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Laviolette C, Johnson CM, Butler JL, Biediger-Friedman L, Sharkey JR. Nutrition Effects of a Family-Centered Health Promotion Program for Mexican-Heritage Children in the Lower Rio Grande Valley of Texas. Nutrients 2023; 15:nu15071600. [PMID: 37049438 PMCID: PMC10097021 DOI: 10.3390/nu15071600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Systemic and social factors, like poverty and food insecurity, negatively influence fruit and vegetable (FV) intake and body mass index (BMI) among Latino/a children. Behavioral programs are needed to support children’s nutrition. This study examined program effects on FV intake and BMI outcomes for Mexican-heritage children (9–11 years). The program used a modified stepped-wedge design in the Lower Rio Grande Valley of Texas (2019 and 2020). Promotoras led experiential nutrition education sessions and collected height, weight, and instant skin carotenoid scores (biomarker for FV intake) at pre-test (baseline), post-test (6 weeks), and maintenance (3–4 months after post-test). Mean changes and group differences in skin carotenoid scores, BMI z-scores and percentiles were obtained from analyses of variance. Linear mixed-effects models were used to determine overall program effects. Mexican-heritage children were enrolled (n = 57 and 52.6% female). An overall decrease in skin carotenoid scores was observed at post-test (−15.1; 95% CI: −24.95, −5.33). While scores varied widely (range: 17–498), an increase of 14.8 ± 23.8 points occurred in one intervention group. Compared to the control period, greater reductions in BMI outcomes occurred during the program. These findings provide evidence for the use of strengths-based approaches in behavioral nutrition programs.
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Karssen LT, Larsen JK, Burk WJ, Kremers SPJ, Hermans RCJ, Ruiter ELM, Vink JM, de Weerth C. Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial. Front Public Health 2022; 10:1012431. [PMID: 36620259 PMCID: PMC9822729 DOI: 10.3389/fpubh.2022.1012431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP). Objective The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices. Methods A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles. Results Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI. Conclusions This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families. Trial registration Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.
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Affiliation(s)
- Levie T. Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands,*Correspondence: Levie T. Karssen ✉
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Stef P. J. Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Roel C. J. Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L. M. Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Strączek K, Horodnicka-Józwa A, Szmit-Domagalska J, Jackowski T, Safranow K, Petriczko E, Walczak M. Impact of One-Year Dietary Education on Change in Selected Anthropometric and Biochemical Parameters in Children with Excess Body Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11686. [PMID: 36141955 PMCID: PMC9517116 DOI: 10.3390/ijerph191811686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Obesity is regarded as a civilization disease that increases mortality and the risk of cardiovascular complications. In Poland, the prevalence of excess body weight in the paediatric population has been steadily increasing. The consequences of excess body weight in the developmental age population affect children's health and destabilize their development. Appropriate dietary interventions are the main non-invasive methods of preventing and treating obesity. They should be aimed at the whole family, optimally with the use of simple tools such as the Healthy Eating Pyramid. Due to the increasing prevalence of excess body weight in the developmental age population and the problems with the treatment of this condition, studies were undertaken in order to determine the impact of a dietary intervention on anthropometric and biochemical parameters in children with excess body weight. A total of 68 (72.3%) children completed the study. Based on BMI SDS, 59 (86.8%) were diagnosed with obesity and 9 (13.2%) with overweight. After the completion of the one-year dietary educational program, a significant improvement in weight loss, waist and hip circumference, as well as the value of the WHtR index was demonstrated. There was also a significant increase in the percentage of muscle tissue and a decrease in the content of adipose tissue in the bodies of examined children. A significant improvement in the parameters of carbohydrate metabolism, and almost all parameters of lipid metabolism, except for total cholesterol. A significant (by 28.0%) reduction in the incidence of fatty liver was also noted. No influence of dietary education on arterial blood pressure was observed.
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Affiliation(s)
- Kamilla Strączek
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Anita Horodnicka-Józwa
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Justyna Szmit-Domagalska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Tomasz Jackowski
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, 71-252 Szczecin, Poland
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Freedman DS, Goodwin Davies AJ, Phan TLT, Cole FS, Pajor N, Rao S, Eneli I, Kompaniyets L, Lange SJ, Christakis DA, Forrest CB. Measuring BMI change among children and adolescents. Pediatr Obes 2022; 17:e12889. [PMID: 35064761 PMCID: PMC11135243 DOI: 10.1111/ijpo.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Weight control programs for children monitor BMI changes using BMI z-scores that adjust BMI for the sex and age of the child. It is, however, uncertain if BMIz is the best metric for assessing BMI change. OBJECTIVE To identify which of 6 BMI metrics is optimal for assessing change. We considered a metric to be optimal if its short-term variability was consistent across the entire BMI distribution. SUBJECTS 285 643 2- to 17-year-olds with BMI measured 3 times over a 10- to 14-month period. METHODS We summarized each metric's variability using the within-child standard deviation. RESULTS Most metrics' initial or mean value correlated with short-term variability (|r| ~ 0.3 to 0.5). The metric for which the within-child variability was largely independent (r = 0.13) of the metric's initial or mean value was the percentage of the 50th expressed on a log scale. However, changes in this metric between the first and last visits were highly (r ≥ 0.97) correlated with changes in %95th and %50th. CONCLUSIONS Log %50 was the metric for which the short-term variability was largely independent of a child's BMI. Changes in log %50th, %95th, and %50th are strongly correlated.
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Affiliation(s)
- David S. Freedman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy J. Goodwin Davies
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thao-Ly Tam Phan
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - F. Sessions Cole
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Nathan Pajor
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado, Colorado, Aurora, USA
| | - Ihuoma Eneli
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samantha J. Lange
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dimitri A. Christakis
- Seattle Children’s Research Institute, University of Washington, Seattle, Washington, USA
| | - Christopher B. Forrest
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Yau KW, Tang TS, Görges M, Pinkney S, Kim AD, Kalia A, Amed S. Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review. JMIR Pediatr Parent 2022; 5:e34967. [PMID: 35343908 PMCID: PMC9002598 DOI: 10.2196/34967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. OBJECTIVE This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. METHODS MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. RESULTS Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ≥1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. CONCLUSIONS Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed.
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Affiliation(s)
- Kiana W Yau
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Matthias Görges
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Susan Pinkney
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Annie D Kim
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Angela Kalia
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Shazhan Amed
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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Strączek K, Horodnicka-Józwa A, Szmit-Domagalska J, Jackowski T, Safranow K, Petriczko E, Walczak M. Familial dietary intervention in children with excess body weight and its impact on eating habits, anthropometric and biochemical parameters. Front Endocrinol (Lausanne) 2022; 13:1034148. [PMID: 36531483 PMCID: PMC9751449 DOI: 10.3389/fendo.2022.1034148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Obesity is considered a civilisation disease which increases mortality and impairs quality of life, also among children and adolescents. The prevalence of overweight and obesity is steadily increasing in the developmental age population. Environmental factors are responsible for the main reason of excessive adipose tissue accumulation. Among these, poor eating habits and lack of exercise play the largest role. Familial prevalence of obesity and family dietary patterns also receive significant attention. Many specialists believe that the treatment of obesity should be multidirectional, effective and minimally invasive. Therefore, effective and safe methods are being investigated to effectively reduce body weight and improve eating habits. Dietary education programmes are an alternative to improve the health status of obese and overweight children and adolescents. To be fully effective, these programmes should involve the whole family. AIM OF THE STUDY In the face of constantly increasing prevalence of overweight and obesity in the developmental age population and the lack of effective methods to combat its occurrence, it seems appropriate to try to assess the effectiveness of a one-year-long dietary education of children and adolescents with excess body weight on their eating habits and the eating habits of their mothers, as well as selected anthropometric and biochemical parameters in these children using a simple educational tool, the Healthy Food Pyramid. PATIENTS AND METHODS The study group consisted of 68 children with overweight and obesity, patients of the Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age of the Pomeranian Medical University in Szczecin. The study used a proprietary questionnaire to assess dietary habits. Patients participated in six individual educational meetings over a twelve-month period. Eating habits were assessed in children and mothers before and after dietary intervention. Sixty-seven questionnaires before and after the dietary intervention were used for analysis. RESULTS Sixty-eight children completed the study. Those who did not complete the study came from families living in rural areas and their mothers mostly had primary or vocational education. One-year dietary education resulted in significant improvements in body weight, waist and hip circumference, WHtR and selected measured carbohydrate and lipid metabolism parameters with the exception of total cholesterol. The one-year dietary intervention did not have the same effect on the change in dietary habits in children and in their mothers.
