. The aim of this review is to summarise current understanding of the pathophysiology of childhood obesity after intrauterine exposure to maternal hyperglycaemia and to highlight possible opportunities for intervention. I present here a new unified hypothesis for the pathophysiology of childhood obesity in infants born to mothers with diabetes, which involves self-perpetuating twin cycles of pancreatic beta cell hyperfunction and altered lipid metabolism, both acutely and chronically upregulated by intrauterine exposure to maternal hyperglycaemia.
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Affiliation(s)
- Claire L Meek
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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3
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Ahadi Z, Kelishadi R, Qorbani M, Zahedi H, Motlagh ME, Ardalan G, Shafiee G, Asayesh H, Larijani B, Heshmat R. Association between meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents. Minerva Pediatr (Torino) 2023; 75:39-48. [PMID: 27471819 DOI: 10.23736/s2724-5276.16.04525-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND This study aimed to assess the association of meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents. METHODS In this national survey, 14,880 students with 6-18 years of age were selected by stratified multistage sampling method from urban and rural regions of 30 provinces of Iran. Meal frequency was assessed by a questionnaire prepared based on global school-based student health survey. Physical measurements included height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP). RESULTS The participation rate was 90.6% including 49.24% girls and 75.5% urban residents. Skipping breakfast and dinner were more frequent in girls than in boys (71.6% vs. 64.1%, 91.2% vs. 86.9%, respectively, P<0.05). Overweight, obesity, and abdominal obesity were more prevalent in those who had two meals, one meal, or very low intake (P<0.001) than those had three meals. There were no significant differences in SBP, DBP, and blood pressure across to different meal frequency groups (P>0.05). Students who had very low intake and one meal per week had a higher risk of abdominal obesity compared with those who had three meals (OR 1.7, 95% CI: 1.3-2.3, and OR 1.6, 95% CI: 1.4-2.0, respectively). CONCLUSIONS An inverse significant association between higher meal frequency and anthropometric indices was observed. Therefore, encouraging children and adolescents for regular meal intake should be considered as a health priority in the pediatric population.
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Affiliation(s)
- Zeinab Ahadi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Hoda Zahedi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad E Motlagh
- Department of Pediatrics, Ahvaz University of Medical Sciences, Ahvaz, Iran
| | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran -
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4
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Chang JJ, Xu N, Song LL, Li YH, Yuan MY, Zhang TT, He Y, Chen SS, Wang GF, Su PY. Association between the dietary literacy of children's daily diet providers and school-age children's nutritional status and eating behaviours: a cross-sectional study. BMC Public Health 2022; 22:2286. [PMID: 36474189 PMCID: PMC9727954 DOI: 10.1186/s12889-022-14621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Overweight and obesity rates have increased rapidly in Chinese school-age children, and previous studies have indicated that poor dietary literacy can lead to unhealthy eating behaviours. However, few studies have investigated the association between the dietary literacy of daily diet providers and the eating behaviours and nutritional status of school-age children raised by the providers. Thus, we aimed to explore this association. METHODS We collected data on the eating behaviours and nutritional status of children in two primary schools in Anhui Province, as well as the dietary literacy of their daily diet providers. T-tests, one-way ANOVA, chi-square tests, and multiple linear regression were used to analyse the association. RESULTS We found significant differences in the scores on the Questionnaire of Children's Daily Diet Providers' Dietary Literacy (QCDDPDL) by region, relationship with the child, age, and educational level of the daily diet provider (all p < .05). Moreover, the children in the low QCDDPDL score group were inclined to engage in unhealthy eating behaviours such as emotional undereating and overeating (p < .05). In addition, the incidence of overweight and obesity was higher in the low QCDDPDL attitude score group than in the high score group (p = .006). CONCLUSIONS Our study showed that the dietary literacy of diet providers may influence children's health and eating behaviours. Improving the dietary literacy of diet providers may promote the health status and eating behaviours of school-age children.
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Affiliation(s)
- Jun-Jie Chang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Nuo Xu
- Maternal and Child Health Care and Family Planning Service Center Wujiang District of Suzhou City, No.551 Gaoxin Road, Jiangsu, 215200 China
| | - Ling-Ling Song
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Yong-Han Li
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Meng-Yuan Yuan
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Ting-Ting Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Yang He
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Shan-Shan Chen
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Geng-Fu Wang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
| | - Pu-Yu Su
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Anhui, 230032 China
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Röszer T. Metabolic impact of adipose tissue macrophages in the early postnatal life. J Leukoc Biol 2022; 112:1515-1524. [PMID: 35899927 PMCID: PMC9796690 DOI: 10.1002/jlb.3mr0722-201r] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/02/2022] [Indexed: 01/07/2023] Open
Abstract
Adipose tissue macrophages (ATMs) play key roles in metabolic inflammation, insulin resistance, adipose tissue fibrosis, and immune disorders associated with obesity. Research on ATM biology has mostly been conducted in the setting of adult obesity, since adipocyte hypertrophy is associated with a significant increase in ATM number. Signals that control ATM activation toward a proinflammatory or a proresolving phenotype also determine the developmental program and lipid metabolism of adipocytes after birth. ATMs are present at birth and actively participate in the synthesis of mediators, which induce lipolysis, mitobiogenesis, and mitochondrial uncoupling in adipocytes. ATMs in the newborn and the infant promote a lipolytic and fatty acid oxidizing adipocyte phenotype, which is essential to support the lipid-fueled metabolism, to maintain nonshivering thermogenesis and counteract an excessive adipose tissue expansion. Since adipose tissue metabolism in the early postnatal life determines obesity status in adulthood, early-life ATM functions may have a life-long impact.
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Affiliation(s)
- Tamás Röszer
- Division of Pediatric Obesity, Children's Hospital and Institute of PediatricsUniversity of DebrecenDebrecenHungary,Institute of NeurobiologyUlm UniversityUlmGermany
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Kawuki J, Musa TH, Ghimire U, Obore N, Papabathini SS. The 100 top-cited articles on childhood obesity: a bibliometric analysis. GLOBAL HEALTH JOURNAL 2022. [DOI: 10.1016/j.glohj.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Tohi M, Bay JL, Tu’akoi S, Vickers MH. The Developmental Origins of Health and Disease: Adolescence as a Critical Lifecourse Period to Break the Transgenerational Cycle of NCDs-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6024. [PMID: 35627561 PMCID: PMC9141771 DOI: 10.3390/ijerph19106024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023]
Abstract
Noncommunicable diseases (NCDs), including type 2 diabetes and cardiovascular disease, represent a significant and growing global health burden. To date, a primary focus has been on treatment approaches to NCDs once manifested rather than strategies aimed at prevention. In this context, there is clear evidence that a range of adverse early life exposures can predispose individuals towards a greater risk of developing NCDs across the lifecourse. These risk factors can be passed to future generations, thus perpetuating a cycle of disease. This concept, preferentially termed "developmental programming", forms the basis of the Developmental Origins of Health and Disease (DOHaD) framework. To date, DOHaD has focused on preconception, pregnancy, lactation and, more recently, paternal health at the time of conception. However, it is becoming increasingly clear that investment in the window of adolescence is perhaps the most critical developmental window. Adolescence is a period where lifestyle behaviours become entrained. Therefore, a focus on adolescent behaviours, health literacy and emotional development may afford the best opportunity to break the cycle of NCDs. As the next generation of parents, adolescents should therefore be considered a priority group in advancing appropriate and informed actions aimed at reducing NCD risk factors across the lifecourse. This advancement requires a more comprehensive community understanding and uptake of DOHaD knowledge and concepts. NCD prevention strategies have typically entailed siloed (and often disease-specific) approaches with limited efficacy in curbing NCD prevalence and breaking the transgenerational transmission of disease traits. Recent findings across various disciplines have highlighted that a lifecourse systems approach is required to establish a comprehensive and sustainable framework for NCD intervention. A whole community approach with a particular focus on adolescents as potential agents of change is necessary to break the disease cycle.
