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Rajbhandari-Thapa J, Chung SR, Hu H, Hall DB, Tiwari BB. Utilization of Counseling Services by Pediatric Patients With Obesity Using MarketScan Data (2017-2019). Child Obes 2023; 19:570-574. [PMID: 36413350 DOI: 10.1089/chi.2022.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The United States has implemented policy efforts for public and private insurance to cover counseling services related to the treatment of obesity. However, no research has yet studied counseling service utilization among pediatric patients with obesity. We used 3 years (2017-2019) of IBM MarketScan Commercial Claims and Encounters Database and IBM MarketScan Multi-State Medicaid Data to examine such utilization patterns. We found the proportion of patients receiving any counseling services to be low among both privately insured (7.06%-7.97%) and Medicaid patients (9.51%-11.61%) within 6 months from diagnosis of obesity. This underutilization is concerning as many pediatric patients go undiagnosed, as evidenced in this research. Among the utilized services, nutrition counseling and face-to-face counseling were utilized the most by privately and Medicaid-insured patients over 6- and 12-month follow-ups. Our study underscores the need for implementing policies and programs to promote the utilization of counseling services among pediatric patients.
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Affiliation(s)
| | - Sae Rom Chung
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
| | - Huimin Hu
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
| | - Daniel B Hall
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
| | - Biplav Babu Tiwari
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
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2
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Domingos DS, Troster EJ, Vieira TCA. Content validation of a questionnaire to assess the knowledge of pediatricians, family, and community physicians on obesity. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022063. [PMID: 36921177 PMCID: PMC10013993 DOI: 10.1590/1984-0462/2023/41/2022063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/16/2022] [Indexed: 03/17/2023]
Abstract
OBJECTIVE The aim of this study was to validate the content of a questionnaire in order to assess the attitudes and practices in childcare consultations, knowledge on overweight and obesity, their risk factors, and barriers in addressing the issue by pediatricians and family physicians. METHODS The Delphi technique was used, with the objective of reaching a consensus on a certain subject, through experts' opinions. The content validity index (CVI) of each item, axis, and questionnaire was calculated. The inter-rater reliability was calculated using an agreement coefficient suitable for the answer distribution such as Gwet's AC2 with ordinal weight. RESULTS A total of 63 experts were invited to assess and give their opinion on the questionnaire. In all, 52 accepted the invitation and analyzed the instrument. After two rounds, the questionnaire reached the proper CVI for the study and was considered complete, with its final version having 40 questions, a final index of 95%, and an inter-rate reliability of 0.905. CONCLUSIONS This instrument, developed to assess attitudes and practices, knowledge, and barriers found in addressing the obesity by primary care physicians, obtained a CVI greater than 0.8 and an excellent agreement coefficient of the 52 judges. Therefore, its content can be considered validated.
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Affiliation(s)
| | - Eduardo Juan Troster
- Universidade de São Paulo, São Paulo, SP, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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3
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Ray D, Sniehotta F, McColl E, Ells L. Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review. Obes Rev 2022; 23:e13417. [PMID: 35064723 PMCID: PMC9285925 DOI: 10.1111/obr.13417] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022]
Abstract
Primary care providers (PCPs) have an important role in prevention of excess weight gain in pre-school children. Guidelines exist to support PCPs' practices. This systematic review of PCPs' practice behaviors and their perceptions of barriers to and facilitators of implementation of guidelines was the first step toward the development of an intervention aimed at supporting PCPs. Five databases were searched to identify qualitative, quantitative, and mixed methods studies which examined PCPs' practice patterns and factors influencing implementation of recommended practices. The convergent integrated approach of the Joanna Briggs Institute (JBI) methodology for mixed methods reviews was used for data synthesis. Following analyses, the resultant factors were mapped onto the Capability, Opportunity, and Motivation model of Behaviour (COM-B). Fifty studies met the eligibility criteria. PCPs inconsistently implement recommended practices. Barriers and facilitators were identified at the provider (e.g., lack of knowledge), parent (e.g., lack motivation), and organization level (e.g., inadequate training). Factors were mapped to all three components of the COM-B model: psychological capability (e.g., lack of skills), reflective motivation (e.g., beliefs about guidelines), automatic motivation (e.g., discomfort), physical opportunity (e.g., time constraints), and social opportunity (e.g., stigma). These findings reflect the complexity of implementation of childhood obesity prevention practices.
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Affiliation(s)
- Devashish Ray
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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4
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Lam C, Milne-Ives M, Harrington R, Jani A, Helena van Velthoven M, Harding T, Meinert E. Internet of things-Enabled technologies as an intervention for childhood obesity: A systematic review. PLOS DIGITAL HEALTH 2022; 1:e0000024. [PMID: 36812526 PMCID: PMC9931243 DOI: 10.1371/journal.pdig.0000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Childhood obesity is one of the most serious public health challenges of the 21st century, with consequences lasting into adulthood. Internet of Things (IoT)-enabled devices have been studied and deployed for monitoring and tracking diet and physical activity of children and adolescents as well as a means of providing remote, ongoing support to children and their families. This review aimed to identify and understand current advances in the feasibility, system designs, and effectiveness of IoT-enabled devices to support weight management in children. We searched Medline, PubMed, Web of Science, Scopus, ProQuest Central and the IEEE Xplore Digital Library for studies published after 2010 using a combination of keywords and subject headings related to health activity tracking, weight management, youth and Internet of Things. The screening process and risk of bias assessment were conducted in accordance with a previously published protocol. Quantitative analysis was conducted for IoT-architecture related findings and qualitative analysis was conducted for effectiveness-related measures. Twenty-three full studies are included in this systematic review. The most used devices were smartphone/mobile apps (78.3%) and physical activity data (65.2%) from accelerometers (56.5%) were the most commonly tracked data. Only one study embarked on machine learning and deep learning methods in the service layer. Adherence to IoT-based approaches was low but game-based IoT solutions have shown better effectiveness and could play a pivotal role in childhood obesity interventions. Researcher-reported effectiveness measures vary greatly amongst studies, highlighting the importance for improved development and use of standardised digital health evaluation frameworks.