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Affiliation(s)
- Kamilla Strączek
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
- *Correspondence: Kamilla Strączek,
| | - Anita Horodnicka-Józwa
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Justyna Szmit-Domagalska
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Jackowski
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Mieczysław Walczak
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
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Penilla C, Tschann JM, Pasch LA, Flores E, Deardorff J, Martinez SM, Butte NF, Greenspan LC. Style of meal service and feeding practices among Mexican American fathers and mothers: An analysis of video-recorded children's evening mealtime at home. Appetite 2021; 169:105851. [PMID: 34883137 DOI: 10.1016/j.appet.2021.105851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022]
Abstract
The aim of this study was to examine video-recorded observations of evening family mealtime at home among Mexican American children to help elucidate style of meal service, fathers' and mothers' feeding practices and child's eating behavior. Consistent with guidelines for coding behaviors, we analyzed observational data of evening mealtimes of 71 Mexican American children aged eight to 10 years. Regarding style of meal service, in almost all cases (96%), parents plated the child's food, with more available on the table or counter in 40% of the observations. Mothers almost always served the child (94%). Regarding parental feeding practices, parents used positive involvement in meals (80%), pressure to eat (42%) and restriction of food (9%). Using food as a reward to control behavior was never used by either parent. The majority (75%) of children requested or negotiated to eat less food, or only eat certain items. In Mexican American families, both mothers and fathers play a role in family mealtimes and both use positive involvement in child's meals, and to a lesser extent pressure to eat, with their children aged eight to 10 years. To help reduce the obesity epidemic, intervention strategies are needed, which integrate the family, a plating style of meal and parental feeding practices that promote healthy eating in the home. To reduce obesity among Mexican American children, interventions that focus on parental positive involvement in child's meal and maintenance of home cooked meals could have a positive impact on the entire family.
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Affiliation(s)
- Carlos Penilla
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, Box 0503, San Francisco, CA, 94118-0503, USA.
| | - Jeanne M Tschann
- Department of Psychiatry, University of California, San Francisco, Box 0848, San Francisco, CA, 94143-0848, USA.
| | - Lauri A Pasch
- Department of Psychiatry, University of California, San Francisco, Box 0848, San Francisco, CA, 94143-0848, USA.
| | - Elena Flores
- Department of Counseling Psychology, University of San Francisco, 2130 Fulton St, San Francisco, CA, 94118, USA.
| | - Julianna Deardorff
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720-7360, USA.
| | - Suzanna M Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
| | - Nancy F Butte
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, 1100 Bates St, Houston, TX, 77030-2600, USA.
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Nally S, Carlin A, Blackburn NE, Baird JS, Salmon J, Murphy MH, Gallagher AM. The Effectiveness of School-Based Interventions on Obesity-Related Behaviours in Primary School Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2021; 8:489. [PMID: 34201145 PMCID: PMC8228296 DOI: 10.3390/children8060489] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/11/2022]
Abstract
School-based interventions are promising for targeting a change in obesity-related behaviours in children. However, the efficacy of school-based interventions to prevent obesity remains unclear. This review examined the effectiveness of school-based interventions at changing obesity-related behaviours (increased physical activity, decreased sedentary behaviour and improved nutrition behaviour) and/or a change in BMI/BMI z-score. Following PRISMA guidelines, seven databases were systematically searched from 1 January 2009 to 31 December 2020. Two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias of each of the included studies. Forty-eight studies met the inclusion criteria and were included in a narrative synthesis. Thirty-eight studies were eligible for inclusion in a meta-analysis. The findings demonstrate that interventions in children when compared to controls resulted in a small positive treatment effect in the control group (2.14; 95% CI = 0.77, 3.50). There was no significant effect on sedentary behaviour, energy intake and fruit and vegetable intake. Significant reductions were found between groups in BMI kg/m2 (-0.39; 95% CI = -0.47, -0.30) and BMI z-score (-0.05; 95% CI = -0.08, -0.02) in favour of the intervention. The findings have important implications for future intervention research in terms of the effectiveness of intervention components and characteristics.
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Affiliation(s)
- Sarah Nally
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Jordanstown Campus, University of Ulster, Newtownabbey BT37 0QB, UK; (A.C.); (M.H.M.)
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Jordanstown Campus, University of Ulster, Newtownabbey BT37 0QB, UK; (A.C.); (M.H.M.)
| | - Nicole E. Blackburn
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, University of Ulster, Newtownabbey BT37 0QB, UK;
| | - Judith S. Baird
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Coleraine Campus, University of Ulster, Coleraine BT52 1SA, UK; (J.S.B.); (A.M.G.)
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia;
| | - Marie H. Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Jordanstown Campus, University of Ulster, Newtownabbey BT37 0QB, UK; (A.C.); (M.H.M.)
| | - Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Coleraine Campus, University of Ulster, Coleraine BT52 1SA, UK; (J.S.B.); (A.M.G.)
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Imoisili OE, Lundeen EA, Freedman DS, Womack LS, Wallace J, Hambidge SJ, Federico S, Everhart R, Harr D, Vance J, Kompaniyets L, Dooyema C, Park S, Blanck HM, Goodman AB. Body Mass Index and Blood Pressure Improvements With a Pediatric Weight Management Intervention at Federally Qualified Health Centers. Acad Pediatr 2021; 21:312-320. [PMID: 33279738 PMCID: PMC8091487 DOI: 10.1016/j.acap.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Mind, Exercise, Nutrition, Do It! 7-13 (MEND 7-13) program was adapted in 2016 by 5 Denver Health federally qualified health centers (DH FQHC) into MEND+, integrating clinician medical visits into the curriculum and tracking health measures within an electronic health record (EHR). We examined trajectories of body mass index (BMI, kg/m2) percentile, and systolic and diastolic blood pressures (SBP and DBP) among MEND+ attendees in an expanded age range of 4 to 17 years, and comparable nonattendees. METHODS Data from April 2015 to May 2018 were extracted from DH FQHC EHR for children eligible for MEND+ referral (BMI ≥85th percentile). The sample included 347 MEND+ attendees and 21,061 nonattendees. Mixed-effects models examined average rate of change for BMI percent of the 95th percentile (%BMIp95), SBP and DBP (mm Hg), after completion of the study period. RESULTS Most children were ages 7 to 13 years, half were male, and most were Hispanic. An average of 4.2 MEND+ clinical sessions were attended. Before MEND+, %BMIp95 increased by 0.247 units/month among MEND+ attendees. After attending, %BMIp95 decreased by 0.087 units/month (P < .001). Eligible nonattendees had an increase of 0.084/month in %BMIp95. Before MEND+ attendance, SBP and DBP increased by 0.041 and 0.022/month, respectively. After MEND+ attendance, SBP and DBP decreased by 0.254/month (P < .001) and 0.114/month (P < .01), respectively. SBP and DBP increased by 0.033 and 0.032/month in eligible nonattendees, respectively. CONCLUSIONS %BMIp95, SBP, and DBP significantly decreased among MEND+ attendees when implemented in community-based clinical practice settings at DH FQHC.