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Affiliation(s)
- Melenaite Tohi
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand; (M.T.); (J.L.B.)
| | - Jacquie Lindsay Bay
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand; (M.T.); (J.L.B.)
| | - Siobhan Tu’akoi
- School of Population Health, The University of Auckland, Auckland 1023, New Zealand;
| | - Mark Hedley Vickers
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand; (M.T.); (J.L.B.)
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Al-Hamad AH, Al-Naseeb AM, Al-Assaf MS, Al-Obaid SA, Al-Abdulkarim BS, Olszewski PK. Preliminary Exploration of Obesity-Related Eating Behaviour Patterns in a Sample of Saudi Preschoolers Aged 2-6 Years through the Children's Eating Behaviour Questionnaire. Nutrients 2021; 13:nu13114156. [PMID: 34836411 PMCID: PMC8618833 DOI: 10.3390/nu13114156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Children's Eating Behaviour Questionnaire (CEBQ) is used with parents to determine the characteristics of eating behaviour of their children and, consequently, children's propensity to become obese. It has been successfully used mainly in Western countries, but not in Saudi Arabia. In this pilot study, we explored the use of the Saudi version of the CEBQ for preschool children aged 2-6 years in Saudi Arabia, and assessed the associations between eating behaviours and children's age, gender and relative weight and parental weight. METHODS Parents of 200 Saudi preschool children in Riyadh completed the Saudi version of the CEBQ. Factor analyses on all CEBQ items were performed and differences between genders and age groups were examined. Correlations between children's BMI z-scores and eating behaviours were analysed using linear regression. RESULTS The factor analysis revealed an eight-factor solution similar to the theoretical factor structure, with good internal reliability and acceptable correlations between subscales. Boys scored higher than girls on food responsiveness; no difference between age groups was found. Positive associations between BMI z-scores and 'food approach' subscales, food responsiveness, enjoyment of food and emotional overeating were found, while 'food avoidant' subscales, satiety responsiveness and slowness in eating had inverse relationships with BMI z-scores. Maternal BMI had a positive association with BMI z-scores and food responsiveness. CONCLUSION The CEBQ is a valid psychometric tool that can be reliably used to assess eating behaviour characteristics in Saudi preschool children.
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Affiliation(s)
- Ali H. Al-Hamad
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh 22490, Saudi Arabia
- Correspondence:
| | - Aljohara M. Al-Naseeb
- Clinical Nutrition Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (A.M.A.-N.); (M.S.A.-A.); (S.A.A.-O.); (B.S.A.-A.)
| | - Maha S. Al-Assaf
- Clinical Nutrition Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (A.M.A.-N.); (M.S.A.-A.); (S.A.A.-O.); (B.S.A.-A.)
| | - Suzan A. Al-Obaid
- Clinical Nutrition Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (A.M.A.-N.); (M.S.A.-A.); (S.A.A.-O.); (B.S.A.-A.)
| | - Bandar S. Al-Abdulkarim
- Clinical Nutrition Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (A.M.A.-N.); (M.S.A.-A.); (S.A.A.-O.); (B.S.A.-A.)
| | - Pawel K. Olszewski
- Department of Biological Sciences, University of Waikato, Hamilton 3240, New Zealand;
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Röszer T. Co-Evolution of Breast Milk Lipid Signaling and Thermogenic Adipose Tissue. Biomolecules 2021; 11:1705. [PMID: 34827703 PMCID: PMC8615456 DOI: 10.3390/biom11111705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 12/16/2022] Open
Abstract
Breastfeeding is a unique and defining behavior of mammals and has a fundamental role in nourishing offspring by supplying a lipid-rich product that is utilized to generate heat and metabolic fuel. Heat generation from lipids is a feature of newborn mammals and is mediated by the uncoupling of mitochondrial respiration in specific fat depots. Breastfeeding and thermogenic adipose tissue have a shared evolutionary history: both have evolved in the course of homeothermy evolution; breastfeeding mammals are termed "thermolipials", meaning "animals with warm fat". Beyond its heat-producing capacity, thermogenic adipose tissue is also necessary for proper lipid metabolism and determines adiposity in offspring. Recent advances have demonstrated that lipid metabolism in infants is orchestrated by breast milk lipid signals, which establish mother-to-child signaling and control metabolic development in the infant. Breastfeeding rates are declining worldwide, and are paralleled by an alarming increase in childhood obesity, which at least in part may have its roots in the impaired metabolic control by breast milk lipid signals.
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Affiliation(s)
- Tamás Röszer
- Institute of Neurobiology, Faculty of Science, Ulm University, 89081 Ulm, Germany
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10
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Epstein LH, Schechtman KB, Kilanowski C, Ramel M, Moursi NA, Quattrin T, Cook SR, Eneli IU, Pratt C, Geller N, Campo R, Lew D, Wilfley DE. Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. Contemp Clin Trials 2021; 109:106497. [PMID: 34389519 PMCID: PMC9664376 DOI: 10.1016/j.cct.2021.106497] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nasreen A Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Campo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Cotwright CJ, Alvis C, de Jesus Jimenez F, Farmer P, Okoli C, Delane J, Cox GO. Improving Willingness to Try Fruits and Vegetables Among Low-Income Children Through Use of Characters. Health Equity 2020; 4:84-90. [PMID: 32258959 PMCID: PMC7104895 DOI: 10.1089/heq.2019.0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Low-income children are disproportionately affected by high rates of food insecurity and obesity, placing them at risk for poor health outcomes. Diets that are rich in fruits and vegetables (FV) are associated with health benefits such as reducing the risk of obesity. Despite these benefits, American children do not consume nationally recommended amounts of fruits (63%) and vegetables (90%) per day. Data reveal that young children exhibit increased food neophobia toward vegetables. One way to decrease food neophobia is to introduce FV to young children via recipe tasting. The purpose of the study was to increase willingness to try FV among low-income children using live characters at Summer Food Service Program Sites. Methods: The study design was a small-scale pilot study to conduct taste tests of recipes with 125 low-income children. Researchers created recipe-tasting stations at two different sites. At Site 1, characters promoting FV characters were present at the recipe-tasting station. At Site 2, researchers presented recipes without characters being present. Taste tests were conducted once per week for a period of 4 weeks using two previously validated instruments, Taste Test Tool and the Taste and Rate Questionnaire. Results: Results demonstrated that introducing FV recipes with characters showed a trend toward increasing willingness to try FV among low-income children. Data also suggested that low-income children had limited exposure to specific FV before recipe tastings. Conclusion: The use of characters is a promising approach to increase willingness to try FV among low-income children.
