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Kumar S, King E, Binns HJ, Christison A, Cuda SE, Yee JK, Joseph M, Kirk S. Diabetes screening outcomes in youth presenting for paediatric weight management: A report of the Paediatric Obesity Weight Evaluation Registry. Pediatr Obes 2024; 19:e13102. [PMID: 38296252 DOI: 10.1111/ijpo.13102] [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] [Received: 09/16/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]). STUDY DESIGN Data were collected prospectively from 37 multi-component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry). RESULTS For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100-125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%-6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10-18 years [n = 2915] and age 2-9 years [n = 1047]). CONCLUSION There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Christison
- Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Suzanne E Cuda
- Alamo City Healthy Kids and Families, San Antonio, Texas, USA
| | - Jennifer K Yee
- Division of Pediatric Endocrinology, Harbor-UCLA Medical Center and The Lundquist Institute of Biomedical Innovation at Harbor-UCLA, Torrance, California, USA
| | - Madeline Joseph
- College of Medicine, University of Florida, Jacksonville, Florida, United States
| | - Shelley Kirk
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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2
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Parashette KR, Coakley KE, Kong AS, Jimenez EY, Negrete S. High Prevalence of Elevated Alanine Aminotransferase in American Indian Children Seen in a Pediatric Weight Management Clinic. Am J Gastroenterol 2024:00000434-990000000-01021. [PMID: 38314813 DOI: 10.14309/ajg.0000000000002711] [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] [Received: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Elevated alanine aminotransferase (ALT) can indicate risk of metabolic dysfunction-associated steatotic liver disease. However, there is little data about the prevalence of elevated ALT in American Indian (AI) children. METHODS Baseline data from children attending the pediatric weight management clinic were used to describe the prevalence of elevated ALT, stratified by race and ethnicity. RESULTS The prevalence of elevated ALT was higher among children who were male, were older, had higher body mass index Z scores, and were non-Hispanic and AI. DISCUSSION In this clinic, AI children with overweight and obesity had a disproportionately high prevalence of elevated ALT; root causes of this disparity should be identified.
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Affiliation(s)
- Kalyan Ray Parashette
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Kathryn E Coakley
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alberta S Kong
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Elizabeth Y Jimenez
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Sylvia Negrete
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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3
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Fox CK, Vock DM, Sherwood NE, Gross AC, Ryder JR, Bensignor MO, Bomberg EM, Sunni M, Bramante CT, Jacobs N, Raatz SJ, Kelly AS. SMART use of medications for the treatment of adolescent severe obesity: A sequential multiple assignment randomized trial protocol. Contemp Clin Trials 2024; 138:107444. [PMID: 38219798 PMCID: PMC11037878 DOI: 10.1016/j.cct.2024.107444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Severe obesity is a complex, chronic disease affecting nearly 9% of adolescents in the U.S. Although the current mainstay of treatment is lifestyle therapy, pediatric clinical practice guidelines recommend the addition of adjunct anti-obesity medication (AOM), such as phentermine and topiramate. However, guidance regarding when adjunct AOM should be started and how AOM should be used is unclear. Furthermore, an inherent limitation of current treatment guidelines is their "one-size-fits-all" approach, which does not account for the heterogeneous nature of obesity and high degree of patient variability in response to all interventions. METHODS This paper describes the study design and methods of a sequential multiple assignment randomized trial (SMART), "SMART Use of Medications for the Treatment of Adolescent Severe Obesity." The trial will examine 1) when to start AOM (specifically phentermine) in adolescents who are not responding to lifestyle therapy and 2) how to modify AOM when there is a sub-optimal response to the initial pharmacological intervention (specifically, for phentermine non-responders, is it better to add topiramate to phentermine or switch to topiramate monotherapy). Critically, participant characteristics that may differentially affect response to treatment will be assessed and evaluated as potential moderators of intervention efficacy. CONCLUSION Data from this study will be used to inform the development of an adaptive intervention for the treatment of adolescent severe obesity that includes empirically-derived decision rules regarding when and how to use AOM. Future research will test this adaptive intervention against standard "one-size-fits-all" treatments.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America.
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States of America
| | - Amy C Gross
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Justin R Ryder
- Ann & Robert H. Lurie Children's Hospital of Chicago, United States of America; Northwestern Feinberg School of Medicine, United States of America
| | - Megan O Bensignor
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Muna Sunni
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Nina Jacobs
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Sarah J Raatz
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
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4
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Nosrati M, Seifi N, Hosseini N, Ferns GA, Kimiafar K, Ghayour-Mobarhan M. Essential dataset features in a successful obesity registry: a systematic review. Int Health 2024:ihae017. [PMID: 38366720 DOI: 10.1093/inthealth/ihae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The prevalence of obesity and the diversity of available treatments makes the development of a national obesity registry desirable. To do this, it is essential to design a minimal dataset to meet the needs of a registry. This review aims to identify the essential elements of a successful obesity registry. METHODS We conducted a systematic literature review adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations. Google Scholar, Scopus and PubMed databases and Google sites were searched to identify articles containing obesity or overweight registries or datasets of obesity. We included English articles up to January 2023. RESULTS A total of 82 articles were identified. Data collection of all registries was carried out via a web-based system. According to the included datasets, the important features were as follows: demographics, anthropometrics, medical history, lifestyle assessment, nutritional assessment, weight history, clinical information, medication history, family medical history, prenatal history, quality-of-life assessment and eating disorders. CONCLUSIONS In this study, the essential features in the obesity registry dataset were demographics, anthropometrics, medical history, lifestyle assessment, nutritional assessment, weight history and clinical analysis items.