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Affiliation(s)
- Ching Lam
- Department for Biomedical Engineering, University of Oxford, United Kingdom
| | | | - Richard Harrington
- Nuffield Department of Primary Health Care Services, University of Oxford, United Kingdom
| | - Anant Jani
- Oxford Martin School, University of Oxford, United Kingdom
| | | | - Tracey Harding
- School of Nursing and Midwifery, University of Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, United Kingdom
- School of Nursing and Midwifery, University of Plymouth, United Kingdom
- Department of Primary Care and Public Health, School of Public Health, Imperial College London
- Harvard T.H. Chan School of Public Health, Harvard University, United States of America
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5
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Haidar A, Sharma SV, Durand CP, Barlow SE, Salahuddin M, Butte NF, Hoelscher DM. Cross-Sectional Relationship between Regular Bedtime and Weight Status and Obesity-Related Behaviors among Preschool and Elementary School Children: TX CORD Study. Child Obes 2021; 17:26-35. [PMID: 33259729 DOI: 10.1089/chi.2020.0182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: This study examines the relations between a regular weekday bedtime with weight status, diet quality, physical activity, wellbeing, and parental rules among children 2 to 12 years of age from low-income populations. Methods: The study used baseline data collected in 2012, as part of a larger quasiexperimental study design. A convenience sample of parents of children in preschools, second, or fifth grade attending Head Start centers or elementary schools located in low-income catchment areas, in Houston and Austin, TX, were recruited to participate in the study (n = 32 elementary schools; n = 12 Head Start centers). Regular weekday bedtime was measured with the question "Does your child have a regular weekday bedtime?" Results: The sample of 1467 child-parent dyads were split approximately evenly by sex, and consisted of 44.4% Pre-K, 30.4% second grade, and 25.2% fifth grade students. Six hundred twenty-two (43.6%) children were overweight or obese. Children who had a regular bedtime had 15% lower odds of being overweight or obese (adjusted odds ratio [aOR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p-value: 0.017). Also, children who had a regular bedtime had 45% higher odds of eating the recommended number of fruits and vegetables (aOR: 1.45, 95% CI: 1.02-2.07, p-value: 0.039) and had physical activity more days of the week (β: 0.42, 95% CI: 0.26-0.57, p-value: <0.001). Conclusions: Having a regular weekday bedtime is associated with better weight status and several obesity-related health behaviors in children. Parental report of regular bedtimes for their children may be an indication of parenting skills related to other health-related behaviors for prevention of childhood obesity.
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Affiliation(s)
- Amier Haidar
- University of Texas School of Public Health, Houston, TX, USA
| | | | - Casey P Durand
- University of Texas School of Public Health, Houston, TX, USA
| | | | - Meliha Salahuddin
- University of Texas Health Science Center at Tyler, Population Health, Office of Health Affairs, University of Texas System, Austin, TX, USA
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Camp NL, Robert RC, Kelly KP. Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children. Clin Pediatr (Phila) 2020; 59:978-987. [PMID: 32486901 DOI: 10.1177/0009922820927030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.
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Affiliation(s)
- Nadine L Camp
- Children's National Hospital, Washington, DC, USA.,The George Washington University, Washington, DC, USA.,The Catholic University of America, Washington, DC, USA
| | | | - Katherine P Kelly
- Children's National Hospital, Washington, DC, USA.,The George Washington University, Washington, DC, USA
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7
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Bonder R, Provvidenza CF, Hubley D, McPherson AC. Putting positive weight-related conversations into practice: The pilot implementation of a Knowledge Translation Casebook. Child Care Health Dev 2020; 46:360-368. [PMID: 32083751 DOI: 10.1111/cch.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healthcare professionals (HCPs) play an important role in discussing weight with children and their parents but report barriers such as lack of training and supports. These barriers are especially prevalent within specialized populations such as children with autism spectrum disorder (ASD). To address this, a Knowledge Translation Casebook on positive weight-related conversations was developed by a research team at a Canadian paediatric hospital. The purpose of the current pre-implementation pilot study was to explore initial acceptability and adoption of the Casebook into clinical settings. METHODS An interactive, multimodal education workshop was created to provide HCPs with knowledge and training on how to have positive weight-related conversations with children and parents. Two workshops were conducted using the same curriculum but delivered either in-person or online. Participants were drawn from a team of clinicians at a teaching hospital whose care focuses on medication management for clients with ASD and clinicians participating in a distance learning programme on best practice care for clients with ASD. Participants completed a demographic questionnaire, workshop evaluation, and a pre-workshop and post-workshop questionnaire. Descriptive statistics were used to summarize demographic, questionnaire, and survey data. Answers to open-ended questions were analysed using content analysis. RESULTS Participants agreed that the workshop gave them a clear understanding of the Casebook's content and helped them easily navigate the Casebook. Based on raw scores, self-efficacy in having weight-related conversations seemed to increase from pre-to post-workshop, but reported weight-management clinical practice scores did not change over time. However, the small sample precluded in-depth statistical analysis. CONCLUSIONS The Casebook was acceptable and appeared to increase self-efficacy about having weight-related conversations with children with ASD and parents. More robust implementation strategies are needed to foster the uptake of best practices in weight-related conversations into clinical practice.