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Affiliation(s)
- Caree J Cotwright
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Courtney Alvis
- Medical College of Georgia, Augusta University, Athens, Georgia
| | - Fabiola de Jesus Jimenez
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Paula Farmer
- Clarke County School District Office of Nutrition, Athens, Georgia
| | - Chisom Okoli
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Jennine Delane
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Ginnefer O Cox
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
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Wilfley DE, Agras WS, Fitzsimmons-Craft EE, Bohon C, Eichen DM, Welch RR, Jo B, Raghavan R, Proctor EK, Wilson GT. Training Models for Implementing Evidence-Based Psychological Treatment: A Cluster-Randomized Trial in College Counseling Centers. JAMA Psychiatry 2020; 77:139-147. [PMID: 31693069 PMCID: PMC6865264 DOI: 10.1001/jamapsychiatry.2019.3483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Progress has been made in establishing evidence-based treatments for psychiatric disorders, but these are not often delivered in routine settings. A scalable solution for training clinicians in evidence-based treatments is needed. OBJECTIVE To compare 2 methods of training college (university) counseling center therapists to treat psychiatric disorders using interpersonal psychotherapy. The hypothesis was that the train-the-trainer condition would demonstrate superior implementation outcomes vs the expert condition. Moderating factors were also explored. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized trial was conducted from October 2012 to December 2017 in 24 college counseling centers across the United States. Therapist participants were recruited from enrolled centers, and student patients with symptoms of depression and eating disorders were recruited by therapists. Data were analyzed from 184 enrolled therapists. INTERVENTIONS Counseling centers were randomized to the expert condition, which involved a workshop and 12 months of follow-up consultation, or the train-the-trainer condition, in which a staff member from the counseling center was coached to train other staff members. MAIN OUTCOMES AND MEASURES The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, as assessed via audio recordings of therapy sessions. Therapist knowledge of interpersonal psychotherapy was a secondary outcome. RESULT A total of 184 therapists (mean [SD] age, 41.9 [10.6] years; 140 female [76.1%]; 142 white [77.2%]) were included. Both the train-the-trainer-condition and expert-condition groups showed significant within-group improvement for adherence to interpersonal psychotherapy (change: 0.233 [95% CI, 0.192-0.274] and 0.190 [0.145-0.235], respectively; both P < .001), with large effect sizes (1.64 [95% CI, 1.35-1.93] and 1.34 [95% CI, 1.02-1.66], respectively) and no significant difference between conditions. Both groups also showed significant within-group improvement in interpersonal therapy competence (change: 0.179 [95% CI, 0.132-0.226] and 0.106 [0.059-0.153], respectively; both P < .001), with a large effect size for the train-the-trainer condition (1.16 [95% CI, 0.85-1.46]; P < .001) and a significant difference between groups favoring the train-the-trainer condition (effect size, 0.47 [95% CI, 0.05-0.89]; P = .03). Knowledge of interpersonal psychotherapy improved significantly within both groups (effect sizes: train-the-trainer, 0.64 [95% CI, 0.28-0.99]; P = .005; expert, 0.69 [95% CI, 0.38-1.01]; P < .001), with no significant difference between groups. The significant moderating factors were job satisfaction for adherence (b, 0.120 [95% CI, 0.001-0.24]; P = .048) and competence (b, 0.133 [95% CI, 0.001-0.27]; P = .048), and frequency of clinical supervision for competence (b, 0.05 [95% CI, 0.004-0.09]; P = .03). CONCLUSIONS AND RELEVANCE Results demonstrate that the train-the-trainer model produced training outcomes comparable with the expert model for adherence and was superior on competence. Given its potential capability to train more therapists over time, it has the potential to facilitate widespread dissemination of evidence-based treatments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02079142.
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Affiliation(s)
- Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - W. Stewart Agras
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | | | - Cara Bohon
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego
| | - R. Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Booil Jo
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California
| | - Ramesh Raghavan
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick,Now with Silver School of Social Work, New York University, New York
| | - Enola K. Proctor
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - G. Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway
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Wilson R, Abbott JH. Age, period and cohort effects on body mass index in New Zealand, 1997-2038. Aust N Z J Public Health 2018; 42:396-402. [PMID: 29972270 DOI: 10.1111/1753-6405.12804] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/01/2018] [Accepted: 04/01/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To estimate the effects of age, period and birth cohort on observed trends, and to provide short- to medium-term projections of population BMI in New Zealand. METHODS Data were obtained from New Zealand national health surveys covering the period 1997 to 2015 (n=76,294 individuals). A Hierarchical Age-Period-Cohort (HAPC) model and an Age-Period model with interaction terms were specified for population groups defined by ethnicity and sex. Observed trends were extrapolated to estimate group-specific BMI projections for the period 2015-2038; these were weighted by projected population sizes to calculate population-wide BMI projections. RESULTS Population mean BMI increased from 26.4 kg/m2 (95%CI 26.2-26.5) in 1997 to 28.3 kg/m2 (95%CI 28.2-28.5) in 2015. Both models identified substantial, approximately linear, period trends behind this increase, with no significant cohort effects. Mean BMI was projected to reach 30.6 kg/m2 (95%CI 29.4-31.7; HAPC model) to 30.8 kg/m2 (95%CI 30.2-31.4; Age-Period model) by 2038. CONCLUSIONS BMI continues to increase in New Zealand. On current trends, population mean BMI will exceed 30 kg/m2 - the clinical cut-off for obesity - by the early 2030s. Implications for public health: Unless prevented by comprehensive public health policy changes, increasing population obesity is likely to result in unfavourable economic and health impacts.
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Affiliation(s)
- Ross Wilson
- Centre for Musculoskeletal Outcomes Research, University of Otago, New Zealand
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, University of Otago, New Zealand
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Halah MP, Marangon PB, Antunes-Rodrigues J, Elias LLK. Neonatal nutritional programming impairs adiponectin effects on energy homeostasis in adult life of male rats. Am J Physiol Endocrinol Metab 2018; 315:E29-E37. [PMID: 29438632 DOI: 10.1152/ajpendo.00358.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neonatal nutritional changes induce long-lasting effects on energy homeostasis. Adiponectin influences food intake and body weight. The aim of this study was to investigate the effects of neonatal nutritional programming on the central stimulation of adiponectin. Male Wistar rats were divided on postnatal (PN) day 3 in litters of 3 (small litter, SL), 10 (normal litter, NL), or 16 pups/dam (large litter, LL). We assessed body weight gain for 60 days, adiponectin concentration, and white adipose tissue weight. We examined the response of SL, NL, and LL rats on body weight gain, food intake, oxygen consumption (V̇o2), respiratory exchange ratio (RER), calorimetry, locomotor activity, phosphorylated-AMP-activated protein kinase (AMPK) expression in the hypothalamus, and uncoupling protein (UCP)-1 in the brown adipose tissue after central stimulus with adiponectin. After weaning, SL rats maintained higher body weight gain despite similar food intake compared with NL rats. LL rats showed lower body weight at weaning, with a catch up afterward and higher food intake. Both LL and SL groups had decreased plasma concentrations of adiponectin at PN60. SL rats had increased white adipose tissue. Central injection of adiponectin decreased body weight and food intake and increased V̇o2, RER, calorimetry, p-AMPK and UCP- 1 expression in NL rats, but it had no effect on SL and LL rats, compared with the respective vehicle groups. In conclusion, neonatal under- and overfeeding induced an increase in body weight gain in juvenile and early adult life. Unresponsiveness to central effects of adiponectin contributes to the imbalance of the energy homeostasis in adult life induced by neonatal nutritional programming.
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Affiliation(s)
- Mariana Peduti Halah
- Department of Physiology, Ribeirao Preto Medical School University of Sao Paulo , Sao Paulo , Brazil
| | - Paula Beatriz Marangon
- Department of Physiology, Ribeirao Preto Medical School University of Sao Paulo , Sao Paulo , Brazil
| | - Jose Antunes-Rodrigues
- Department of Physiology, Ribeirao Preto Medical School University of Sao Paulo , Sao Paulo , Brazil
| | - Lucila L K Elias
- Department of Physiology, Ribeirao Preto Medical School University of Sao Paulo , Sao Paulo , Brazil
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Krout D, Roemmich JN, Bundy A, Garcia RA, Yan L, Claycombe-Larson KJ. Paternal exercise protects mouse offspring from high-fat-diet-induced type 2 diabetes risk by increasing skeletal muscle insulin signaling. J Nutr Biochem 2018; 57:35-44. [PMID: 29669306 DOI: 10.1016/j.jnutbio.2018.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 02/06/2023]
Abstract
Paternal obesity increases, while paternal exercise decreases, offspring obesity and type 2 diabetes (T2D) risk; however, no studies have determined whether a paternal high-fat (HF) diet and exercise interact to alter offspring body weight (BW), adiposity and T2D risk. Three-week-old male C57BL/6 mice were fed a normal-fat (NF) diet (16% fat) or an HF diet (45% fat) and assigned to either voluntary wheel running exercise or cage activity for 3 months prior to mating with NF-diet-fed dams. After weaning, male offspring were fed an NF or HF diet for an additional 3 months. F1 male mice whose fathers ate an HF diet had decreased % body fat accompanied by decreased gene expression of beige adipocyte marker FGF21. However, paternal HF-diet-induced reductions in F1 offspring % body fat normalized but did not reduce T2D risk. Exercise was protective against paternal HF-diet-induced insulin resistance by increasing the expression of insulin signaling (GLUT4, IRS1 and PI3K) markers in skeletal muscle resulting in normal T2D risk. When fathers were fed an HF diet and exercised, a postnatal HF diet increased beiging (PPARγ). Thus, these findings show that increases in T2D risk in male offspring when the father consumes an HF diet can be normalized when the father also exercises preconception and that this protection may occur by increases in insulin signaling potential within offspring skeletal muscle. Future studies should further determine the physiological mechanism(s) underlying the beneficial effects of exercise through the paternal lineage.
