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Ramel M, Wilfley DE, Tabak R, Lew D, Moursi NA, Kilanowski C, Cook SR, Eneli IU, Quattrin T, Schechtman KB, Epstein LH. Relationships examined: Parent and child readiness to change and sociodemographic characteristics in family based weight loss treatment. Pediatr Obes 2023; 18:e13062. [PMID: 37282798 PMCID: PMC11342443 DOI: 10.1111/ijpo.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Family based treatment is an effective, multipronged approach to address obesity as it plagues families. OBJECTIVE To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study. METHODS Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline. RESULTS A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (-0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, -0.10, p < 0.05), and Other, non-Hispanic (-0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non-Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change. CONCLUSIONS Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.
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Affiliation(s)
- Melissa Ramel
- Department of Family and Consumer Sciences, Fontbonne University, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Nasreen A. Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Ihouma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth B. Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Sease KK, Rolke LJ, Forrester JE, Griffin SF. Feedback Following a Family-Focused Pediatric Weight Management Intervention: Experiences From the New Impact Program. J Patient Exp 2021; 8:23743735211008309. [PMID: 34179436 PMCID: PMC8205377 DOI: 10.1177/23743735211008309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Weight management interventions have the potential to reduce body mass index and help families adopt healthier behaviors. This study examined feedback from families to identify central aspects of various intervention strategies based on self-determination theory constructs that have the strongest influence on patient success, with the aim of understanding how best to approach weight management in a clinical pediatric setting. Telephone interviews were conducted with 22 individuals (20 parents/guardians and 2 teenagers) who participated in a multidisciplinary weight management program and data was analyzed using inductive and deductive thematic analysis processes. Participants identified motivational interviewing strategies that were most influential to their success. Parents and patient's identified barriers and facilitators to success included patient readiness to change, personal logistics, family engagement, and establishing long- and short-term goals. Successful pediatric obesity management requires consideration to both the patient and family's readiness, structured implementation adaptations to address barriers, intentional efforts to move from external reward to internal motivation, and strategies to ensure families develop self-efficacy toward achievable healthy behaviors.
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Affiliation(s)
- Kerry K Sease
- Department of Pediatrics, Prisma Health Children's Hospital - Upstate, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Laura J Rolke
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Jacqueline E Forrester
- Bradshaw Institute for Community Child Health & Advocacy, Prisma Health, Greenville, SC, USA
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Martínez-Villanueva J, González-Leal R, Argente J, Martos-Moreno GÁ. Parental obesity is associated with the severity of childhood obesity and its comorbidities. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Martínez-Villanueva J, González-Leal R, Argente J, Martos-Moreno GÁ. [Parental obesity is associated with the severity of childhood obesity and its comorbidities]. An Pediatr (Barc) 2018; 90:224-231. [PMID: 30054225 DOI: 10.1016/j.anpedi.2018.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/24/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The influence of parental obesity on their obese offsprings is acknowledged but insufficiently characterised. PATIENTS AND METHODS Retrospective study of 800 obese patients (45.2% girls; age: 10.35±3.40 years, body mass index [BMI]:+4.22±1.68 standard deviation score [SDS]). Group comparison according to the presence of obesity in none (n=347) or any of the parents (n=453), and then whether the obese parent was the father (n=185), the mother (n=151), or both parents (n=117) were performed. The parameters analysed were: Age at the onset of the obesity and at their first visit, birth weight (BW), BMI-SDS, blood glucose, insulin level, homeostatic model assessment (HOMA) index, total cholesterol (TC), HDL, LDL, triglycerides, 25-OH-vitamin-D, area under the curve (AUC) for insulin in the oral glucose tolerance test (OGTT), whole body insulin sensitivity index (WBISI), LDL/HDL and TC/HDL ratios, and weight loss after 12 month follow-up. RESULTS No differences were observed between groups as regarding gender, ethnic background, or pubertal stage. Patients with one obese parent showed higher BW-SDS and BMI-SDS (P<.01), more severe impairment of carbohydrate metabolism (blood insulin, insulin-AUC, HOMA, HbA1c [P<.01] and lower WBISI [P<.05]) than those with no obese parent. Among those patients with a single obese parent, higher BW-SDS, insulin, HOMA, and lower 25-OH-vitamin D (P<.05) was observed when obesity was present in the mother. There was a higher prevalence of metabolic syndrome when both parents were obese (χ2=5.96, P<.05). A total of 132 patients reduced their BMI by ≥1.5SDS, or their weight by ≥10%, with no influence of the background of parental obesity. CONCLUSIONS Obesity in any parent determines a higher severity of their offspring obesity and metabolic comorbidities, more importantly when obesity is present in the mother or in both parents, but without interference in the options of therapeutic success.