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Affiliation(s)
- Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Darlene Hubley
- Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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8
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Lam C, Milne-Ives M, Van Velthoven MH, Meinert E. Internet of Things-Enabled Technologies for Weight Management in Children and Adolescents: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16930. [PMID: 32229473 PMCID: PMC7157501 DOI: 10.2196/16930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/04/2019] [Accepted: 12/11/2019] [Indexed: 01/20/2023] Open
Abstract
Background Childhood obesity is a serious global issue, leading to increased medical spending on obesity-related diseases such as cardiovascular diseases and diabetes. There is a need for health care services that link health behavior to risk factors, such as diet and physical activity, and that provide better advice and feedback to users, which Internet of Things–enabled technologies could facilitate. Objective The objective of the systematic review will be to identify available Internet of Things–enabled technologies for weight management of children and adolescents (users younger than 18 years). It will also aim to understand the use, effectiveness, and feasibility of these technologies. Methods We will search the Medline, PubMed, Web of Science, Scopus, ProQuest Central, and IEEE Xplore Digital Library databases for studies published after 2010, using a combination of keywords and subject headings related to health activity tracking, youth, and Internet of Things. In addition, a Google search to identify grey literature will be conducted. Two authors will independently screen the titles and abstracts identified from the search and accept or reject the studies according to the study inclusion criteria. Any discrepancies will then be discussed and resolved. The quality of the included studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklists. Data from included studies will be extracted into a predesigned form to identify the types of devices or apps, Internet of Things applications, and health outcomes related to weight management. Results A preliminary search on Medline returned 484 results. The publication of the final systematic review is expected in mid-2020. Conclusions The effectiveness and feasibility of physical activity trackers and consumer wearables for different patient groups have been well reviewed, but there are currently no published reviews that look into these technologies in the wider Internet of Things context. This review aims to address this gap by examining Internet of Things–enabled technologies that are designed for youth weight management and thus inform further research and clinical studies to reduce childhood obesity. International Registered Report Identifier (IRRID) PRR1-10.2196/16930
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Affiliation(s)
- Ching Lam
- Digitally Enabled Population Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Madison Milne-Ives
- Digitally Enabled Population Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle Helena Van Velthoven
- Digitally Enabled Population Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Digitally Enabled Population Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, United Kingdom
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9
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Barlow SE, Salahuddin M, Butte NF, Hoelscher DM, Pont SJ. Improvement in Primary Care Provider Self-Efficacy and Use of Patient-Centered Counseling To Address Child Overweight and Obesity after Practice-Based Changes: Texas Childhood Obesity Research Demonstration Study. Child Obes 2019; 14:518-527. [PMID: 30153036 DOI: 10.1089/chi.2018.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Texas Childhood Obesity Research Demonstration project, a multicenter, multisystem approach to childhood overweight and obesity (OW/OB), included training and materials to support primary care clinics (PCCs) in addressing child OW/OB in the office. This study evaluated the impact over 24 months of brief training and practice-based support on primary care providers' (PCPs) perceived self-efficacy and practice behaviors. METHODS The PCPs at five Houston and seven Austin PCCs completed questionnaires at baseline (2012, n = 36), 12 months (2013, n = 30), and 24 months (2014, n = 34) follow-up. Mixed-effects linear regression models were used to compare changes in self-efficacy (15 items, responses 1-4: not at all confident to very confident) and practice behaviors (30 items, responses 0-4: never to always) in obesity-related screening and counseling, and to assess association between prior training and these outcomes. RESULTS Self-efficacy items for identification of (2.9 [0.1] vs. 3.3 [0.1]) and counseling about (2.8 [0.1] vs. 3.4 [0.1]) OW/OB-related parenting practices, and setting behavioral goals (2.9 [0.2] vs. 3.3 [0.2]) improved significantly (p < 0.05) between baseline and 24-month follow-up. Self-efficacy items with "confident" mean baseline scores that further improved included determining child OW/OB (3.6 [0.1] vs. 3.9 [0.1]) and interpreting BMI (3.6 [0.1] vs. 3.9 [0.1]). At all measurements, PCPs reported frequently addressing medical problems and lifestyle behaviors. Use of patient-centered counseling techniques, which was low at baseline, increased significantly, including asking permission before discussing lifestyle (1.5 [0.3] vs. 2.4 [0.3]). Prior training was associated with improved self-efficacy. CONCLUSIONS The improvement in PCPs' self-efficacy and patient-centered counseling to address childhood OW/OB supports implementation of brief training and practice support in clinics that serve Medicaid-eligible children.