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Affiliation(s)
- Danielle Krout
- U.S. Department of Agriculture Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA
| | - James N Roemmich
- U.S. Department of Agriculture Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA
| | - Amy Bundy
- U.S. Department of Agriculture Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA
| | - Rolando A Garcia
- U.S. Department of Agriculture Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA
| | - Lin Yan
- U.S. Department of Agriculture Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA
| | - Kate J Claycombe-Larson
- U.S. Department of Agriculture Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND 58203, USA.
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Gu X, Tucker KL. Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs. Am J Clin Nutr 2017; 105:194-202. [PMID: 27881390 DOI: 10.3945/ajcn.116.135095] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The state of the economy, changes in federal food assistance programs, and policies related to nutrition and the food supply in the United States may influence dietary quality in children and adolescents. OBJECTIVE We investigated dietary quality trends from 1999 to 2012 in the US child and adolescent population and their associations with socioeconomic status and participation in federal food assistance programs. DESIGN In this study, a nationally representative sample of 38,487 children and adolescents, aged 2-18 y, in the NHANES from 1999 to 2012 were included. Dietary information was collected with the use of a 24-h dietary recall. Dietary quality was measured with the use of the Healthy Eating Index 2010 (HEI-2010). RESULTS The mean HEI-2010 increased significantly from 42.5 (95% CI: 41.2, 43.8) to 50.9 (95% CI: 50.0, 51.8) from 1999 to 2012 (P-linear trend < 0.001). The reduction in empty calorie intake contributed to greater than one-third of this improvement in the total HEI-2010. We also observed significant increases in 9 other HEI-2010 component scores. However, the HEI-2010 component score for sodium decreased significantly, which reflected an increase in sodium consumption. We calculated the covariate-adjusted mean HEI-2010 score in subgroups that were defined by sociodemographic status and participation in nutrition assistance program at each NHANES cycle. Non-Hispanic black children and adolescents had a consistently lower HEI-2010 than that of other groups across all NHANES cycles. We observed a trend toward a lower HEI-2010 in Supplemental Nutrition Assistance Program (SNAP) participants than in nonparticipants after the 2003-2004 cycle. We also observed a lower HEI-2010 in participants in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) than in nonparticipants. In general, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children appeared to have a higher HEI-2010 than that of nonparticipants. CONCLUSIONS Although HEI-2010 scores in children and adolescents improved steadily, the overall dietary quality remained poor. Participants in the SNAP and participants in the National School Lunch Program, School Breakfast Program, or both have lower dietary quality than do nonparticipants. Future policy interventions are needed to continue improvement in dietary quality and to address disparities.
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Affiliation(s)
- Xiao Gu
- Department of Epidemiology, School of Public Health, Brown University; and
| | - Katherine L Tucker
- Clinical Laboratory and Nutritional Sciences, Center for Population Health, University of Massachusetts Lowell, Lowell, MA
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Yeung H, Leff M, Rhee KE. Effect of Exclusive Breastfeeding Among Overweight and Obese Mothers on Infant Weight-for-Length Percentile at 1 Year. Breastfeed Med 2017; 12:39-47. [PMID: 27834508 DOI: 10.1089/bfm.2016.0071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Breastfeeding is associated with decreased risk of childhood obesity. However, there is a strong correlation between maternal weight status and childhood obesity, and it is unclear whether or not breastfeeding among overweight mothers could mitigate this risk. Our goal was to examine whether or not exclusive breastfeeding (compared to formula feeding) among overweight and obese mothers is associated with lower weight-for-length (W/L) percentile at 1 year. MATERIALS AND METHODS Data from the Infant Feeding Practices II study were used. Infants who were preterm or underweight at 1 year, and mothers who were underweight before pregnancy, were excluded from analysis. There was a significant interaction between exclusive breastfeeding for 4 months and maternal prepregnancy weight status (normal weight, overweight, obese) on infant W/L percentile at 1 year. Stratified linear mixed-effects growth modeling controlling for covariates was created to test the relationship between exclusive breastfeeding and infant W/L percentile within each maternal weight category. RESULTS A total of 915 subjects met inclusion criteria. Normal weight and obese mothers who exclusively breastfed for 4 months had infants with a smaller rate of increase in W/L percentile during the first year compared with those who used formula. Infants of overweight and obese mothers who exclusively breastfed for 4 months had lower W/L percentile at 1 year than those who used formula. CONCLUSIONS Exclusive breastfeeding for 4 months among normal weight and obese mothers resulted in less increase in W/L percentiles in the first year. Obese mothers often have a difficult time initiating and maintaining breastfeeding. Concerted efforts are needed to support this population with breastfeeding.
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Affiliation(s)
- Hui Yeung
- 1 Department of Pediatrics, University of California , Irvine, Irvine, California
| | - Michelle Leff
- 2 Department of Pediatrics, University of California , San Diego, La Jolla, California
| | - Kyung E Rhee
- 2 Department of Pediatrics, University of California , San Diego, La Jolla, California
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Kwon S, Janz KF, Letuchy EM, Burns TL, Levy SM. Association between body mass index percentile trajectories in infancy and adiposity in childhood and early adulthood. Obesity (Silver Spring) 2017; 25:166-171. [PMID: 27804242 PMCID: PMC5182145 DOI: 10.1002/oby.21673] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/11/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify distinct body mass index (BMI) percentile trajectories during early childhood and examine adiposity levels in childhood and early adulthood according to the BMI percentile trajectories. METHODS Iowa Fluoride Study cohort parents (n = 1,093) reported their child's anthropometric data on average six times between ages 0 and 23 months. A subset of the cohort underwent DXA scans at approximately age 8 years (n = 495) and again at approximately age 19 years (n = 314). Group-based trajectory analysis was conducted to identify distinct BMI percentile trajectories from ages 0 to 23 months. Sex-specific age-adjusted linear regression analyses were conducted to compare fat mass index in childhood and early adulthood among subgroups that follow the distinct BMI percentile patterns. RESULTS Four BMI percentile patterns were identified: consistently low (group 1: 9.8%), increase in the second year (group 2: 33.7%), increase in the first year (group 3: 23.9%), and consistently high (group 4: 32.6%). Compared with group 2 females, groups 3 and 4 females had higher fat mass index in childhood and early adulthood (P < 0.05). However, no significant difference was found in males. CONCLUSIONS Females who experience a steep increase of BMI percentile in the first year of life, as opposed to a steep increase in the second year of life, may have higher body fat later in life, but this was not found in males.
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Affiliation(s)
- Soyang Kwon
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Kathleen F. Janz
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
- Department of Epidemiology, University of Iowa, Iowa City, IA
| | | | - Trudy L. Burns
- Department of Epidemiology, University of Iowa, Iowa City, IA
| | - Steven M. Levy
- Department of Epidemiology, University of Iowa, Iowa City, IA
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA
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Using group model building to understand factors that influence childhood obesity in an urban environment. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21 Suppl 3:S74-8. [PMID: 25828225 DOI: 10.1097/phh.0000000000000219] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin. The coalition conducted a Group Model Building exercise to better understand root causes of childhood obesity in its community. METHODS Group Model Building is a process by which a group systematically engages in model construction to better understand the systems that are in place. It helps participants make their mental models explicit through a careful and consistent process to test assumptions. This process has 3 main components: (1) assembling a team of participants; (2) conducting a behavior-over-time graphs exercise; and (3) drawing the causal loop diagram exercise. RESULTS The behavior-over-time graph portion produced 61 graphs in 10 categories. The causal loop diagram yielded 5 major themes and 7 subthemes. CONCLUSIONS Factors that influence childhood obesity are varied, and it is important to recognize that no single solution exists. The perspectives from this exercise provided a means to create a process for dialogue and commitment by stakeholders and partnerships to build capacity for change within the community.