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Affiliation(s)
- Mina Nosrati
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Seifi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Hosseini
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK
| | - Khalil Kimiafar
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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5
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Fox CK, Kelly AS, Reilly JL, Theis-Mahon N, Raatz SJ. Current and future state of pharmacological management of pediatric obesity. Int J Obes (Lond) 2024:10.1038/s41366-024-01465-y. [PMID: 38321079 DOI: 10.1038/s41366-024-01465-y] [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] [Received: 07/30/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
Pediatric obesity is a highly prevalent chronic disease, which has traditionally been treated with lifestyle therapy alone. Yet for many youth, lifestyle intervention as a monotherapy is often insufficient for achieving clinically significant and durable BMI reduction. While metabolic/bariatric surgery achieves robust and long-lasting outcomes, it is neither widely accessible nor wanted by most pediatric patients and families. In the past 3 years, this treatment gap between lifestyle therapy and metabolic/bariatric surgery has been filled with a number of landmark clinical trials examining the safety and efficacy of anti-obesity medication (AOM) for use in children and adolescents. These trials include studies of liraglutide, phentermine/topiramate ER, semaglutide, and setmelanotide, all of which have led to FDA and/or EMA approval. Concurrent with this developing evidence base, in 2023, the American Academy of Pediatrics published their first Clinical Practice Guideline on the assessment and management of childhood obesity. The Guideline includes the recommendation that pediatric health care providers should offer AOM to youth ages ≥12 years with obesity. Recognizing that AOM use in the pediatric population will likely become the standard of care and to provide perspective on the recently generated data regarding new AOM, this narrative review summarizes the published randomized controlled trials (RCTs) from the past 10 years that examine AOM for the pediatric population. This report additionally includes RCTs examining AOM for special populations of pediatric obesity including monogenic obesity, Bardet Biedl syndrome, Prader Willi syndrome, and hypothalamic obesity. Finally, the clinical application of AOM for children and adolescents, as well as future directions and challenges are discussed.
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Affiliation(s)
- Claudia K Fox
- University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA.
| | - Aaron S Kelly
- University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA
| | - Jessica L Reilly
- Emory University School of Medicine, Department of Pediatrics, Atlanta, USA
| | | | - Sarah J Raatz
- University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA
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6
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Christison A, Tucker J, King E, Sweeney B, Cuda S, Frank M, Kirk S. Treating Children and Adolescents With Obesity: Characteristics of Success. Child Obes 2023. [PMID: 37971786 DOI: 10.1089/chi.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Background: Factors related to clinically meaningful outcomes for pediatric patients seeking care for severe obesity are not well known. Examining patient-level and program-level characteristics related to success may inform future care. Objectives: To determine factors associated with a clinically significant reduction in weight status measured by %BMIp95 after 6 months of treatment. Study Design: This is a retrospective study of youth 5-17 years of age seeking multicomponent weight management care to determine if patient characteristics, treatment recommendations, reported adherence, and additional program-affiliated class participation are associated with 6-month change in %BMIp95. Results: Among 170 children with obesity, higher reductions in %BMIp95 were seen in those with medium-high dietary adherence compared to low-none (-10.8 vs. -4.0, p = 0.002). Post hoc analysis showed higher dietary adherence among those with private insurance than public insurance (59% vs. 41%, respectively, p = 0.04). Conclusion: Children receiving multidisciplinary multicomponent weight management, who achieve clinically meaningful outcomes, are more likely to be adherent to dietary recommendations regardless of the type. Further study is needed of how best to address social determinants of health to improve dietary adherence. Clinical Trial Registration Number: NCT02121132.
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Affiliation(s)
- Amy Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Jared Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brooke Sweeney
- Department of General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
- Children's Center for Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Suzanne Cuda
- Alamo City Healthy Kids & Families, San Antonio, TX, USA
| | - Michelle Frank
- The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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7
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Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T, Summerbell C, Wabitsch M. Child and adolescent obesity. Nat Rev Dis Primers 2023; 9:24. [PMID: 37202378 DOI: 10.1038/s41572-023-00435-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andrew J Hill
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Claude Marcus
- Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany
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Lane TS, Sonderegger DL, Binns HJ, Kirk S, Christison AL, Novick M, Tucker J, King E, Wallace S, Brazendale K, Kharofa RY, Walka S, de Heer H‘D. Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction. Pediatr Obes 2023; 18:e13012. [PMID: 36811325 PMCID: PMC10150645 DOI: 10.1111/ijpo.13012] [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: 06/17/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. OBJECTIVE To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). METHOD Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. RESULTS Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26). CONCLUSION AND RELEVANCE Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.