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Affiliation(s)
- Sarah E Barlow
- 1 Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, TX
| | - Meliha Salahuddin
- 2 Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston (UTHealth) , Austin, TX.,3 Population Health , Office of Health Affairs, UT System, Austin, TX
| | - Nancy F Butte
- 4 Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center , Houston, TX
| | - Deanna M Hoelscher
- 2 Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston (UTHealth) , Austin, TX
| | - Stephen J Pont
- 5 Department of Pediatrics, Dell Medical School, Moody College of Communication, Stan Richards School of Advertising and Public Relations, University of Texas at Austin , Austin, TX
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Belay B, Frintner MP, Liebhart JL, Lindros J, Harrison M, Sisk B, Dooyema CA, Hassink SG, Cook SR. US Pediatrician Practices and Attitudes Concerning Childhood Obesity: 2006 and 2017. J Pediatr 2019; 211:78-84.e2. [PMID: 31113716 PMCID: PMC8856742 DOI: 10.1016/j.jpeds.2019.04.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare primary care pediatricians' practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017. STUDY DESIGN National, random samples of American Academy of Pediatrics members were surveyed in 2006, 2010, and 2017 on practices and attitudes regarding overweight and obesity (analytic n = 655, 592, and 558, respectively). Using logistic regression models (controlling for pediatrician and practice characteristics), we examined survey year with predicted values (PVs), including body mass index (BMI) assessment across 2006, 2010, and 2017 and practices and attitudes in 2006 and 2017. RESULTS Pediatrician respondents in 2017 were significantly more likely than in 2006 and 2010 to report calculating and plotting BMI at every well-child visit, with 96% of 2017 pediatricians reporting they do this. Compared with 2006, in 2017 pediatricians were more likely to discuss family behaviors related to screen time, sugar-sweetened beverages, and eating meals together, P < .001 for all. There were no observed differences in frequency of discussions on parental role modeling of nutrition and activity-related behaviors, roles in food selection, and frequency of eating fast foods or eating out. Pediatricians in 2017 were more likely to agree BMI adds new information relevant to medical care (PV = 69.8% and 78.1%), they have support staff for screening (PV = 45.3% and 60.5%), and there are effective means of treating obesity (PV = 36.3% and 56.2%), P < .001 for all. CONCLUSIONS Results from cross-sectional surveys in 2006 and 2017 suggest nationwide, practicing pediatricians have increased discussions with families on several behaviors and their awareness and practices around obesity care.
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Affiliation(s)
- Brook Belay
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics (AAP), Itasca, IL
| | | | | | - Megan Harrison
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics (AAP), Itasca, IL
| | - Carrie A. Dooyema
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Stephen R. Cook
- Institute for Healthy Childhood Weight, AAP, Itasca, IL;,Department of Research, University of Rochester Medical Center, Rochester, NY
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Whipps J, Mort SC, Beverly EA, Guseman EH. Influence of Osteopathic Medical Students' Personal Health on Attitudes Toward Counseling Obese Pediatric Patients. ACTA ACUST UNITED AC 2019; 119:488-498. [PMID: 31355889 DOI: 10.7556/jaoa.2019.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Research has shown that physicians with positive health and lifestyle behaviors have more positive attitudes toward effective counseling, but little is known about how personal health behaviors of medical students influence their attitudes regarding pediatric obesity counseling before entering practice. Objective To determine whether the personal health status and habits of osteopathic medical students influence their attitudes toward counseling obese pediatric patients regarding lifestyle behaviors. Methods A cross-sectional survey was distributed electronically to first- through fourth-year osteopathic medical students. The survey assessed students' personal lifestyle habits and their top anticipated barriers to providing pediatric weight counseling. Results A total of 200 participants completed the survey. National physical activity recommendations were met by 81 participants (40.5%). These 81 participants had significantly more positive attitudes toward pediatric physical activity counseling than participants who did not meet the recommendations (H=-35.06, P=.001) or those who only met resistance training recommendations (H=40.63, P=.021). Participants with obesity had significantly lower pediatric weight management counseling scores than overweight participants (H=40.77, P=.028). Thirty-one participants (15.5%) consumed a healthy amount of both vegetables and fruit. These 31 participants had significantly higher dietary mean item counseling scores than those who did not (H=-30.40, P=.048). Participants identified the barriers "Time" (137 [68.5%]) and "Difficult for patients to change behavior" (99 [49.5%]) most frequently. Clinical participants identified "Poor or lacking reimbursement" (21 [28.0%]) more frequently than preclinical participants (12 [9.6]). Conclusion Medical students who exhibited healthier lifestyle habits were more likely to positively view pediatric obesity management counseling.
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Gavarkovs AG. Behavioral Counseling Training for Primary Care Providers: Immersive Virtual Simulation as a Training Tool. Front Public Health 2019; 7:116. [PMID: 31143761 PMCID: PMC6521729 DOI: 10.3389/fpubh.2019.00116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
Behavioral counseling represents an efficacious approach for improving health behaviors on a population level, and the primary care setting is an appropriate context in which to implement this approach. However, evidence suggests that the utilization of behavioral counseling techniques in primary care, including those informed by motivational interviewing, is sub-optimal. Insufficient training has been cited as a barrier to utilizing counseling in the primary care setting. Recent work has evaluated the effectiveness of virtual simulations that can provide access to "virtual" patients while retaining the scalability inherent to a digital medium. However, these educational interventions have been limited to simulations delivered through a two-dimensional screen. More immersive simulations delivered through a head-mounted display can create a realistic practice environment that encompasses a learner's entire field of view, which may confer additional benefits with respect to training outcomes. The purpose of this short article is to briefly review the relevant literature across disciplines to conceptualize the potential effectiveness of this technology as a training tool for behavioral counseling. Immersive virtual simulations are designed to induce a psychological phenomenon referred to as presence, whereby a learner perceives themselves as existing within the virtual environment. As such, immersive virtual simulations can provide opportunities for practice, coaching, and feedback in an environment that closely approximates the clinical setting in which counseling will be delivered. Through its effects on presence, this technology may be particularly useful for developing empathy, which is an important component of counseling. Recommendations for future research are also provided.