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Abstract
580 adult men and 616 adult women from an entire community were asked to estimate the heights of both of their parents. Estimations by the men were consistently greater at all ages and for both parents than the equivalent estimations by the women. The men's estimation of their mothers' heights was on average four centimetres greater than that of the women's estimations, but their estimations of their fathers' heights was only on average about one centimetre greater. Actual measurement of parental heights (for 180 subjects) showed that these differences were perceptual and not factual. It is shown that the men consistently overestimated the heights of their parents, the mothers' more than the fathers'. In both sexes overestimation increased after middle age. It is argued that overestimation of parents' heights is an indication of perceived parental importance.
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Lass NJ, Andes SE, Mc Nair CD, Cline AL, Pecora MC. Correlational Study of Subjects' Self-Reported and Measured Heights and Weights. Percept Mot Skills 2016. [DOI: 10.2466/pms.1982.54.1.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cash TF, Counts B, Hangen J, Huffine CE. How Much Do You Weigh?: Determinants of Validity of Self-Reported Body Weight. Percept Mot Skills 2016. [DOI: 10.2466/pms.1989.69.1.248] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although researchers often employ self-report measures of current body weight, the validity of such self-reports remains questionable. The present experiment with 133 college women examined such self-reports under two conditions—reporting prior to unanticipated objective weighing (Order 1) versus reporting subsequent to weighing without weight disclosure (Order 2). Analysis indicated significantly less accurate, particularly underestimated, self-reports for Order 1 than for Order 2. Moreover, for Order 1 but not Order 2, under-reporting was disproportionately related to objectively heavier weight and was also predictable from lower personal weight ideals independent of actual weight. Findings and their implications for investigation were viewed from a social self-presentational framework.
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Abstract
This study tests the explanatory power of an integrated sociocultural and personality model in predicting bulimic symptomatology. Family, peer, and personality factors were assessed at three levels of analysis. The first level of the model measured the general functioning of the family system and friendship network. The second level assessed the extent to which the family system and friendship network were concerned with issues of weight and dieting, as well as the rate of eating disorders among members in these groups. The third level investigated the relationship of certain personality variables to bulimic symptoms. Based on self-report data from approximately 400 high school girls, correlates of bulimic symptomatology at each of the three levels of analysis were identified. An integrated model, in which the three levels of analysis were considered in unison, demonstrated that risk factors at each level of analysis cumulatively contribute to an increase in bulimic symptoms.
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Trends in Socioeconomic Inequalities in Body Mass Index, Underweight and Obesity among English Children, 2007-2008 to 2011-2012. PLoS One 2016; 11:e0147614. [PMID: 26812152 PMCID: PMC4727904 DOI: 10.1371/journal.pone.0147614] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/06/2016] [Indexed: 11/25/2022] Open
Abstract
Background Socioeconomic inequalities in childhood obesity have been reported in most developed countries, with obesity more common in deprived groups. Whether inequalities are found in the prevalence of underweight, the rest of the body mass index (BMI) distribution, or have changed across time is not clear. Methods and Findings The sample comprised 5,027,128 children on entry (4 to 5 years old) and leaving (10 to 11 years) state primary (elementary) school who participated in the National Child Measurement Programme (England, United Kingdom). We used area-level deprivation (Indices of Multiple Deprivation at the lower super output area) as a measure of socioeconomic deprivation. From 2007–2008 to 2011–2012 inequalities in obesity between the most compared to least deprived group increased (from 7.21% to 8.30%; p<0.001), whereas inequalities in the prevalence of underweight (1.50% to 1.21%; p = 0.15) were stable during this period. There were no differences by age group or by sex, but a three-way interaction suggested inequalities in obesity had increased at a faster rate for 10 to 11 year old girls, than 4 to 5 year old boys, (2.03% vs 0.07%; p<0.001 for interaction). Investigating inequalities across the distribution of zBMI showed increases in mean zBMI (0.18 to 0.23, p<0.001) could be attributed to increases in inequalities between the 50th and 75th centiles of BMI. Using the 2011 to 2012 population attributable risk estimates, if inequalities were halved, 14.04% (95% CI 14.00% to 14.07%) of childhood obesity could be avoided. Conclusions Socioeconomic inequalities in childhood obesity and zBMI increased in England between 2007–2008 and 2011–2012. Inequalities in the prevalence of underweight did not change. Traditional methods of examining inequalities only at the clinical thresholds of overweight and obesity may have led the magnitude of inequalities in childhood BMI to be underestimated.
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Suzuki K, Sato M, Zheng W, Shinohara R, Yokomichi H, Yamagata Z. Childhood growth trajectories according to combinations of pregestational weight status and maternal smoking during pregnancy: a multilevel analysis. PLoS One 2015; 10:e0118538. [PMID: 25680116 PMCID: PMC4332663 DOI: 10.1371/journal.pone.0118538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022] Open
Abstract
Pregestational weight status and maternal smoking during pregnancy are significantly associated with fetal and childhood growth. However, few studies have examined associations between childhood growth and combinations of these factors using multilevel analysis. This study aimed to describe differences in childhood growth trajectories according to these combinations, using data from a prospective cohort study in Japan. The study participants were 1,973 women and their singletons, who were born between April 1, 1991 and March 31, 2003. Children were categorized according to whether they were born to normal-weight, nonsmoking mothers (NN); normal-weight, smoking mothers (NS); underweight, nonsmoking mothers (UN); underweight, smoking mothers (US); overweight, nonsmoking mothers (ON); or overweight, smoking mothers (OS). Birth weight and anthropometric data were collected from 1,965 children at birth (99.6%), 1,655 aged 3 (83.9%), 1,527 aged 5 (77.4%), 1,497 aged 7–8 (75.9%), and 1,501 aged 9–10 (76.1%). Multilevel analysis examining both individual and age as different level variables according to sex was used to describe the trajectories of body mass index z scores for statistical analyses. Although children of the OS group were the leanest at birth, their body mass indices had increased rapidly by 3 years of age. Moreover, body mass index was also likely to increase in boys in the NS and ON groups. A different trend was observed in girls. Body mass index decreased from 5 years of age in girls in the US group. There were no remarkable differences in body mass index trajectories between children in the other groups. In conclusion, childhood growth trajectories differed according to combinations of pregestational weight status and maternal smoking during pregnancy. Further, there were sex-related differences in the associations between childhood growth and factor combinations.
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Affiliation(s)
- Kohta Suzuki
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
- * E-mail:
| | - Miri Sato
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Wei Zheng
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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Chang LL, Wun WSA, Wang PS. Recovery from developmental nonylphenol exposure is possible for female rats. Chem Biol Interact 2014; 221:52-60. [DOI: 10.1016/j.cbi.2014.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/04/2014] [Accepted: 07/25/2014] [Indexed: 11/25/2022]
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Paul IM, Williams JS, Anzman-Frasca S, Beiler JS, Makova KD, Marini ME, Hess LB, Rzucidlo SE, Verdiglione N, Mindell JA, Birch LL. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. BMC Pediatr 2014; 14:184. [PMID: 25037579 PMCID: PMC4105401 DOI: 10.1186/1471-2431-14-184] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/09/2014] [Indexed: 12/15/2022] Open
Abstract
Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings. Discussion With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings. Trial registration NCT01167270. Registered 21 July 2010.
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, HS83, Penn State College of Medicine, 500 University Dr,, Hershey 17033, PA, USA.