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Affiliation(s)
| | | | - David S. Freedman
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Lindsay S. Womack
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Ga; United States Public Health Service,Rockville, Md
| | | | | | | | | | - Delia Harr
- Denver Health Ambulatory Care Services, Denver, Co
| | | | - Lyudmyla Kompaniyets
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Carrie Dooyema
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Sohyun Park
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Heidi M. Blanck
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity,National, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga; United States Public Health Service, Rockville, Md
| | - Alyson B. Goodman
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga; United States Public Health Service, Rockville, Md
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10
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Fowler LA, Grammer AC, Staiano AE, Fitzsimmons-Craft EE, Chen L, Yaeger LH, Wilfley DE. Harnessing technological solutions for childhood obesity prevention and treatment: a systematic review and meta-analysis of current applications. Int J Obes (Lond) 2021; 45:957-981. [PMID: 33627775 PMCID: PMC7904036 DOI: 10.1038/s41366-021-00765-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/24/2020] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Technology holds promise for delivery of accessible, individualized, and destigmatized obesity prevention and treatment to youth. OBJECTIVES This review examined the efficacy of recent technology-based interventions on weight outcomes. METHODS Seven databases were searched in April 2020 following PRISMA guidelines. Inclusion criteria were: participants aged 1-18 y, use of technology in a prevention/treatment intervention for overweight/obesity; weight outcome; randomized controlled trial (RCT); and published after January 2014. Random effects models with inverse variance weighting estimated pooled mean effect sizes separately for treatment and prevention interventions. Meta-regressions examined the effect of technology type (telemedicine or technology-based), technology purpose (stand-alone or adjunct), comparator (active or no-contact control), delivery (to parent, child, or both), study type (pilot or not), child age, and intervention duration. FINDINGS In total, 3406 records were screened for inclusion; 55 studies representing 54 unique RCTs met inclusion criteria. Most (89%) included articles were of high or moderate quality. Thirty studies relied mostly or solely on technology for intervention delivery. Meta-analyses of the 20 prevention RCTs did not show a significant effect of prevention interventions on weight outcomes (d = 0.05, p = 0.52). The pooled mean effect size of n = 32 treatment RCTs showed a small, significant effect on weight outcomes (d = ‒0.13, p = 0.001), although 27 of 33 treatment studies (79%) did not find significant differences between treatment and comparators. There were significantly greater treatment effects on outcomes for pilot interventions, interventions delivered to the child compared to parent-delivered interventions, and as child age increased and intervention duration decreased. No other subgroup analyses were significant. CONCLUSIONS Recent technology-based interventions for the treatment of pediatric obesity show small effects on weight; however, evidence is inconclusive on the efficacy of technology based prevention interventions. Research is needed to determine the comparative effectiveness of technology-based interventions to gold-standard interventions and elucidate the potential for mHealth/eHealth to increase scalability and reduce costs while maximizing impact.
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Affiliation(s)
- Lauren A. Fowler
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Anne Claire Grammer
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Amanda E. Staiano
- grid.250514.70000 0001 2159 6024LSU’s Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Ellen E. Fitzsimmons-Craft
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Ling Chen
- grid.4367.60000 0001 2355 7002Division of Biostatistics, Washington University School of Medicine, St. Louis, MO USA
| | - Lauren H. Yaeger
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
| | - Denise E. Wilfley
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
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11
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El-Medany AY, Birch L, Hunt LP, Matson RI, Chong AH, Beynon R, Hamilton-Shield J, Perry R. What Change in Body Mass Index Is Required to Improve Cardiovascular Outcomes in Childhood and Adolescent Obesity through Lifestyle Interventions: A Meta-Regression. Child Obes 2020; 16:449-478. [PMID: 32780648 PMCID: PMC7575353 DOI: 10.1089/chi.2019.0286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Using meta-regression, this article aims at establishing the minimum change in BMI-standard deviation score (SDS) needed to improve lipid profiles and blood pressure in children and adolescents with obesity, to aid future trials and guidelines. Methods: Studies with participants involved in lifestyle interventions, aged 4-19 years, with a diagnosis of obesity according to defined BMI thresholds, were considered for inclusion in a large systematic review. Interventions had to report pre- and post-intervention (or mean change in) BMI-SDS, plus either systolic blood pressure (SBP), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and/or triglycerides (TGs). Random-effects meta-regression quantified the relationship between mean change in BMI-SDS and mean change in cardiovascular outcomes. Results: Seventy-one papers reported various cardiovascular measurements and mean change in BMI-SDS. Fifty-four, 59, 46, and 54 studies were analyzed, reporting a change in SBP, HDL, LDL, and TG, respectively. Reduction in mean BMI-SDS was significantly related to improvements in SBP, LDL, TG, and HDL (p < 0.05); BMI-SDS reductions of 1, 1.2, and 0.7 ensured a mean reduction of SBP, LDL, and TG, respectively, although an equivalent value for HDL improvement was indeterminate. Conclusion: Reductions in mean BMI-SDS of >1, >1.2, or >0.7 are likely to reduce SBP, LDL, and TG, respectively. Further studies are needed to clarify the optimal duration, intensity, and setting for interventions. Consistency is required regarding derived BMI values to facilitate future systematic reviews and meta-analyses.
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Affiliation(s)
- Ahmed Y.M. El-Medany
- Cardiology Department, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,Address correspondence to: Ahmed Y.M. El-Medany, MSc, Cardiology Department, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol BS2 8HW, United Kingdom
| | - Laura Birch
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Linda P. Hunt
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Rhys I.B. Matson
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Amanda H.W. Chong
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Rhona Beynon
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
| | - Julian Hamilton-Shield
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom.,Level 6 University Hospitals Bristol Education Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Rachel Perry
- Level 3 University Hospitals Bristol Education Centre, NIHR Bristol Biomedical Research Centre—Nutrition, Bristol, United Kingdom
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12
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Gow ML, Tee MSY, Garnett SP, Baur LA, Aldwell K, Thomas S, Lister NB, Paxton SJ, Jebeile H. Pediatric obesity treatment, self-esteem, and body image: A systematic review with meta-analysis. Pediatr Obes 2020; 15:e12600. [PMID: 32020780 DOI: 10.1111/ijpo.12600] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric obesity impacts on multiple domains of psychological health, including self-esteem and body image. OBJECTIVE To determine the effect of multicomponent pediatric obesity treatment interventions on self-esteem and body image. METHODS A systematic search of published literature up to June 2019 was undertaken using electronic databases MEDLINE, EMBASE, Cochrane Library, and PsychINFO. Eligible studies implemented an obesity treatment intervention, including a dietary and physical activity component with/without a behavioral component, in children and adolescents with overweight/obesity, and assessed self-esteem and/or body image. Data were extracted by one reviewer and cross-checked. Meta-analysis was used to combine outcome data and moderator analysis conducted to identify intervention characteristics influencing outcomes. RESULTS 64 studies were identified. Meta-analysis of 49 studies (n = 10471) indicated that pediatric obesity treatment results in increased self-esteem postintervention (standardized mean difference, [SE] 0.34 [0.03], P < .001, I2 87%), maintained at follow-up (0.35 [0.05] P < .001, I2 79%, 17 studies). Similarly, meta-analysis of 40 studies (n = 2729) indicated improvements in body image postintervention (0.40 [0.03], P < .001, I2 73%), maintained at follow-up (0.41 [0.08], P < .001, I2 89%, 16 studies). CONCLUSIONS Pediatric obesity treatment improves self-esteem and body image in the short and medium term. These findings may underpin improvements in other psychological outcomes.