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Affiliation(s)
- Adam G Gavarkovs
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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A Clinical Vignette-Based Study of Physicians' Adherence to Guidelines for Dental Referrals of Young Children. Acad Pediatr 2019; 19:195-202. [PMID: 30361125 DOI: 10.1016/j.acap.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age <4 years and barriers to implementation of these guidelines. METHODS A cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age <4 years was completed in 2013. The PCPs' referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply. RESULTS The survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to >90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction. CONCLUSIONS PCPs' adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.
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Conlon BA, Mcginn AP, Isasi CR, Mossavar-Rahmani Y, Lounsbury DW, Ginsberg MS, Diamantis PM, Groisman-Perelstein AE, Wylie-Rosett J. Home Environment Factors and Health Behaviors of Low-income, Overweight, and Obese Youth. Am J Health Behav 2019; 43:420-436. [PMID: 30808480 DOI: 10.5993/ajhb.43.2.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management program. Multivariable logistic regression examined how home environment (parenting practices, family meal habits, and home availability of fruits/vegetables, sugar-sweetened beverages (SSBs), screen media, and physical activity resources) are related to children's intake of fruit, vegetables, and SSBs, and moderate-vigorous physical activity and sedentary time (ST) after adjusting for potential confounders. Results: Children were more likely to consume fruit if their families frequently ate meals together and infrequently watched TV during meals, and more likely to consume vegetables with high fruit/vegetable availability and low SSB availability. Children were more likely to engage in ST if parents practiced monitoring and frequently watched TV during meals. Conclusions: Overweight or obese children appear to have healthier habits if their families eat meals together without watching TV and if healthy food choices are available in the home. Encouraging parents to focus these practices may promote healthier body weight in children.
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Affiliation(s)
- Beth A. Conlon
- Postgraduate Student, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY;,
| | - Aileen P. Mcginn
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Carmen R. Isasi
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Yasmin Mossavar-Rahmani
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - David W. Lounsbury
- Assistant Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Mindy S. Ginsberg
- Senior Associate, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Pamela M. Diamantis
- Attending Physician, Department of Pediatrics, Children's Health Services Jacobi Medical Center, Bronx, NY
| | | | - Judith Wylie-Rosett
- Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
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15
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Sastre LR, Matson S, Gruber KJ, Haldeman L. A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic. SAGE Open Med 2019; 7:2050312119834117. [PMID: 30834116 PMCID: PMC6396046 DOI: 10.1177/2050312119834117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. Methods: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. Results: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child’s weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. Conclusion: Results suggest that successful management of children’s weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.
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Affiliation(s)
- Lauren R Sastre
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Stephanie Matson
- Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
| | - Kenneth J Gruber
- Center for Youth, Family and Community Partnerships, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Lauren Haldeman
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC, USA
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16
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Ulker İ, Yildiran H. The effects of bariatric surgery on gut microbiota in patients with obesity: a review of the literature. BIOSCIENCE OF MICROBIOTA FOOD AND HEALTH 2018; 38:3-9. [PMID: 30705797 PMCID: PMC6343052 DOI: 10.12938/bmfh.18-018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/13/2018] [Indexed: 12/19/2022]
Abstract
Obesity is a disease with a rapidly increasing prevalence all over the world in recent years. Genetic and environmental factors are involved in the etiology of obesity, and the effect of
microbiota on obesity is becoming increasingly clear. Obesity treatment has various treatment modalities such as behavior modification, medical nutrition therapy, physical activity
enhancement, and surgical intervention. When other treatment methods are not successful, bariatric surgery is usually resorted to as the treatment method. Some changes such as food choices,
the level of hormones and enzymes due to anatomical changes, pH of the stomach, and microbiota are observed after bariatric surgery. Alteration in the microbiota composition after bariatric
surgery has also been reported to be important in achieving body weight loss and preserving body weight loss.
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Affiliation(s)
- İzzet Ulker
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
| | - Hilal Yildiran
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Besevler, Ankara, Turkey
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17
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Kracht CL, Sisson SB, Kerr K, Walker D, Stephens L, Seward J, Anderson A, Weedn AE, Cheney M, Copeland KA, Tallbear C, Jacob A, Key M, Dennison M, Horm D, Salvatore AL. Health Care Provider's Role in Obesity Prevention and Healthy Development of Young American Indian Children. J Transcult Nurs 2018; 30:231-241. [PMID: 30071776 DOI: 10.1177/1043659618792605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Health care providers (HCPs) serving American Indian (AI) populations are critical stakeholders in promoting healthy weight-related behaviors of young AI children. The purpose of this study is to develop an understanding of how HCP perceive their role in the healthy development of young AI children, and how they envision working with early care and education teachers and parents to enhance children's health. METHOD Twenty HCP that serve young AI children in Oklahoma participated in individual interviews. Thematic analysis was conducted on coded transcripts and three main themes, each with two to four subthemes were identified. RESULTS HCP had limited contact with teachers, felt family health was equal or more important than child health, and parental empowerment and gradual change was essential for success. CONCLUSION Creating ways to involve HCP, early care and education teachers, and parents together in multilevel and multisector interventions has the potential to improve the health of young AI children.