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Affiliation(s)
| | - Rocío González-Leal
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Jesús Argente
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España; IMDEA Food Institute, Madrid, España
| | - Gabriel Ángel Martos-Moreno
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España.
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Schmied EA, Chuang E, Madanat H, Moody J, Ibarra L, Ortiz K, Macias K, Ayala GX. A Qualitative Examination of Parent Engagement in a Family-Based Childhood Obesity Program. Health Promot Pract 2018; 19:905-914. [PMID: 29448812 DOI: 10.1177/1524839918757487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.
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Affiliation(s)
- Emily A Schmied
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Hala Madanat
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Jamie Moody
- 4 University of California, San Diego, La Jolla, CA, USA
| | | | - Kenia Ortiz
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Karla Macias
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Guadalupe X Ayala
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
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Chronic Headaches After a Concussion in an Obese 16-Year-Old Girl. J Dev Behav Pediatr 2017; 37:771-774. [PMID: 27661197 DOI: 10.1097/dbp.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Jennifer is a 16-year-old Latina girl who is new to your practice. During her first well visit, she mentions that she has had daily headaches for 2 years. They began after sustaining a concussion in a car accident. Typically, her headaches are bilateral and "squeezing"; they occur in the afternoons and last for a few hours. Her concussion also resulted in depressed mood, which has improved over time.When you ask if her headaches have changed recently, she says that they have been worse for the last few days. The quality and severity are unchanged; however, they now occur first thing in the morning, are worse when supine, and no longer remit. In the last 2 days, she has developed new-onset blurry vision, nausea, dizziness, photophobia, and sonophobia. Although she previously experienced sadness with her concussion, she now feels irritable. She has never used tobacco, alcohol, or drugs, and she takes no medications.On examination, her body mass index is above the 99th percentile. You note mild papilledema bilaterally. She has no focal neurological deficits. The remainder of her examination is normal.You send her to an emergency department. Her head computed tomography is normal. A lumbar puncture demonstrates an opening pressure of 32 cm H2O; she feels relief after the procedure. She is admitted with a diagnosis of benign intracranial hypertension and is started on acetazolamide. What is the differential diagnosis of chronic headaches in an obese adolescent? How should a busy community pediatrician manage Jennifer acutely? What follow-up care should Jennifer receive?
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Mokhtari S, Grace B, Pak Y, Reina A, Durand Q, Yee JK. Motivation and perceived competence for healthy eating and exercise among overweight/obese adolescents in comparison to normal weight adolescents. BMC OBESITY 2017; 4:36. [PMID: 29177057 PMCID: PMC5693573 DOI: 10.1186/s40608-017-0172-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/10/2017] [Indexed: 11/14/2022]
Abstract
Background The current literature on determinants of behavior change in weight management lacks sufficient studies on type of motivation among children/adolescents, on perceived competence, and in relation to healthy eating. This study aimed to investigate type of motivation and levels of perceived competence for healthy diet and exercise, as well as general self efficacy among adolescents. We hypothesized that overweight/obese adolescents would demonstrate lower autonomous motivation and perceived competence regarding diet and exercise, and lower self-efficacy in general, and that the scores would be influenced by socioeconomic factors. Methods Normal weight (n = 40, body mass index < 85% for age and gender) and overweight or obese adolescents (n = 60, body mass index ≥ 85% for age and gender) aged 13-18 years were recruited from pediatric ambulatory clinics. Information was collected about demographics, socioeconomic factors, and lifestyle behaviors. The study subjects completed a survey including the Treatment Self-Regulation Questionnaire (TSRQ) and the Perceived Competence Scale (PCS) for healthy eating and exercise, and the General Self-Efficacy Scale (GSES). Composite scores for the three scales were compared between the two groups using the using the two-sample t-test (for normal data) or the Mann-Whitney U test (for non-parametric data). Relationships between the composite scores and patient characteristics were determined using Pearson or Spearman’s correlations. Results The average age of the total cohort was 15.9 ± 1.9 years. 54% were female, and 82% identified as Latino/Hispanic. In comparison to normal weight subjects, overweight/obese adolescents exhibited higher scores for controlled motivation (mean ± standard deviation 28.3 ± 9.3 vs 18.1 ± 8.1) and higher perceived competence [median and 25-75% interquartile range 22.5 (19.0-26.0) vs 20.0 (15.5-25.0)] in relation to eating a healthy diet. These differences persisted after adjustment for age, sex, paternal education, and family income. Conclusions Overweight/obese adolescents did not lack autonomous motivation but demonstrated higher controlled motivation and perceived competence for healthy eating in comparison to normal weight adolescents, independent of socioeconomic factors. In the clinical practice of weight management, providers should carefully assess adolescents for type of motivation and perceived competence, while accounting for potential barriers to behavior change.