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Abstract
Obesity is a pervasive global public health concern of utmost priority. Effective and efficient interventions are urgently needed to reverse current trends, especially among children. The past decade has witnessed increasing adoption and implementation of community-engaged and -participatory interventions that employ a bottom-up approach to identifying and realizing sustainable solutions within communities. It is argued herein that community-based approaches are most effective when implemented via a systems perspective that integrates across societal sectors. This approach seizes upon the synergistic effects that result from simultaneously mobilizing community assets at multiple levels. This paper provides an overview of the evolution and theory behind community-engaged, community-participatory, and systems-level interventions, discusses recent findings in the field, offers reflections based on first-hand experience, outlines advances in relevant resources, and lays forth potential and promising directions for future research. It emphasizes the centrality and necessity of community-engaged systems-level interventions in halting and reversing the obesity epidemic.
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Affiliation(s)
- Christina Economos
- Friedman School of Nutrition, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Stacy Blondin
- Food Policy and Applied Nutrition, Friedman School of Nutrition, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
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Suzuki K, Sato M, Ando D, Kondo N, Yamagata Z. Differences in the effect of maternal smoking during pregnancy for childhood overweight before and after 5 years of age. J Obstet Gynaecol Res 2013; 39:914-21. [DOI: 10.1111/jog.12025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Kohta Suzuki
- Department of Health Sciences; Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo Yamanashi Japan
| | - Miri Sato
- Center for Birth Cohort Studies; Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo Yamanashi Japan
| | - Daisuke Ando
- Department of Physical Education; National Defence Academy; Yokosuka Kanagawa Japan
| | - Naoki Kondo
- Department of Health Economics and Epidemiology Research; University of Tokyo School of Public Health; Tokyo Japan
| | - Zentaro Yamagata
- Department of Health Sciences; Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo Yamanashi Japan
- Center for Birth Cohort Studies; Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi; Chuo Yamanashi Japan
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Price JH, Desmond SM, Ruppert E, Sauder PJ. Parents' Perceptions of Childhood Obesity and the Role of Schools. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10556699.1992.10616262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- James H. Price
- a Health Education in the Department of Health Promotion and Human Performance , University of Toledo , Toledo , OH , 43606 , USA
| | - Sharon M. Desmond
- b Health Education in the Department of Human Services , University of Virginia , Charlottesville , VA , 22903 , USA
| | - Elizabeth Ruppert
- c Department of Pediatrics , Medical College of Ohio , Toledo , OH , 43699 , USA
| | - Peg J. Sauder
- d Pediatric Nurse Practitioner , Morton , IL , 61550 , USA
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Polivy J, Herman CP, Trottier K, Sidhu R. Who are you trying to fool: does weight underreporting by dieters reflect self-protection or self-presentation? Health Psychol Rev 2013; 8:319-38. [DOI: 10.1080/17437199.2013.775630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shi Y, De Groh M, Morrison H. Perinatal and early childhood factors for overweight and obesity in young Canadian children. Canadian Journal of Public Health 2013. [PMID: 23618121 DOI: 10.1007/bf03405658] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study assessed potential early-life factors and their interrelationships with obesity among young Canadian children. METHODS Data from a nationally representative sample of children aged 6 to 11 years in the Canadian Health Measures Survey were analyzed. The associations of perinatal and early childhood behaviours and socio-economic factors with overweight or obesity were evaluated using multivariate logistic regression models. Adjusted population attributable risk fractions (PARFs) were calculated using multivariate logistic regression models. RESULTS Of 968 term-born children, 21% were overweight and another 13% were obese. Maternal smoking during pregnancy (adjusted odds ratio, 2.26; 95% confidence interval, 1.23-4.15) was positively associated with obesity. This association was mediated by birth weight (suppression effect); once controlled, the strength of the association between smoking and child obesity increased by 12%. Birth weight per 100 g (1.05; 1.005-1.09) was significantly associated with obesity. Exclusive breastfeeding for 6 months (0.44; 0.31-0.61), adequate sleep hours (0.39; 0.16-0.94) and being physically active (0.50; 0.26-0.93) were found to be protective. Breastfeeding, whether exclusive or not, significantly reduced obesity risk among children whose mothers never smoked in pregnancy. PARFs indicated that 24.4%, 11.5%, 11.3% and 6.0% prevalent cases of child obesity might be prevented by exclusive breastfeeding, smoking cessation during pregnancy, adequate sleep during childhood, and avoiding high birth weight, respectively. CONCLUSIONS This study identified multiple perinatal and childhood factors associated with obesity in young Canadian children. Effective prevention strategies targeting four modifiable maternal and child risk factors may reduce childhood obesity by up to 54% in Canada.
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Affiliation(s)
- Yipu Shi
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Ottawa, ON.
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Dichlorodiphenyltrichloroethane (DDT), DDT metabolites and pregnancy outcomes. Reprod Toxicol 2012; 35:156-64. [PMID: 23142753 DOI: 10.1016/j.reprotox.2012.10.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 09/28/2012] [Accepted: 10/30/2012] [Indexed: 11/20/2022]
Abstract
Organochlorine pesticides (OCPs) are persistent endocrine disruptors. OCPs cross the placenta; this prenatal exposure has been associated with adverse pregnancy outcomes. We investigated associations between prenatal exposure to OCPs and gestational age and birth weight in 600 infants born between 1960 and 1963. The primary OCP was 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT), its primary metabolite, 1,1'-dichloro-2,2'-bis(p-chlorophenyl)ethylene (p,p'-DDE) and the contaminant, 1,1,1-trichloro-2-(p-chlorophenyl)-2-(o-chlorophenyl)-ethane (o,p'-DDT). Regression analysis indicated that for each natural log unit increase in p,p'-DDT, birth weight increased by 274 g (95% CI: 122, 425) when controlling for p,p'-DDE and o,p'-DDT. At a given level of p,p'-DDT exposure, o,p'-DDT and p,p'-DDE were associated with decreased birth weight. p,p'-DDE was negatively associated with length of gestation, controlling for p,p'-DDT and o,p'-DDT. These findings suggest opposing associations between exposure to p,p'-DDT and p,p'-DDE and birth weight. We did not find evidence to support mediation by maternal thyroid hormone status nor that the association differed by sex.
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Schellong K, Schulz S, Harder T, Plagemann A. Birth weight and long-term overweight risk: systematic review and a meta-analysis including 643,902 persons from 66 studies and 26 countries globally. PLoS One 2012; 7:e47776. [PMID: 23082214 PMCID: PMC3474767 DOI: 10.1371/journal.pone.0047776] [Citation(s) in RCA: 252] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/17/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Overweight is among the major challenging health risk factors. It has been claimed that birth weight, being a critical indicator of prenatal developmental conditions, is related to long-term overweight risk. In order to check this important assumption of developmental and preventive medicine, we performed a systematic review and comprehensive meta-analysis. METHODS AND FINDINGS Relevant studies published up to January 2011 that investigated the relation between birth weight and later risk of overweight were identified through literature searches using MEDLINE and EMBASE. For meta-analysis, 66 studies from 26 countries and five continents were identified to be eligible, including 643,902 persons aged 1 to 75 years. We constructed random-effects and fixed-effects models, performed subgroup-analyses, influence-analyses, assessed heterogeneity and publication bias, performed meta-regression analysis as well as analysis of confounder adjusted data. Meta-regression revealed a linear positive relationship between birth weight and later overweight risk (p<0.001). Low birth weight (<2,500 g) was found to be followed by a decreased risk of overweight (odds ratio (OR) =0.67; 95% confidence interval (CI) 0.59-0.76). High birth weight (>4,000 g) was associated with increased risk of overweight (OR=1.66; 95% CI 1.55-1.77). Results did not change significantly by using normal birth weight (2,500-4,000 g) as reference category (OR=0.73, 95% CI 0.63-0.84, and OR=1.60, 95% CI 1.45-1.77, respectively). Subgroup- and influence-analyses revealed no indication for bias/confounding. Adjusted estimates indicate a doubling of long-term overweight risk in high as compared to normal birth weight subjects (OR=1.96, 95% CI 1.43-2.67). CONCLUSIONS Findings demonstrate that low birth weight is followed by a decreased long-term risk of overweight, while high birth weight predisposes for later overweight. Preventing in-utero overnutrition, e.g., by avoiding maternal overnutrition, overweight and/or diabetes during pregnancy, might therefore be a promising strategy of genuine overweight prevention, globally.