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Affiliation(s)
- Chelsea L Kracht
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B Sisson
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kelly Kerr
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Devon Walker
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lancer Stephens
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,2 Oklahoma Shared Clinical and Translational Resources, Oklahoma City, OK, USA
| | - Julie Seward
- 3 Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Amber Anderson
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ashley E Weedn
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Kristen A Copeland
- 5 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,6 University of Cincinnati, Cincinnati, OH, USA
| | - Chris Tallbear
- 1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Michelle Key
- 8 Chickasaw Nation Department of Community Services, Ada, OK, USA
| | | | - Diane Horm
- 10 University of Oklahoma, Tulsa, OK, USA
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18
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Kracht CL, Sisson SB, Walker D, Kerr K, Stephens L, Anderson A, Seward J, Weedn AE, Cheney M, Copeland K, Salvatore AL, Jacob A, Key M, Dennison M, Tallbear C, Horm D. Early Care and Education Teacher’s Role in Obesity Prevention and Healthy Development of Young American Indian Children. J Transcult Nurs 2018; 30:75-85. [DOI: 10.1177/1043659618786363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children’s health. Methodology: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. Results: Teachers felt that nutrition and physical activity were important to children’s health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child’s behavior. Discussion: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.
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Affiliation(s)
- Chelsea L. Kracht
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B. Sisson
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Devon Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kelly Kerr
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lancer Stephens
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Shared Clinical and Translational Resources, Oklahoma City, OK, USA
| | - Amber Anderson
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Ashley E. Weedn
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Kristen Copeland
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Michelle Key
- Chickasaw Nation Department of Community Services, Ada, OK, USA
| | | | - Chris Tallbear
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Diane Horm
- Early Childhood Education Institute, University of Oklahoma, Tulsa, OK, USA
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19
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McPherson AC, Knibbe TJ, Oake M, Swift JA, Browne N, Ball GDC, Hamilton J. "Fat is really a four-letter word": Exploring weight-related communication best practices in children with and without disabilities and their caregivers. Child Care Health Dev 2018; 44:636-643. [PMID: 29761539 DOI: 10.1111/cch.12575] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Health care professionals play a critical role in preventing and managing childhood obesity, but the American Academy of Pediatrics recently stressed the importance of using sensitive and nonstigmatizing language when discussing weight with children and families. Although barriers to weight-related discussions are well known, there are few evidence-based recommendations around communication best practices. Disability populations in particular have previously been excluded from work in this area. The objectives were to present the findings of a recent scoping review to children with and without disabilities and their caregivers for their reactions; and to explore the experiences and perceptions of the children and their caregivers regarding weight-related communication best practices. METHODS Focus group and individual interviews were conducted with 7-18-year olds with and without disabilities and their caregivers. The interview guide was created using findings from a recent scoping review of weight-related communication best practices. Inductive thematic analysis was employed. RESULTS Eighteen children (9 boys; 7 children with disabilities) and 21 caregivers (17 mothers, 1 step-father, 3 other caregivers) participated in 8 focus group and 7 individual interviews. Preferred communication strategies were similar across those with and without disabilities, although caregivers of children with autism spectrum disorder endorsed more concrete approaches. Discussions emphasizing growth and health were preferred over weight and size. Strengths-based, solution-focused approaches for weight conversations were endorsed, although had not been widely experienced. CONCLUSION Perceptions of weight-related communication were similar across stakeholder groups, regardless of children's disability or weight status. Participants generally agreed with the scoping review recommendations, suggesting that they apply broadly across different settings and populations; however, tailoring them to specific circumstances is critical. Empirical evaluations are still required to examine the influence of weight-related communication on clinically important outcomes, including behaviour change and family engagement in care.
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Affiliation(s)
- A C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - T J Knibbe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - M Oake
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - J A Swift
- School of Biosciences, University of Nottingham, Nottinghamshire, UK
| | - N Browne
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - G D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J Hamilton
- Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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20
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Management of Childhood Obesity and Overweight in Primary Care Visits: Gaps Between Recommended Care and Typical Practice. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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21
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Wong MS, Showell NN, Bleich SN, Gudzune KA, Chan KS. The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity. PATIENT EDUCATION AND COUNSELING 2017; 100:1588-1597. [PMID: 28318844 PMCID: PMC5478425 DOI: 10.1016/j.pec.2017.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. METHODS We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. RESULTS Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. CONCLUSION Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. PRACTICE IMPLICATIONS Healthcare providers should ensure effective communication with obese parents of obese children.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Nakiya N Showell
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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22
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O'Malley G, Ring-Dimitriou S, Nowicka P, Vania A, Frelut ML, Farpour-Lambert N, Weghuber D, Thivel D. Physical Activity and Physical Fitness in Pediatric Obesity: What are the First Steps for Clinicians? Expert Conclusion from the 2016 ECOG Workshop. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2017; 10:487-496. [PMID: 28674594 PMCID: PMC5466409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
One of the main aims of the European Childhood Obesity Group (ECOG) is to assist healthcare workers in delivering evidence-based assessment and treatment of childhood obesity. Every year the ECOG Congress includes working groups whose objective is to highlight concerns faced by clinicians and practitioners who work in the field of pediatric obesity. This year, a working group was devoted to the assessment of physical activity and physical fitness in this population. The present commentary attempts to summarize the main themes identified by practitioners during these workshops in order to provide the basic and essential first steps required to address physical activity and fitness in children with obesity.