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Affiliation(s)
- Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Melissa S Y Tee
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Weight Management Services, The Children's Hospital at Westmead, Sydney, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Sarah Thomas
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
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13
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Bayoumi NS, Helzner E, Afable A, Joseph MA, Dhuper S. A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population. BMC Pediatr 2019; 19:378. [PMID: 31651274 PMCID: PMC6813042 DOI: 10.1186/s12887-019-1763-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents. Methods The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2–19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%95 and BMI z-score. Results The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%95 at follow-up compared was − 3.0 (95% CI: − 5.0, − 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was − 0.15 (95% CI: − 0.2, − 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of − 15.3 mmHg (p < 0.0001) and − 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and − 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%95 was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043). Conclusions Participation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.
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Affiliation(s)
- Nagla S Bayoumi
- Department of Epidemiology & Biostatistics, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Elizabeth Helzner
- Department of Epidemiology & Biostatistics, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Aimee Afable
- Department of Community Health Sciences, SUNY Downstate Medical Center, School of Public Health, Brooklyn, NY, USA
| | - Michael A Joseph
- Department of Epidemiology & Biostatistics, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Sarita Dhuper
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, USA
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14
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Farnesi BC, Perez A, Holt NL, Morrison KM, Gokiert R, Legault L, Chanoine JP, Sharma AM, Ball GDC. Continued attendance for paediatric weight management: A multicentre, qualitative study of parents' reasons and facilitators. Clin Obes 2019; 9:e12304. [PMID: 30775853 DOI: 10.1111/cob.12304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/02/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
Although prolonged engagement in paediatric weight management (PWM) is associated with positive treatment outcomes, little is currently known about enablers of long-term programme attendance. The purpose of our study was to explore families' reasons for and facilitators of their continued attendance at health services for PWM. Semi-structured, individual interviews were conducted with parents of children (10-17 year old; body mass index ≥85th percentile) who completed the active phase of treatment in one of four Canadian multidisciplinary clinics for PWM. Interview data were recorded digitally, transcribed verbatim and analysed thematically. Parents' (n = 40) reasons for continued clinic attendance included ongoing concerns (eg, parental concern about their child's health), actual and expected benefits from treatment (eg, lifestyle improvements) and perceived quality of care (eg, structured, comprehensive, tailored health services). Several logistical and motivational factors contributed to continued attendance, including flexible work schedules, flexible appointment times, financial resources and children's motivation for treatment. Helping families address treatment barriers and ensuring that weight management services meet families' treatment expectations are promising strategies to enhance retention in PWM to optimize health outcomes.
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Affiliation(s)
| | - Arnaldo Perez
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - Katherine M Morrison
- Department of Pediatrics and Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Hamilton, Canada
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, Canada
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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15
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Spaeth AM, Hawley NL, Raynor HA, Jelalian E, Greer A, Crouter SE, Coffman DL, Carskadon MA, Owens JA, Wing RR, Hart CN. Sleep, energy balance, and meal timing in school-aged children. Sleep Med 2019; 60:139-144. [PMID: 30905623 DOI: 10.1016/j.sleep.2019.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine associations among objectively-measured nocturnal sleep time, bedtime and obesogenic behaviors, including dietary intake, timing of intake, and physical activity, in a diverse sample of school-aged children who presented for behavioral treatment to enhance sleep duration. METHODS Eighty-seven children (8-11 y, 66.7% female, zBMI: 0.86 ± 1.0) who self-reported sleeping <9.5 h/night were studied for one week using wrist actigraphy to estimate sleep; hip-worn accelerometers to measure physical activity; and 24 h dietary recalls to capture dietary intake and meal timing. Pearson and Spearman's rho correlations and linear regressions controlling for age, gender and race were used for statistical analyses. RESULTS AND CONCLUSION Mean bedtime was 10:31 PM (±58.2 min) and mean nocturnal sleep time was 7.7 h (±37.5 min). Although later bedtime was associated with shorter sleep time (r = -0.61, p < 0.001), the two variables were differentially related to obesity risk factors. Later bedtime, but not sleep time, correlated with greater daily fat intake, later first meal of the day, and greater after-dinner intake (all p < 0.05). Nocturnal sleep time, but not bedtime, correlated with zBMI (p = 0.04). Both sleep time and later bedtime were associated with a later last meal of the day (all p < 0.05). Findings remained consistent after controlling for demographic factors. In short-sleeping school-aged children, bedtime may be more predictive of dietary obesity risk factors whereas sleep duration may be more predictive of zBMI. Results suggest that health providers should consider both bedtime and sleep duration for reducing obesity risk in children. CLINICAL TRIAL Enhancing Sleep Duration: Effects on Children's Eating and Activity Behaviors, NCT03186508, https://clinicaltrials.gov/ct2/show/NCT03186508.
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Affiliation(s)
- Andrea M Spaeth
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA.
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Hollie A Raynor
- Department of Nutrition, College of Education, Health and Human Sciences, The University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, School of Medicine, Brown University, Providence, RI, USA
| | - Ashley Greer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Scott E Crouter
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Donna L Coffman
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, School of Medicine, Brown University, Providence, RI, USA
| | - Judith A Owens
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, School of Medicine, Brown University, Providence, RI, USA
| | - Chantelle N Hart
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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16
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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17
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Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits. Eur J Pediatr 2018; 177:1-12. [PMID: 29556792 DOI: 10.1007/s00431-018-3115-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 02/09/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive. CONCLUSIONS This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.
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Armstrong S, Mendelsohn A, Bennett G, Taveras EM, Kimberg A, Kemper AR. Texting Motivational Interviewing: A Randomized Controlled Trial of Motivational Interviewing Text Messages Designed to Augment Childhood Obesity Treatment. Child Obes 2018; 14:4-10. [PMID: 29019418 DOI: 10.1089/chi.2017.0089] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Text messages improve health outcomes for adults engaged in weight management. Little is known about whether text messaging parents of children enrolled in obesity treatment will improve child health. METHODS We conducted a 2-group randomized controlled study among 101 children aged 5-12 and their parent/guardian enrolling in tertiary-care obesity treatment. Participants were randomized to standard care or standard care plus daily motivational interviewing-based text messages. The primary outcome was change in child BMI at 3 months. Secondary outcomes included feasibility, health behaviors, attrition, motivation, and parent BMI. RESULTS We enrolled 101 parent-child dyads and retained 81% to 3-month follow-up. Child participants had a mean age of 9.9 years, and baseline BMI of 30.5 kg/m2. Half (48%) of participants were Black, and 64% of parent participants had a high school equivalent education or less. Ninety-nine percent of parents owned a mobile device with unlimited text messaging. Parents responded to 80% of texts, and 95% felt the texts "always" or "almost always" helped them make a good health decision. We observed no between-group difference in child zBMI from baseline to 3 months (0.0 vs. 0.2, p = 0.2). Intervention participants had significantly better adherence to clinic visits (3.3 visits vs. 2.1 visits/3 months, p < 0.001). CONCLUSIONS Parent-directed text messages did not significantly change child BMI. However, texting significantly reduced attrition for treatment visits. Nearly all parents in this racially diverse, low-income sample engaged in daily text messaging, making this a feasible approach.