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Affiliation(s)
- Karen Schellong
- Clinic of Obstetrics, Division of ‘Experimental Obstetrics’, Charité – University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Sandra Schulz
- Clinic of Obstetrics, Division of ‘Experimental Obstetrics’, Charité – University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Thomas Harder
- Clinic of Obstetrics, Division of ‘Experimental Obstetrics’, Charité – University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas Plagemann
- Clinic of Obstetrics, Division of ‘Experimental Obstetrics’, Charité – University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Quattrin T, Roemmich JN, Paluch R, Yu J, Epstein LH, Ecker MA. Efficacy of family-based weight control program for preschool children in primary care. Pediatrics 2012; 130:660-6. [PMID: 22987879 PMCID: PMC4074628 DOI: 10.1542/peds.2012-0701] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To test the efficacy of an innovative family-based intervention for overweight preschool-aged children and overweight parents conducted in the primary care setting. METHODS Children with BMI ≥ 85th percentile and an overweight parent were randomized to intervention or information control (IC). Trained staff delivered dietary and physical/sedentary activities education to parents over 6 months (10 group meetings and 8 calls). Parents in the intervention received also behavioral modification. An intention-to-treat analysis was performed by using mixed analysis of variance models to test changes in child percent over BMI (%OBMI) and z-BMI and to explore potential moderators of group differences in treatment response. RESULTS Ninety-six of 105 randomized families started the program: 46 children (31 girls/15 boys) in the intervention and 50 (33 girls/17 boys) in the IC, with 33 and 39 mothers and 13 and 11 fathers in intervention and IC, respectively. Baseline characteristics did not differ between groups. Children in the intervention group had greater %OBMI and z-BMI decreases at 3 and 6 months compared with those assigned to IC (P < .0021). A greater BMI reduction over time was also observed in parents in the intervention compared with parents assigned to IC (P < .0001). Child %OBMI and parent BMI changes were correlated (r = .31; P = .003). Children with greater baseline %OBMI were more likely to have a greater %OBMI decrease over time (P = .02). CONCLUSIONS Concurrently targeting preschool-aged overweight youth and their overweight parents for behavioral weight control in a primary care setting reduced child %OBMI and parent BMI, with parent and child weight changes correlating.
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Affiliation(s)
| | | | - Rocco Paluch
- Pediatrics and,Women and Children’s Hospital, Buffalo, New York
| | - Jihnhee Yu
- Biostatistics, University at Buffalo, Buffalo, New York; and
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Mansourian M, Marateb HR, Kelishadi R, Motlagh ME, Aminaee T, Taslimi M, Majdzadeh R, Heshmat R, Ardalan G, Poursafa P. First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study. BMC Pediatr 2012; 12:149. [PMID: 22985219 PMCID: PMC3471000 DOI: 10.1186/1471-2431-12-149] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 09/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10-19 years, and to explore how well these anthropometric data match with international growth references. METHODS In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10-19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines. RESULTS The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10-14 years , and 3118 (58%) with 15-19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P < 0.001). The mean BMI-for-age, and the average height-for-age of Iranian children aged 10-19 years were lower than the WHO 2007 and United states Centers for Disease Control and Prevention 2000 (USCDC2000) references. CONCLUSIONS The current growth curves generated from a national dataset may be included for establishing WHO global database on children's growth. Similar to most low-and middle income populations, Iranian children aged 10-19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in public health policy-making.
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Affiliation(s)
- Marjan Mansourian
- Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Science, Isfahan, Iran
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Koga M, Suzuki K, Takeda Y, Kondo N, Matsumura Y, Oguri S, Okayama A, Yanagawa H, Yamagata Z. Dietary fat intake of Japanese male children and its associated factors: Results of the 1995 National Nutrition Survey in Japan. Health (London) 2012. [DOI: 10.4236/health.2012.412a202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Volpato AM, Schultz A, Magalhães-da-Costa E, Correia MLDG, Águila MB, Mandarim-de-Lacerda CA. Maternal high-fat diet programs for metabolic disturbances in offspring despite leptin sensitivity. Neuroendocrinology 2012; 96:272-84. [PMID: 22456428 DOI: 10.1159/000336377] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 12/30/2011] [Indexed: 02/04/2023]
Abstract
A fatty diet during pregnancy in mouse dams causes metabolic abnormalities (similar to metabolic syndrome in humans) in the rodents' offspring. We tested the hypothesis that the offspring of dams fed a high-fat diet during pregnancy and lactation develop metabolic abnormalities and leptin resistance. Pregnant C57BL/6 mice (n = 20) were fed either standard chow (SC; 19% fat) or a high-fat diet (HF; 49% fat). After weaning, male offspring were divided into four groups, according to the diet of dams and offspring: SC(dams)/SC(offspring), SC/HF, HF/SC and HF/HF (n = 30/group). For a metabolic analysis, we evaluated body mass, fat mass depots, blood plasma and adipocyte structure at 12 weeks of age. To analyse leptin sensitivity, each group was divided into two groups (vehicle or leptin) to identify the feeding response and pSTAT3 expression after acute intracerebroventricular (ICV) treatment. The offspring of mothers fed a high-fat diet presented increased body mass and visceral fat, adipocyte hypertrophy and insulin resistance. This phenotype was not associated with central leptin resistance. Thus, maternal programming by HF predisposes offspring to metabolic abnormalities despite leptin sensitivity.
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Affiliation(s)
- Ana Maria Volpato
- Laboratory of Morphometry, Biomedical Center, Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Developmental origins of health and disease: experimental and human evidence of fetal programming for metabolic syndrome. J Hum Hypertens 2011; 26:405-19. [PMID: 21697895 DOI: 10.1038/jhh.2011.61] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The concept of developmental origins of health and disease has been defined as the process through which the environment encountered before birth, or in infancy, shapes the long-term control of tissue physiology and homeostasis. The evidence for programming derives from a large number of experimental and epidemiological observations. Several nutritional interventions during diverse phases of pregnancy and lactation in rodents are associated with fetal and neonatal programming for metabolic syndrome. In this paper, recent experimental models and human epidemiological studies providing evidence for the fetal programming associated with the development of metabolic syndrome and related diseases are revisited.
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Power C, Pouliou T, Li L, Cooper R, Hyppönen E. Parental and offspring adiposity associations: insights from the 1958 British birth cohort. Ann Hum Biol 2011; 38:390-9. [PMID: 21671834 DOI: 10.3109/03014460.2011.591827] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/AIMS Parent-offspring adiposity associations are well-established: offspring of obese parents have elevated risks of overweight/obesity. The aim of studies based on the 1958 British birth cohort has been to gain insights into explanations of these associations, such as whether parent-offspring BMI associations are due to offspring lifestyles or depend on socio-economic conditions. METHODS All major studies on intergenerational adiposity associations in the three generations of the 1958 birth cohort were reviewed. In addition, BMI data for parents (G1) and the cohort (G2) were analysed stratified by social class. RESULTS BMI of G1 and G2 were correlated both when offspring were children and in mid-adulthood: a 1 kg/m(2) higher parental BMI was associated with an average 0.24-0.35 kg/m(2) higher offspring (mothers/fathers vs sons/daughters) BMI at 45 years. Associations were little affected by adjustment for lifestyle and socio-economic factors, but varied by social class: average BMI gain in offspring relative to parents was greater in lower classes, e.g. for males vs fathers by 3.6 and 2.5 kg/m(2) in classes IV&V and I&II, respectively. Parent-offspring BMI associations were stronger for recent (G2 and G3) than older (G1 and G2) generations. CONCLUSIONS Parent-offspring associations in BMI were not explained by offspring lifestyles, but varied over successive generations and by social class, suggesting that intergenerational transmission of adiposity at a population level is modifiable rather than immutable.
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Affiliation(s)
- Chris Power
- MRC Centre of Epidemiology for Child Health, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK.