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Affiliation(s)
- Suzanne Mokhtari
- Department of Pediatrics, Division of Hospital Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA USA
| | - Benjamin Grace
- Department of Pediatrics, Division of Pediatric Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA USA
| | - Youngju Pak
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA USA
| | - Astrid Reina
- Department of Psychiatry, Division of Psychology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA USA
| | - Quinn Durand
- Department of Psychiatry, Division of Psychology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA USA
| | - Jennifer K Yee
- Department of Pediatrics, Division of Pediatric Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA USA
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Patriota PF, Filgueiras AR, de Almeida VBP, Alexmovitz GAC, da Silva CE, de Carvalho VFF, Carvalho N, de Albuquerque MP, Domene SMA, do Prado WL, Torres GES, de Oliveira APR, Sesso R, Sawaya AL. Effectiveness of a 16-month multi-component and environmental school-based intervention for recovery of poor income overweight/obese children and adolescents: study protocol of the health multipliers program. BMC Public Health 2017; 17:708. [PMID: 28915797 PMCID: PMC5603054 DOI: 10.1186/s12889-017-4715-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/05/2017] [Indexed: 02/05/2023] Open
Abstract
Background Excess of weight is a serious public health concern in almost all countries, afflicting people of different ages and socioeconomic backgrounds. Studies have indicated the need for developing treatment strategies that intervene directly in the obesogenic environment. This study aims to evaluate the effectiveness of a multi-component and environmental school-based intervention, lasting 16 months, on the recovery of the nutritional status of low-income children and adolescents with overweight/ obesity. Methods/study design The study was conducted by the Center for Recovery and Nutritional Education (CREN) in São Paulo, Brazil. Two schools located in poor neighborhoods were selected for the intervention, between March 2016 and June 2017. The participants were all students aged 8 to 12 years from the two participating schools. At the beginning of the intervention, anthropometric measurements were carried out to assess the nutritional status of the students. For convenience, students from one of the schools were considered as the control group, while those from the other school formed the experimental group. The intervention in the experimental group (n = 438) consists of the following weekly activities at school: psychological counseling in groups, theoretical/practical nutrition workshops, and supervised physical education classes. In addition, theoretical and practical educational activities are held regularly for parents, teachers, and cooks. Students with excess of weight (≥1 body mass index [BMI] –for-age Z score, n = 138) received clinical and nutritional care periodically at the outpatient care at CREN. Students enrolled in the control group (n = 353) participated in psychological counseling groups and theoretical/practical nutrition workshops for 6 months held in the school environment to provide motivation to entire classrooms. In the following 10 months, students with excess of weight from the control group (n = 125) were invited to attend the routine outpatient care at CREN. Discussion This study is the first to assess the effectiveness of a multi-component and environmental school-based intervention for the recovery of low-income, overweight/obese children and adolescents. If positive, the results demonstrate the feasibility for the recovery of excess of weight in populations of similar conditions and age. Trial registration Brazilian Registry of Clinical Trials - ReBEC Primary Id Number RBR-9t2jr8. Registration Date: Nov. 30, 2016. Retrospectively registered. Protocol version: 3.