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Affiliation(s)
- Sarah Armstrong
- 1 Department of Pediatrics, Duke University School of Medicine , Durham, NC
| | - Alan Mendelsohn
- 2 Division of Developmental Pediatrics, Department of Pediatrics, New York University School of Medicine , New York, NY.,3 Department of Population Health, New York University School of Medicine , New York, NY
| | - Gary Bennett
- 4 Department of Psychology and Neuroscience, Duke Digital Health Science Center, Duke Global Health Institute, Duke University , Durham, NC
| | - Elsie M Taveras
- 5 Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children , Harvard Medical School, Boston, MA
| | - Amanda Kimberg
- 6 Division of General Pediatrics and Psychiatry, Mt. Sinai School of Medicine , New York, NY
| | - Alex R Kemper
- 7 Division of Ambulatory Pediatrics, Nationwide Children's Hospital , Columbus, OH
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Berry DC, McMurray RG, Schwartz TA, Hall EG, Neal MN, Adatorwover R. A cluster randomized controlled trial for child and parent weight management: children and parents randomized to the intervention group have correlated changes in adiposity. BMC OBESITY 2017; 4:39. [PMID: 29225899 PMCID: PMC5715629 DOI: 10.1186/s40608-017-0175-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022]
Abstract
Background Studies have suggested that obesity is linked within families and that successful interventions involve both the parent and child with obesity. However little information exists regarding similarities in adiposity and weight loss between the parent and child, especially in low socio-economic ethnically diverse households. Methods The purpose of this study was to examine the relationships between the changes from baseline over time in adiposity, weight, health behaviors, and self-efficacy in children (n = 184) and parents (n = 184) participating in an 18-month weight loss program. Within the intervention group only and for each post-baseline time point, Pearson correlation coefficients were computed for children's changes (from baseline) in adiposity, weight, health behaviors, and self-efficacy, with their parents' corresponding changes from baseline, to determine how strongly the dyads were correlated. Results At the completion of 18 months, the intervention group parents demonstrated strong positive correlations between parent and child change in waist circumference (r = 0.409, p < 0.001), triceps (r = 0.332, p < 0.001), and subscapular (r = 0.292, p = 0.002) skinfolds. There were no significant correlations between weight, health behaviors, eating, and exercise self-efficacy. Conclusions The results suggest that in the Southern United States low-income parents and their children with obesity are strongly correlated. Trial registration NCT01378806 Retrospectively Registered on June 22, 2011.
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Affiliation(s)
- Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Robert G. McMurray
- Department of Exercise and Sport Science, Department of Nutrition, The University of North Carolina at Chapel Hill, Campus Box 8700, Chapel Hill, NC 27599-8700 USA
| | - Todd A. Schwartz
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7420, Chapel Hill, NC 27599-7420 USA
| | - Emily G. Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Madeline N. Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Reuben Adatorwover
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7420, Chapel Hill, NC 27599-7420 USA
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Dupart G, Berry DC, D’Auria J, Sharpe L, McDonough L, Houser M, Flanary S, Koppelberger S. A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting. J Sch Nurs 2017; 35:178-188. [DOI: 10.1177/1059840517744020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45–60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.
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Affiliation(s)
- Gary Dupart
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer D’Auria
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Sharpe
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Butte NF, Hoelscher DM, Barlow SE, Pont S, Durand C, Vandewater EA, Liu Y, Adolph AL, Pérez A, Wilson TA, Gonzalez A, Puyau MR, Sharma SV, Byrd-Williams C, Oluyomi A, Huang T, Finkelstein EA, Sacher PM, Kelder SH. Efficacy of a Community- Versus Primary Care-Centered Program for Childhood Obesity: TX CORD RCT. Obesity (Silver Spring) 2017; 25:1584-1593. [PMID: 28703504 DOI: 10.1002/oby.21929] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This randomized controlled trial was conducted to determine comparative efficacy of a 12-month community-centered weight management program (MEND2-5 for ages 2-5 or MEND/CATCH6-12 for ages 6-12) against a primary care-centered program (Next Steps) in low-income children. METHODS Five hundred forty-nine Hispanic and black children (BMI ≥ 85th percentile), stratified by age groups (2-5, 6-8, and 9-12 years), were randomly assigned to MEND2-5 (27 contact hours)/MEND/CATCH6-12 (121.5 contact hours) or Next Steps (8 contact hours). Primary (BMI value at the 95th percentile [%BMIp95 ]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase). RESULTS For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMIp95 than Next Steps during the Intensive Phase. Effect size (95% CI) was -1.94 (-3.88, -0.01) percentage points (P = 0.05). For age group 9-12, effect size was -1.38 (-2.87, 0.16) percentage points for %BMIp95 (P = 0.07). MEND2-5 did not differentially affect %BMIp95 . Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMIp95 during the Intensive Phase (P < 0.05). In the Transition Phase, %BMIp95 was maintained or rebounded in both programs (P < 0.05). CONCLUSIONS MEND/CATCH6-12 was more efficacious for BMI reduction at 3 months but not 12 months compared to Next Steps in underserved children. Intervention compliance influenced outcomes, emphasizing the need for research in sustaining family engagement in low-income populations.
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Affiliation(s)
- Nancy F Butte
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Sarah E Barlow
- Children's Health, GI Practice, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Casey Durand
- Center for Systems and Community Design; Department of Community Health and Social Sciences; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Elizabeth A Vandewater
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Yan Liu
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anne L Adolph
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Theresa A Wilson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandra Gonzalez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Maurice R Puyau
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Shreela V Sharma
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Courtney Byrd-Williams
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Abiodun Oluyomi
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
| | - Terry Huang
- Center for Systems and Community Design; Department of Community Health and Social Sciences; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Eric A Finkelstein
- Duke University Global Health Institute, Durham, North Carolina, USA, and Duke-NUS Medical School, Singapore
| | - Paul M Sacher
- Childhood Nutrition Research Centre, University College-London, London, UK
| | - Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA
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Mollerup PM, Gamborg M, Trier C, Bøjsøe C, Nielsen TRH, Baker JL, Holm JC. A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting. PLoS One 2017; 12:e0173033. [PMID: 28264043 PMCID: PMC5338817 DOI: 10.1371/journal.pone.0173033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/13/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. METHODS In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations. Changes in BMI SDS and WC were analyzed using linear mixed models based upon the repeated measures in each child. RESULTS From June 2012 to January 2015, 1,001 children (455 boys) were consecutively enrolled in the community-based treatment program. Upon entry, the median age was 11 years (range: 3-18), and the median BMI SDS was 2.85 (range: 1.26-8.96) in boys and 2.48 (range: 1.08-4.41) in girls. After 1.5 years of treatment BMI SDS was reduced in 74% of the children. BMI SDS was reduced by a mean of 0.38 (95% confidence interval (CI): 0.30-0.45, p<0.0001) in boys and 0.18 (95% CI: 0.12-0.25, p<0.0001) in girls after 1.5 years of treatment, independently of baseline age, BMI SDS, and Tanner stage (all p>0.08). WC was reduced by a mean of 3.8 cm (95% CI: 2.7-4.9, p>0.0001) in boys and 5.1 cm (95% CI: 4.0-6.2, p>0.0001) in girls. The dropout rate was 31% after 1.5 years. A median of 4.5 consultation hours was invested per child per year. CONCLUSION BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility.
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Affiliation(s)
- Pernille Maria Mollerup
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Michael Gamborg
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
| | - Cæcilie Trier
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Christine Bøjsøe
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Tenna Ruest Haarmark Nielsen
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer Lyn Baker
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Mollerup PM, Nielsen TRH, Bøjsøe C, Kloppenborg JT, Baker JL, Holm JC. Quality of life improves in children and adolescents during a community-based overweight and obesity treatment. Qual Life Res 2017; 26:1597-1608. [PMID: 28213684 DOI: 10.1007/s11136-017-1504-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity. METHODS Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). RESULTS Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001). CONCLUSIONS Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS. TRIAL REGISTRATION Clinicaltrials.gov, ID-no.: NCT02013843.