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Affiliation(s)
- Grace O'Malley
- Division of Population Health Sciences, Royal College of Surgeons of Ireland, Dublin, IRELAND
- European Childhood Obesity Group, Brussels, BELGIUM
- Department of Physiotherapy, Temple Street Children's University Hospital, Dublin, IRELAND
- European Association for the Study of Obesity, London, UK
| | - Susanne Ring-Dimitriou
- European Childhood Obesity Group, Brussels, BELGIUM
- Department of Sport Science and Kinesiology, Paris Lodron-University, Salzburg, AUSTRIA
| | - Paulina Nowicka
- European Childhood Obesity Group, Brussels, BELGIUM
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, SWEDEN
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, SWEDEN
| | - Andrea Vania
- European Childhood Obesity Group, Brussels, BELGIUM
- Department of Paediatrics and Paediatric Neuropsychiatry, Sapienza University, Rome, ITALY
| | - Marie-Laure Frelut
- European Childhood Obesity Group, Brussels, BELGIUM
- Pediatric Endocrinology Department, Bicêtre Paris Sud University Hospital, FRANCE
| | - Nathalie Farpour-Lambert
- European Association for the Study of Obesity, London, UK
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, SWITZERLAND
| | - Daniel Weghuber
- European Childhood Obesity Group, Brussels, BELGIUM
- Department of Pediatrics, Paracelsus Medical University, Salzburg, AUSTRIA
- Obesity Research Unit, Paracelsus Medical University, Salzburg, AUSTRIA
| | - David Thivel
- European Childhood Obesity Group, Brussels, BELGIUM
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Clermont Auvergne University, Clermont-Ferrand, FRANCE
- Auvergne Regional Center for Human Nutrition, Clermont-Ferrand, FRANCE
- CALORIS Obesity Clinical & Research Group, Clermont-Ferrand, FRANCE
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23
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Camp NL, Robert RC, Nash JE, Lichtenstein CB, Dawes CS, Kelly KP. Modifying Provider Practice To Improve Assessment of Unhealthy Weight and Lifestyle in Young Children: Translating Evidence in a Quality Improvement Initiative for At-Risk Children. Child Obes 2017; 13:173-181. [PMID: 28121467 DOI: 10.1089/chi.2016.0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We designed a quality improvement (QI) project to address the high prevalence of childhood overweight and obesity (OW/OB) in our patient population and the inconsistencies among primary care providers in recognizing and addressing OW/OB. METHODS We used mixed methods data collection approach to evaluate a QI project, the Childhood Healthy Behaviors Intervention (CHBI), to improve provider obesity prevention practice in two low-income, predominantly African American pediatric primary care clinics. Electronic record data were extracted from all 2-9 year well visits pre- and postintervention for frequency of appropriate diagnostic coding of OW/OB. We reviewed a random sample of records for details of health habit assessment and counseling documentation. Focused interviews were conducted to elicit provider responses regarding impressions of the intervention. RESULTS The preintervention sample of records (n = 267) was extracted from 18 providers and the postsample (n = 253) from 19 providers. Providers showed improvement in the recognition of OW/OB with appropriate diagnostic coding (52% pre, 68% post), improvement in assessment of health habits informed by the habit survey (0% pre, 76% post), improvement in counseling of healthy behaviors (86% pre, 92% post), and improvement in goal setting of healthy behaviors (12% pre, 70% post). CONCLUSIONS Our findings suggest that implementing a time efficient primary care intervention with brief provider training can improve provider recognition of OW/OB, as well as improve provider behavior targeted at childhood obesity prevention. This project contributes needed QI evidence on interventions to prevent and address OW/OB in primary care settings and calls for further work to strengthen implementation in similar contexts.
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Affiliation(s)
- Nadine L Camp
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,2 School of Nursing, The Catholic University of America , Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Rebecca C Robert
- 2 School of Nursing, The Catholic University of America , Washington, DC
| | - Jessica E Nash
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Cara B Lichtenstein
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Candice S Dawes
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Katherine Patterson Kelly
- 4 Department of Nursing Research and Quality Outcomes, Children's National Health System , Washington, DC
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24
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Alexander GL, Olden HA, Troy T, Miree CA, Joseph CLM. Overweight adolescents and asthma: Revealing motivations and challenges with adolescent-provider communication. J Asthma 2017; 55:266-274. [PMID: 28562121 DOI: 10.1080/02770903.2017.1323921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Among teens with asthma, challenges of disease management may be greater in those with a body mass index (BMI) >85th percentile compared to youth within the parameters for normal weight-for-age. This mixed-methods study assessed teens' awareness of the link between weight and asthma management, and perspectives on how medical providers might open a discussion about managing weight. METHOD Teens aged 13-18, having BMI >85 percentile and chronic asthma, identified using health system databases and a staff email message board, were invited to complete a semi-structured, in-depth phone interview. Interviews were audio taped, transcribed, and qualitatively analyzed, using the Framework Method. Responses were summarized and themes identified. Descriptive summaries were generated for a 16-item survey of weight conversation starters. RESULTS Of 35 teens interviewed, 24 (69%) were girls, 11 (31%) boys, 20 (63%) African-American. All teens reported having "the weight conversation" with their doctors, and preferred that parents be present. Half knew from their doctor about the link between being overweight and asthma, others knew from personal experience. Nearly all expressed the importance of providers initiating a weight management conversation. Most preferred conversation starters that recognized challenges and included parents' participation in weight management; least liked referred to "carrying around too much weight." CONCLUSIONS Most teens responded favorably to initiating weight loss if it impacted asthma management, valued their provider addressing weight and family participation in weight management efforts. Adolescents' views enhance program development fostering more effective communication targeting weight improvement within the overall asthma management plan.