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Affiliation(s)
- Pollyanna Fernandes Patriota
- Department of Physiology, Federal University of São Paulo, UNIFESP, Rua Botucatu, 862, 2° andar, Vila Clementino. CEP, São Paulo, SP, 04023062, Brazil.
| | - Andrea Rocha Filgueiras
- Department of Physiology, Federal University of São Paulo, UNIFESP, Rua Botucatu, 862, 2° andar, Vila Clementino. CEP, São Paulo, SP, 04023062, Brazil
| | - Viviane Belucci Pires de Almeida
- Department of Public Health and Collective Health, Health and Society Institute, Federal University of São Paulo, UNIFESP, Santos, SP, Brazil
| | - Guilherme Aparecido Costa Alexmovitz
- Department of Physiology, Federal University of São Paulo, UNIFESP, Rua Botucatu, 862, 2° andar, Vila Clementino. CEP, São Paulo, SP, 04023062, Brazil
| | - Carlos Eduardo da Silva
- Department of Physiology, Federal University of São Paulo, UNIFESP, Rua Botucatu, 862, 2° andar, Vila Clementino. CEP, São Paulo, SP, 04023062, Brazil
| | - Vivian Fortuna Feres de Carvalho
- Department of Physiology, Federal University of São Paulo, UNIFESP, Rua Botucatu, 862, 2° andar, Vila Clementino. CEP, São Paulo, SP, 04023062, Brazil
| | - Natália Carvalho
- Department of Pediatrics, Federal University of São Paulo, UNIFESP, São Paulo, SP, Brazil
| | | | | | | | - Gustavo Enrique Salazar Torres
- Department of Computer Science, Institute of Mathematics and Statistics, University of São Paulo, USP, São Paulo, SP, Brazil
| | | | - Ricardo Sesso
- Department of Nephrology, Federal University of São Paulo, UNIFESP, São Paulo, SP, Brazil
| | - Ana Lydia Sawaya
- Department of Physiology, Federal University of São Paulo, UNIFESP, Rua Botucatu, 862, 2° andar, Vila Clementino. CEP, São Paulo, SP, 04023062, Brazil
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Larsen KT, Huang T, Ried-Larsen M, Andersen LB, Heidemann M, Møller NC. A Multi-Component Day-Camp Weight-Loss Program Is Effective in Reducing BMI in Children after One Year: A Randomized Controlled Trial. PLoS One 2016; 11:e0157182. [PMID: 27362497 PMCID: PMC4928840 DOI: 10.1371/journal.pone.0157182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/25/2016] [Indexed: 12/14/2022] Open
Abstract
The objective of the present study was to evaluate the effectiveness of a one-year multi-component immersive day-camp weight-loss intervention for children with overweight and obesity. The study design was a parallel-group randomized controlled trial. One hundred fifteen 11-13-year-old children with overweight and obesity were randomized into either: A six-week day-camp intervention arm focusing on increased physical activity, and healthy diet followed by a subsequent one-year family-based intervention, or a standard intervention arm consisting of one weekly exercise session for six weeks. Body mass index (BMI) was the primary outcome. BMI z-score, clustered cardiovascular risk z-score, and body composition were secondary outcomes. All outcomes were measured at baseline, six week-, and 52 week follow-up. After six weeks, children from the day-camp intervention arm had improved their BMI (-2.2 kg/m2 (95% CI -2.6 to -1.7, P<0.001)) and all secondary outcomes when compared to the children from the standard intervention arm. After 52 weeks, the day-camp intervention arm had a lower BMI (-1.2 kg/m2 (95% CI -1.8 to -0.5, P = 0.001)), and BMI z-score (-0.20 (95% CI -0.35 to -0.05, P = 0.008)), and clustered cardiovascular risk z-score (-0.23 (95% CI -0.37 to -0.08, P = 0.002)) compared to the standard intervention arm. No group differences were detected in body composition after 52 weeks. This study shows that the day-camp intervention arm is effective in reducing BMI and improving the metabolic health of children with overweight and obesity. However, the effects seem to be diminishing over time.
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Affiliation(s)
- Kristian Traberg Larsen
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Tao Huang
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism (CIM) and The Centre for Physical Activity Research (CFAS), The Danish Diabetes Academy, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Lars Bo Andersen
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Niels Christian Møller
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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