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Affiliation(s)
- Pernille M Mollerup
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark.
| | - Tenna R H Nielsen
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
| | - Christine Bøjsøe
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
| | - Julie T Kloppenborg
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- Department of Paediatrics, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Jennifer L Baker
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Jens-Christian Holm
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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Elvsaas IKØ, Giske L, Fure B, Juvet LK. Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses. J Obes 2017; 2017:5021902. [PMID: 29391949 PMCID: PMC5748119 DOI: 10.1155/2017/5021902] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Treatment of childhood obesity is important in preventing development of obesity-related diseases later in life. This systematic review evaluates the effect of multicomponent lifestyle interventions for children and adolescents from 2 to 18 years. METHODS AND RESULTS We performed systematic searches in nine databases. Thirty-nine studies met the criteria for meta-analyses. We found a significant difference in body mass index (BMI) after 6 months (MD -0.99 (95% CI -1.36 to -0.61)), 12 months (MD -0.67 (95% CI -1.01 to -0.32)), and 24 months (MD -0.96 (95% CI -1.63 to -0.29)) in favour of multicomponent lifestyle interventions compared to standard, minimal, and no treatment. We also found a significant difference in BMI Z scores after 6 months (MD -0.12 (95% CI -0.17 to -0.06)), 12 months (MD -0.16 (95% CI -0.21 to -0.11)), and 24 months (MD -0.16 (95% CI -0.21 to -0.10)) in favour of multicomponent lifestyle interventions. Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention. CONCLUSION Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMI Z score after 6, 12, and 24 months compared with standard, minimal, and no treatment.
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Affiliation(s)
| | - L. Giske
- Norwegian Institute of Public Health, Oslo, Norway
| | - B. Fure
- Norwegian Institute of Public Health, Oslo, Norway
- The Arctic University of Norway, Tromsø, Norway
| | - L. K. Juvet
- Norwegian Institute of Public Health, Oslo, Norway
- University College of Southeast Norway, Notodden, Norway
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25
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Nobles J, Radley D, Dimitri P, Sharman K. Psychosocial Interventions in the Treatment of Severe Adolescent Obesity: The SHINE Program. J Adolesc Health 2016; 59:523-529. [PMID: 27544459 DOI: 10.1016/j.jadohealth.2016.06.014] [Citation(s) in RCA: 12] [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] [Received: 04/08/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Psychosocial interventions (PSIs) are characterized by three phases: (1) an initial in-depth assessment, (2) an intensive multifaceted intervention to stem a condition, and (3) an extensive maintenance program. PSIs are often used for treatment of mental health conditions; however, applicability in the treatment of adolescent obesity is unknown. This article sought to evaluate the service-level outcomes of a PSI for young people (aged 10-17) with severe obesity. METHODS A retrospective evaluation of participants attending the Self Help, Independence, Nutrition and Exercise program between 2011 and 2016 (n = 435; age: 13.1 ± 2.1 years, male: 51%, white: 87.4%, body mass index [BMI]: 33.5 ± 7.5 kg/m2, standardized BMI [BMI SDS]: 3.1 ± .5 units). Anthropometric measurements (BMI and waist circumference) were collected at baseline, 3, 6, 9, and 12 months. Psychosocial measures (anxiety, depression, and self-esteem) were collected at baseline and 3 months. Participant retention was also assessed. RESULTS After 3 months, 95% of participants remained with a mean BMI SDS reduction of .19 units (95% confidence interval: .17, .21). Anxiety, depression, and self-esteem improved by 50%, 54%, and 38%, respectively. BMI SDS reductions of .29, .35, and .41 units were found at 6, 9, and 12 months. Fifty-four percent of participants chose to attend the final intervention phase. A higher baseline BMI SDS and a greater reduction in BMI SDS predicted final intervention phase attendance. CONCLUSIONS The Self Help, Independence, Nutrition and Exercise PSI demonstrated positive mean reductions in all measurements across all time points. In contrast to other community-based weight management services, these results suggest the utility of, and further exploration of, PSIs in the treatment of severe adolescent obesity.
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Affiliation(s)
- James Nobles
- Institute of Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, United Kingdom.
| | - Duncan Radley
- Institute of Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, United Kingdom
| | - Paul Dimitri
- Department of Paediatric Endocrinology, The Academic Unit of Child Health, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Kath Sharman
- SHINE Health Academy Ltd., Sheffield, United Kingdom
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Pojednic R, Peabody S, Carson S, Kennedy M, Bevans K, Phillips EM. The effect of before school physical activity on child development: A study protocol to evaluate the Build Our Kids Success (BOKS) Program. Contemp Clin Trials 2016; 49:103-8. [PMID: 27339866 DOI: 10.1016/j.cct.2016.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Most childhood physical activity interventions focus on reducing childhood obesity with varying success, indicating that body mass index (BMI) may be a limited marker of health in children. To better understand overall childhood health and wellbeing, this study is investigating BOKS (Build Our Kids Success), an established ongoing before-school physical activity program, to evaluate students' physical health, mental health, cognitive capacity, and academic performance. DESIGN AND METHODS The study is a non-randomized controlled trial with 26 elementary and middle schools in 3 Massachusetts communities, including first through eighth grade (aged 5-14) students, their parents, and teachers. Data collection is occurring during the 2015-2016 school year. Physical fitness is being assessed via 400m run and anthropometrics via height and weight measures (BMI). Psychosocial outcomes are being assessed via student, parent, and teacher survey and include nutrition, daily activities, emotional and relationship scales, bullying and victimization, vitality and energy, student engagement, stress, positive affect, self-efficacy and life satisfaction. Academic performance is reported by grades. Statistical methods include a psychometric evaluation of study measures, Pearson correlations, Student's t-tests, ANOVA/ANCOVA and multivariate linear regression including multilevel modeling analyses to account for the hierarchical organization of the data. DISCUSSION This study is investigating a before school physical activity program on parameters of physical health, mental health, cognitive capacity, and academic performance by employing a novel triad approach, correlating the input of the child, parent, and teacher. Outcomes will evaluate the effectiveness of a before school physical activity program in elementary and middle schools and potentially provide valuable information for schools looking to institute innovative physical activity programs.
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Affiliation(s)
- Rachele Pojednic
- Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
| | - Stephanie Peabody
- Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Shelley Carson
- Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Mary Kennedy
- Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Katherine Bevans
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Edward M Phillips
- Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
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Hampl S, Odar Stough C, Poppert Cordts K, Best C, Blackburn K, Dreyer Gillette ML. Effectiveness of a Hospital-Based Multidisciplinary Pediatric Weight Management Program: Two-Year Outcomes of PHIT Kids. Child Obes 2016; 12:20-5. [PMID: 26790094 DOI: 10.1089/chi.2014.0119] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For children with obesity, long-term sustainability of weight loss after treatment is difficult to achieve. This study examined 2-year anthropometric outcomes of a moderately intensive group behaviorally based weight management program. METHODS One hundred seventy-three children with obesity ages 8-18 years participated with their parent or adult caregiver in a 24-week multicomponent intervention, which was followed by monthly sessions for a total of 2 years. Children were considered treatment completers if they attended ≥50% of the 24 weekly sessions. A multilevel model (multiple assessment time points nested within participants) was used to test person-level change in BMI z-score (BMIz) for program completers between (1) pre- and post-treatment, (2) pretreatment and 24-month follow-up, (3) post-treatment and 12-month follow-up, and (4) post-treatment and 24-month follow-up. RESULTS One hundred twenty-four (72%) of the participants completed the 24-week intervention. Significant reductions in BMIz were observed over the course of treatment (β = -0.03; standard error [SE] = 0.004; t = -6.85; p < 0.001). Completers showed a significant reduction in BMIz between initiation of treatment and 2-year follow-up (n = 110 at 24 weeks; n = 38 at 24 months; β = -0.02; SE = 0.005; t = -4.12; p < 0.001). Children did not show any significant changes in BMIz between post-treatment and 24-month follow-up (β = -0.006; SE = 0.011; t = -0.61; p = 0.54), suggesting that treatment effects were maintained. CONCLUSIONS Children maintained treatment gains achieved during a 24-week family-based behavioral weight management program at 2-year follow-up. Although these findings suggest that gains are sustainable, further research is needed to understand how these long-term changes impact child health.