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Affiliation(s)
- Gwen L Alexander
- a Henry Ford Health System , Public Health Sciences , Detroit , Michigan , USA
| | - Heather A Olden
- a Henry Ford Health System , Public Health Sciences , Detroit , Michigan , USA
| | - Tanya Troy
- b Johns Hopkins University Bloomberg School of Public Health , Department of Epidemiology , Baltimore , Maryland , USA
| | - Cheryl A Miree
- a Henry Ford Health System , Public Health Sciences , Detroit , Michigan , USA
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25
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Kumar GS, Bryan M, Bayakly R, Drenzek C, Merlo C, Perry GS. Reported Motivations for and Locations of Healthy Eating Among Georgia High School Students. THE JOURNAL OF SCHOOL HEALTH 2017; 87:353-362. [PMID: 28382665 PMCID: PMC8951171 DOI: 10.1111/josh.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 08/19/2016] [Accepted: 10/14/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Understanding how youth perceive eating healthy foods can inform programs and policies that aim to improve healthy eating. We assessed the reasons for and the most common locations of eating healthy foods among Georgia's (GA) high school (HS) students. METHODS Using the 2013 GA HS Youth Risk Behavior Survey, we examined motivations for and locations of eating healthy foods by sociodemographic characteristics and daily fruit and vegetable intake. Weighted chi-square tests were used to examine differences in responses for each perception. RESULTS Nineteen percent of GA HS students consumed fruit ≥3 times/day and 11% consumed vegetables ≥3 times/day. The most frequently chosen response to motivations for eating healthy foods was the desire to be healthy (42%), followed by enjoying their taste (18%). The most likely location to eat healthy foods was at home (80%), followed by at school (13%). CONCLUSIONS GA HS students are most motivated to eat healthy foods by the desire to be healthy and their enjoyment of the taste of healthy foods. Incorporating messages that align with students' motivations to eat healthy foods could be considered when developing promotional programs/policies targeting healthy eating.
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Affiliation(s)
- Gayathri S. Kumar
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341
| | - Michael Bryan
- Georgia Department of Public Health, 2 Peachtree Street NW, Atlanta, Georgia 30303
| | - Rana Bayakly
- Georgia Department of Public Health, 2 Peachtree Street NW, Atlanta, Georgia 30303
| | - Cherie Drenzek
- Georgia Department of Public Health, 2 Peachtree Street NW, Atlanta, Georgia 30303
| | - Caitlin Merlo
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341
| | - Geraldine S. Perry
- Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, Georgia 30341
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26
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Mkhatshwa VB, Ogunbanjo GA, Mabuza LH. Knowledge, attitudes and management skills of medical practitioners regarding weight management. Afr J Prim Health Care Fam Med 2016; 8:e1-e9. [PMID: 28155319 PMCID: PMC5153405 DOI: 10.4102/phcfm.v8i1.1187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/19/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa. METHODS We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant. RESULTS Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient's family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013). CONCLUSION Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient's family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels.
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Affiliation(s)
| | | | - Langalibalele H Mabuza
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University.
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Lenders CM, Manders AJ, Perdomo JE, Ireland KA, Barlow SE. Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going? Curr Obes Rep 2016; 5:214-40. [PMID: 27048522 PMCID: PMC5497516 DOI: 10.1007/s13679-016-0210-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Since the "2007 summary report of child and adolescent overweight and obesity treatment" published by Barlow, many obesity intervention studies have been conducted in pediatric ambulatory care. Although several meta-analyses have been published in the interim, many studies were excluded because of the focus and criteria of these meta-analyses. Therefore, the primary goal of this article was to identify randomized case-control trials conducted in the primary care setting and to report on treatment approaches, challenges, and successes. We have developed four themes for our discussion and provide a brief summary of our findings. Finally, we identified major gaps and potential solutions and describe several urgent key action items.
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Affiliation(s)
- Carine M Lenders
- Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Vose Hall-3, 88, East Newton Street, Boston, MA, 02118, USA.
| | - Aaron J Manders
- Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Vose Hall-3, 88, East Newton Street, Boston, MA, 02118, USA
| | - Joanna E Perdomo
- Boston Combined Residency Program, Boston University School of Medicine and Harvard Medical School, Dowling 3-870 Harrison Avenue, Boston, MA, 02118, USA
| | - Kathy A Ireland
- Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Vose Hall-3, 88, East Newton Street, Boston, MA, 02118, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Suite 1010, Houston, TX, 77030, USA
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