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41
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Pre- and postnatal determinants of childhood body size: cohort and sibling analyses. J Dev Orig Health Dis 2011; 2:99-111. [DOI: 10.1017/s2040174411000067] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Paul IM, Savage JS, Anzman SL, Beiler JS, Marini ME, Stokes JL, Birch LL. Preventing obesity during infancy: a pilot study. Obesity (Silver Spring) 2011; 19:353-61. [PMID: 20725058 PMCID: PMC3477360 DOI: 10.1038/oby.2010.182] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
More than 20% of US children between ages 2 and 5 years are overweight suggesting efforts to prevent obesity must begin earlier. This study tested the independent and combined effects of two behavioral interventions delivered to parents, designed to promote healthy infant growth in the first year. Mother-newborn dyads intending to breastfeed were recruited from a maternity ward. With a 2 × 2 design, 160 dyads were randomized into one of four treatment cells to receive both, one, or no interventions delivered at two nurse home visits. The first intervention ("Soothe/Sleep") instructed parents on discriminating between hunger and other sources of infant distress. Soothing strategies were taught to minimize feeding for non-hunger-related fussiness and to prolong sleep duration, particularly at night. The second intervention ("Introduction of Solids") taught parents about hunger and satiety cues, the timing for the introduction of solid foods, and how to overcome infants' initial rejection of healthy foods through repeated exposure. A total of 110 mother-infant dyads completed the year-long study. At 1 year, infants who received both interventions had lower weight-for-length percentiles (P = 0.009). Participants receiving both interventions had a mean weight-for-length in the 33rd percentile; in contrast, those in other study groups were higher first intervention only--50th percentile; second intervention only--56th percentile; control group--50th percentile).This suggests that multicomponent behavioral interventions may have potential for long-term obesity prevention (ClinicalTrials.gov number, NCT00359242).
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
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Lo Presti R, Lai J, Hildebrandt T, Loeb KL. Psychological Treatments for Obesity in Youth and Adults. ACTA ACUST UNITED AC 2010; 77:472-87. [DOI: 10.1002/msj.20205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gender differences in the association between maternal smoking during pregnancy and childhood growth trajectories: multilevel analysis. Int J Obes (Lond) 2010; 35:53-9. [PMID: 20921965 DOI: 10.1038/ijo.2010.198] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Cooper R, Hyppönen E, Berry D, Power C. Associations between parental and offspring adiposity up to midlife: the contribution of adult lifestyle factors in the 1958 British Birth Cohort Study. Am J Clin Nutr 2010; 92:946-53. [PMID: 20702606 DOI: 10.3945/ajcn.2010.29477] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parent-offspring associations in adiposity are well known, but the extent to which they are explained by modifiable environmental and lifestyle factors remains to be elucidated. OBJECTIVES The objectives were to assess whether 1) parent-offspring associations in body mass index (BMI; in kg/m(2)) persist from childhood to midadulthood, 2) parental BMI is associated with the offspring's adult lifestyle, and 3) parent-offspring BMI associations in midadulthood are explained by lifestyle factors. DESIGN Participants in the 1958 British Birth Cohort Study and their parents (n = 9346) were examined. Parental BMI was assessed in 1969; offspring (ie, cohort members) BMI was ascertained prospectively at 11 and 44-45 y. Lifestyle factors of the offspring, including diet, physical activity, alcohol consumption, and smoking, were assessed prospectively in adulthood. RESULTS Maternal and paternal BMI were positively associated with offspring BMI in both childhood and midadulthood, and the strength of the association did not diminish with offspring age. Maternal BMI was associated with several offspring lifestyle factors across adulthood; fewer associations were observed for paternal BMI. Parent-offspring BMI associations in adulthood were largely maintained after adjustment for multiple lifestyle and socioeconomic factors at different life stages: if parental BMI was 1 unit higher, offspring BMI at 44-45 y was higher by between 0.21 and 0.29 units in adjusted models. CONCLUSIONS Strong parent-offspring BMI associations are maintained into midlife. These associations are largely unaffected by adjustment for a wide range of lifestyle factors. Offspring of obese parents are an important target for interventions aimed at reducing population levels of overweight and obesity.
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Affiliation(s)
- Rachel Cooper
- Medical Research Council Unit for Lifelong Health and Ageing and Division of Population Health, University College London, London, United Kingdom.
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Winter JD, Langenberg P, Krugman SD. Newborn adiposity by body mass index predicts childhood overweight. Clin Pediatr (Phila) 2010; 49:866-70. [PMID: 20522605 DOI: 10.1177/0009922810369698] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the association between adiposity at birth and in infancy with overweight at age 5 years. This study hypothesizes that adiposity at birth as approximated by body mass index (BMI) predicts childhood fatness. METHODS Anthropomorphic data from birth to 5 years were used to calculate BMI percentiles. Multiple logistic regression assessed the association between BMI percentile > or =85% at 2 weeks and BMI percentile > or =85% at 6, 12, 36, and 60 months. RESULTS Elevated BMI at age 2 weeks > or =85th percentile was associated with significant increases in risk of overweight at 6, 12, 36, and 60 months of age. Infants with a BMI at age 2 weeks > or =85th percentile had an adjusted odds ratio of 3.42 (95% confidence interval [CI] = 1.79, 6.50) and an adjusted risk ratio of 2.12 (95% CI = 1.71, 2.61) of being overweight at 60 months of age. CONCLUSIONS Adiposity at birth as approximated by BMI is a significant predictor of overweight at 5 years.
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Affiliation(s)
- Jonathan David Winter
- Shenandoah Valley Family Practice Residency, 140 West 11th Street, Front Royal, VA 22630, USA.
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Risk profiles for overweight/obesity among preschoolers. Early Hum Dev 2010; 86:563-8. [PMID: 20716472 DOI: 10.1016/j.earlhumdev.2010.07.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 04/29/2010] [Accepted: 07/16/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The epidemic of overweight/obesity among U.S. children has led to an alarming increase in health-related consequences, including early-onset diabetes and cardiovascular disease. Recent research has identified the independent contribution of several maternal and child factors to the development of childhood overweight/obesity. Few studies, however, have examined risk profiles of childhood obesity. AIM This study used classification and regression tree (CART) analysis to examine the combined effect of maternal and child factors in generating risk profiles for overweight/obesity among preschoolers. STUDY DESIGN Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) study were used. The sample was comprised of preschool children. CART and logistic regression models were built and compared. RESULTS Children who were overweight/obese at two years of age had an increased risk of being overweight/obese at four years of age. Children born to overweight/obese mothers were more likely to be overweight/obese by age four, even if their BMI at two years of age was normal. Children with high birth weight (> or = 4000 g.) were also more likely to be overweight/obese at age four years if they were born to mothers with a normal pregravid BMI, but were of a lower socioeconomic status. Among preschoolers whose mothers were black or white and who had a high pregravid BMI, breastfeeding duration and parity played an important role in determining their risk of being overweight/obese. CONCLUSIONS Classification tree analysis confirms and extends current knowledge of preschool overweight/obesity by providing preliminary risk profiles that are structured within the context of prenatal and postnatal maternal and child characteristics.
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Garn SM, Pilkington JJ. Comparison of three‐year weight and fat change distributions of lean and obese individuals. Ecol Food Nutr 2010. [DOI: 10.1080/03670244.1984.9990805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- Stanley M. Garn
- a Center for Human Growth and Development, Nutrition Unit, School of Public Health , University of Michigan , Ann Arbor, Michigan
| | - Stephen M. Bailey
- a Center for Human Growth and Development, Nutrition Unit, School of Public Health , University of Michigan , Ann Arbor, Michigan
| | - Patricia E. Cole
- a Center for Human Growth and Development, Nutrition Unit, School of Public Health , University of Michigan , Ann Arbor, Michigan
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Vilhjalmsdottir L, Ferris AG, Beal VA, Pellett PL. Short stature and overweight in infants of Western Massachusetts. Ecol Food Nutr 2010. [DOI: 10.1080/03670244.1979.9990554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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