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Affiliation(s)
- Sarah Hampl
- 1 Department of Pediatrics, Children's Mercy Hospital , Kansas City, MO.,2 Center for Children's Healthy Lifestyles and Nutrition , Kansas City, MO
| | | | | | - Cora Best
- 4 Division of Nutritional Sciences, College of Human Ecology, Cornell University , Ithaca, NY
| | - Katherine Blackburn
- 5 Department of Health Outcomes and Policy, University of Florida College of Medicine , Gainesville, FL
| | - Meredith L Dreyer Gillette
- 1 Department of Pediatrics, Children's Mercy Hospital , Kansas City, MO.,2 Center for Children's Healthy Lifestyles and Nutrition , Kansas City, MO
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Kolotourou M, Radley D, Gammon C, Smith L, Chadwick P, Sacher PM. Long-Term Outcomes following the MEND 7-13 Child Weight Management Program. Child Obes 2015; 11:325-30. [PMID: 25764056 DOI: 10.1089/chi.2014.0092] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the current study, we report outcomes 2.4 years from baseline in a random subsample of overweight and obese children who attended MEND 7-13 programs delivered in UK community settings under service level conditions. METHODS The study employed an uncontrolled pre-follow-up design. A total of 165 children were measured. Outcomes included anthropometry, parental perception of emotional distress, body esteem, and self-esteem. RESULTS Overall, there were significant improvements in all outcomes apart from BMI z-score. In boys, BMI z-score, waist circumference z-score, and psychometrics all improved. In girls, there were no statistically significant differences at 2.4 years, except for body esteem. CONCLUSIONS In real-world settings, the MEND intervention, when delivered by nonspecialists, may result in modest, yet positive, long-term outcomes. Subsequent research should focus on improving the outcome effect size, providing effective behavior change maintenance strategies, and further investigating the reasons behind the observed gender differences.
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Affiliation(s)
| | - Duncan Radley
- 2Leeds Metropolitan University, School of Sport, Carnegie Faculty, Leeds, United Kingdom
| | - Catherine Gammon
- 3Department of Kinesiology, Michigan State University, East Lansing, MI
| | - Lindsey Smith
- 4University of Derby, Department of Sport and Exercise Science, Derby, United Kingdom
| | - Paul Chadwick
- 5Department of Diabetes, Royal Free Hampstead NHS Trust, London, United Kingdom
| | - Paul M Sacher
- 1Mytime Active, Bromley, United Kingdom
- 6Childhood Nutrition Research Center, University College London, Institute of Child Health, London, United Kingdom
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Godin K, Leatherdale ST, Elton-Marshall T. A systematic review of the effectiveness of school-based obesity prevention programmes for First Nations, Inuit and Métis youth in Canada. Clin Obes 2015; 5:103-15. [PMID: 25880029 DOI: 10.1111/cob.12099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/10/2015] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Abstract
First Nations, Inuit and Métis (FNIM) youth are disproportionately affected by obesity and represent known a high-risk group in Canada. School-based prevention programmes may have the potential to effectively influence obesity-related health behaviours (i.e. healthy eating and physical activity) among this population. We conducted a systematic review of nine electronic databases (2003-2014) to identify studies that describe school-based programmes that have been developed to improve obesity-related health behaviours and outcomes among FNIM youth in Canada. The objectives of this review were to identify and evaluate the effectiveness of these programmes and assess the strength of the methodologies used to evaluate them. Fifteen studies, representing seven distinct interventions, met our inclusion criteria. The majority of these programmes did not result in significant improvements in outcomes related to obesity, healthy eating, or physical activity among FNIM youth. The studies varied in design rigour and use of evaluation activities. The lack of literature on effective school-based programmes for FNIM youth in Canada that target obesity-related outcomes highlights a priority area for future intervention development, evaluation and dissemination within the peer-reviewed literature. Further research is needed on interventions involving Métis and Inuit youth, secondary school-aged FNIM youth and FNIM youth living in urban settings.
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Affiliation(s)
- K Godin
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - S T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - T Elton-Marshall
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Canada
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Cao ZJ, Wang SM, Chen Y. A randomized trial of multiple interventions for childhood obesity in China. Am J Prev Med 2015; 48:552-60. [PMID: 25891054 DOI: 10.1016/j.amepre.2014.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 12/08/2014] [Accepted: 12/17/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Family- and school-based interventions for childhood obesity have been widely applied; however, the prevalence of childhood obesity remains high. The purpose of this RCT is to evaluate the effectiveness of a family-individual-school-based comprehensive intervention model. DESIGN Cluster RCT. SETTING/PARTICIPANTS Fourteen primary schools were selected from 26 primary schools in a district of Shanghai, China, and then randomly divided into intervention and control groups with seven schools in each. The trial started with first-grade students. A total of 1,287 students in the intervention group and 1,159 in the control group were studied overall. INTERVENTION The baseline study was conducted in January 2011, and family-individual-school-based interventions started in March 2011 and ended in December 2013 for intervention group students. Three follow-up studies were conducted in January 2012, January 2013, and January 2014. Data analysis was conducted in March 2014. MAIN OUTCOME MEASURES Students' weight and height were measured. The prevalence of obesity/overweight and BMI z-scores were calculated and analyzed using a generalized estimating equation approach. RESULTS The overall prevalence of overweight/obesity declined from 28.92% in 2011 to 24.77% in 2014, with a difference of 4.15% in the intervention group compared with a 0.03% decline (from 30.71% to 30.68%) in the control group. The intervention group had significantly lower odds of developing obesity or overweight and had decreased average BMI z-scores compared with the control group, especially for obese or overweight students. CONCLUSIONS The family-individual-school-based comprehensive intervention model is effective for controlling childhood obesity and overweight.
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Affiliation(s)
- Zhi-Juan Cao
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Xuhui District, Shanghai, China
| | - Shu-Mei Wang
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Xuhui District, Shanghai, China.
| | - Yue Chen
- Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Ottawa, Canada
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Peirson L, Fitzpatrick-Lewis D, Morrison K, Warren R, Usman Ali M, Raina P. Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis. CMAJ Open 2015; 3:E35-46. [PMID: 25844368 PMCID: PMC4382035 DOI: 10.9778/cmajo.20140047] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Childhood obesity is a public health concern. One-third of North American children and youth are overweight or obese. We reviewed the evidence of behavioural and pharmacological weight-management interventions on body mass index (BMI), BMI z-score and the prevalence of overweight and obesity in children and youth. METHODS We updated the search of a previous review. We searched 4 databases up to August 2013. We included randomized trials of primary care-relevant behavioural (diet, exercise, lifestyle) and pharmacological (orlistat) interventions for treating overweight and obesity in children and youth aged 2-18 years if 6-month post-baseline data were provided for BMI, BMI z-score or prevalence of overweight and obesity. In addition, we examined secondary health outcomes such as lipid and glucose levels, blood pressure, quality of life and physical fitness. We included any study reporting harms. We performed meta-analyses when possible, and we examined the features of interventions that showed benefits. RESULTS Thirty-one studies (29 behavioural, 2 pharmacological and behavioural) were included. Both intervention types showed a significant effect on BMI or BMI z-score in favour of treatment (behavioural: standardized mean difference [SMD] -0.54, 95% confidence interval [CI] -0.73 to -0.36; orlistat plus behavioural: SMD -0.43, 95% CI -0.60 to -0.25). Studies reported no significant difference between groups in the likelihood of reduced prevalence of overweight or overweight and obesity. Pooled estimates for blood pressure and quality of life showed significant benefits in favour of treatment (systolic blood pressure mean difference [MD] -3.42, 95% CI -6.65 to -0.29; diastolic blood pressure MD -3.39, 95% CI -5.17 to -1.60; quality of life MD 2.10, 95% CI 0.60 to 3.60). Gastrointestinal difficulties were more common in youth taking orlistat than in the control group (risk ratio 3.77, 95% CI 2.56 to 5.55). We saw much variability across efficacious interventions. INTERPRETATION Low- to moderate-quality evidence suggests behavioural treatments are associated with a medium effect in terms of reduced BMI or BMI z-score compared with a small effect shown by combined pharmacological-behavioural interventions. Future research should evaluate active weight maintenance interventions in adolescents with longer follow-up and examine the effectiveness of combined pharmacological and behavioural interventions. REGISTRATION PROSPERO no. CRD42012002754.
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Affiliation(s)
- Leslea Peirson
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario
- School of Nursing, McMaster University, Hamilton, Ontario
| | - Donna Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario
- School of Nursing, McMaster University, Hamilton, Ontario
| | | | - Rachel Warren
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario
- School of Nursing, McMaster University, Hamilton, Ontario
| | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ontario
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
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van Nassau F, Singh AS, van Mechelen W, Brug J, Chinapaw MJM. Body mass index, waist circumference and skin-fold thickness in 12- to 14-year-old Dutch adolescents: differences between 2003 and 2011. Pediatr Obes 2014; 9:e137-40. [PMID: 25044777 DOI: 10.1111/ijpo.233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to compare anthropometrics of 12- to 14-year-old Dutch adolescents attending lower levels of education in 2011 with adolescents measured in 2003. METHODS We used baseline data from two trials evaluating a school-based obesity prevention programme in 2003 (randomized controlled trial with 18 schools) and in 2011 (cluster controlled trial with 29 schools). We measured adolescents' body height and weight, skin-fold thickness, and waist circumference in 2003 (n = 1000; response rate 76%) and 2011 (n = 1898; response rate 86%). We used multivariable multilevel linear or logistic regression analyses stratifying for gender, ethnicity and prevocational education track (vocational or theoretical) where appropriate. RESULTS In boys, prevalence of overweight, waist circumference, triceps, biceps and subscapular skin-folds were significantly higher in 2011. This was also true for vocational girls, except for the subscapular skin-fold. Girls, attending the theoretical track, had a significantly larger waist circumference, but thinner subscapular and suprailiac skin-fold thickness in 2011. CONCLUSIONS The increased prevalence of overweight and obesity in Dutch adolescents attending prevocational education is worrisome. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN87127361 and Current Controlled Trials ISRCTN92755979.
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Affiliation(s)
- F van Nassau
- EMGO Institute for Health and Care Research and the Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
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Clarson CL, Brown HK, De Jesus S, Jackman M, Mahmud FH, Prapavessis H, Robinson T, Shoemaker JK, Watson M, Dowd AJ, Hill DJ. Effects of a Comprehensive, Intensive Lifestyle Intervention Combined with Metformin Extended Release in Obese Adolescents. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:659410. [PMID: 27433488 PMCID: PMC4897295 DOI: 10.1155/2014/659410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 12/13/2022]
Abstract
Objective. To assess a comprehensive, intensive lifestyle intervention in combination with metformin extended release (MXR) or placebo on body mass index (BMI) and risk factors for type 2 diabetes and cardiovascular disease in obese adolescents. Study Design. Sixty-nineobese adolescents (mean BMI 32.5) received a comprehensive lifestyle intervention with structured dietary, physical activity, and behavioral components for 24 months. Subjects were randomized to 1 of 4 groups: MXR (33) 2,000 mg daily or placebo, with either moderate or vigorous intensity exercise for the first 3 months. Subsequently the exercise intervention was the same for all 4 groups. Results. Anthropometry measurements did not differ with initial exercise intensity at any time. At 3 months % body fat decreased in all 4 groups (P < 0.006). BMI and % body fat decreased in the MXR groups, but not the placebo groups, at 6 (-0.88, -3.16) and 12 months (-0.56, -2.34) (P < 0.05). Insulin resistance, fasting blood glucose, and leptin improved in all groups at 6 and 12 months. A high subject attrition rate (58%) occurred by 24 months. Conclusion. A comprehensive, intensive lifestyle intervention combined with MXR led to a decline in BMI and % body fat at 1 year independent of initial exercise intensity. This trial is registered with ClinicalTrials.gov NCT00934570 .
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Affiliation(s)
- Cheril L. Clarson
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Paediatrics, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Hilary K. Brown
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Stefanie De Jesus
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Michelle Jackman
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - Farid H. Mahmud
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - Harry Prapavessis
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Tracy Robinson
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - J. Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Margaret Watson
- Children's Hospital, London Health Sciences Centre, P.O. Box 5010, London, ON, Canada N6A 5W9
| | - A. Justine Dowd
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - David J. Hill
- Lawson Health Research Institute, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada N6A 5A5
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Berry DC, Schwartz TA, McMurray RG, Skelly AH, Neal M, Hall EG, Aimyong N, Amatuli DJ, Melkus G. The family partners for health study: a cluster randomized controlled trial for child and parent weight management. Nutr Diabetes 2014; 4:e101. [PMID: 24418827 PMCID: PMC3904082 DOI: 10.1038/nutd.2013.42] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this study was to test a two-phased nutrition and exercise education, coping skills training, and exercise intervention program for overweight or obese low-income ethnic minority 2nd to 4th grade children and their parents in rural North Carolina, USA. METHODS A cluster randomized controlled trial was carried out with 358 children (7-10 years) and a parent for each child (n=358). General linear mixed models were used to determine the effects of the intervention on weight, adiposity, health behaviors, and eating and exercise self-efficacy by examining changes in children and parents from baseline to completion of the study (18 months). RESULTS At 18 months, children in the experimental group did not have a significantly decreased body mass index (BMI) percentile (P=0.470); however, they showed a reduction in the growth rate of their triceps (P=0.001) and subscapular skinfolds (P<0.001) and an improvement in dietary knowledge (P=0.018) and drank less than one glass of soda per day (P=0.052) compared with the control group. Parents in the experimental group had decreased BMI (P=0.001), triceps (P<0.001) and subscapular skinfolds (P<0.001) and increased nutrition (P=0.003) and exercise (P<0.001) knowledge and more often drank water or unsweetened drinks (P=0.029). At 18 months, children in the experimental group did not show significant improvement in eating (P=0.956) or exercise self-efficacy (P=0.976). Experimental parents demonstrated improved socially acceptable eating self-efficacy (P=0.013); however, they did not show significant improvement in self-efficacy pertaining to emotional eating (P=0.155) and exercise (P=0.680). CONCLUSION The results suggest that inclusion of children and parents in the same intervention program is an effective way to decrease adiposity and improve nutrition behaviors in both children and parents and improve weight and eating self-efficacy in parents.
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Affiliation(s)
- D C Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Schwartz
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R G McMurray
- School of Exercise and Sport Science and Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A H Skelly
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E G Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N Aimyong
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D J Amatuli
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G Melkus
- School of Nursing, Muriel and Virginia Pless Center for Nursing Research, New York University, New York, NY, USA
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