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Affiliation(s)
- Taylor S Lane
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Derek L Sonderegger
- Department of Math and Statistics, Northern Arizona University, Flagstaff, AZ
| | - Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL
| | - Shelley Kirk
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- The Heart Institute, Center for Better Health and Nutrition Cincinnati Children’s Hospital Medical Center Cincinnati, OH
| | - Amy L. Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Marsha Novick
- Department of Pediatrics and Family & Community Medicine, Healthy Weight Program for Children and Teens, Penn State Milton S. Hershey Children’s Hospital, Hershey, PA
| | - Jared Tucker
- Health Optimization Services, Helen DeVos Children’s Hospital, Grand Rapids, MI
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Stephenie Wallace
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
- Adolescent Medicine, Children’s Alabama, Birmingham, AL
| | - Keith Brazendale
- Department of Health Sciences, University of Central Florida, Orlando, FL
| | - Roohi Y. Kharofa
- The Heart Institute, Center for Better Health and Nutrition Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sherry Walka
- Northern Arizona Healthcare Inspire Program, Northern Arizona Healthcare, Flagstaff, AZ
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9
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Cohen J, Alexander S, Signorelli C, Williams K, Sim KA, Chennariyil L, Baur LA. Clinician and healthcare managers' perspectives on the delivery of secondary and tertiary pediatric weight management services. J Child Health Care 2023; 27:128-144. [PMID: 34719287 DOI: 10.1177/13674935211052148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinician and healthcare managers' (HCMs) views on weight management service delivery are imperative for informing the nature of future services to treat children with obesity. This qualitative study used semi-structured focus groups and one-on-one semi-structured interviews. Participants were 27 clinicians (medical, nursing, or allied health) and nine HCMs (senior executives in the hospital) who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. Clinicians reported that using a combination of group and individual sessions improved engagement with families and reduced attrition rates. Clinicians and HCMs recommended integrating clinics into community centers and providing specific programs for sub-groups, such as children from culturally and linguistically diverse communities or children with developmental delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. To improve the likelihood of future funding for pediatric weight management clinics and to optimize models of care, centers must embed research into their practice. Addressing common barriers to current pediatric weight management services and designing future models of care based on key stakeholders' preferences is critical to achieving optimal care provision for this high-risk population.
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Affiliation(s)
- Jennifer Cohen
- Weight Management Services, 8538The Children's Hospital at Westmead, Westmead, NSW, Australia.,Discipline of Paediatrics, School of Women's & Children's Health, 7800The UNSW Sydney, Sydney, NSW, Australia
| | - Shirley Alexander
- Weight Management Services, 8538The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's & Children's Health, 7800The UNSW Sydney, Sydney, NSW, Australia.,Kids Cancer Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Kathryn Williams
- Charles Perkins Centre, 4334The University of Sydney, Camperdown, NSW, Australia.,Nepean Family Metabolic Health Service, 223690Nepean Blue Mountains Local Health District, Kingswood, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Kyra A Sim
- Charles Perkins Centre, 4334The University of Sydney, Camperdown, NSW, Australia.,Obesity Prevention and Management, 222415Sydney Local Health District, Camperdown, NSW, Australia
| | - Lenina Chennariyil
- Discipline of Paediatrics, School of Women's & Children's Health, 7800The UNSW Sydney, Sydney, NSW, Australia.,Department of Paediatrics, 36666Canterbury Hospital, Campsie, NSW, Australia
| | - Louise A Baur
- Weight Management Services, 8538The Children's Hospital at Westmead, Westmead, NSW, Australia.,Charles Perkins Centre, 4334The University of Sydney, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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10
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Neshteruk CD, Skinner AC, Counts J, D’Agostino EM, Frerichs L, Howard J, Story M, Armstrong SC. Translating knowledge into action for child obesity treatment in partnership with Parks and Recreation: study protocol for a hybrid type II trial. Implement Sci 2023; 18:6. [PMID: 36829237 PMCID: PMC9951422 DOI: 10.1186/s13012-023-01264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Safe and effective treatment exists for childhood obesity, but treatment recommendations have largely not been translated into practice, particularly among racial and ethnic minorities and low-wealth populations. A key gap is meeting the recommended treatment of ≥26 h of lifestyle modification over 6-12 months. Fit Together is an effective treatment model that meets these recommendations by integrating healthcare and community resources. Pediatric providers screen children for obesity, deliver counseling, and treat co-morbidities, while Parks and Recreation partners provide recreation space for a community nutrition and physical activity program. METHODS This study will use a hybrid type II implementation-effectiveness design to evaluate the effectiveness of an online implementation platform (the Playbook) for delivering Fit Together. Clinical and community partners in two North Carolina communities will implement Fit Together, using the Playbook, an implementation package designed to facilitate new partnerships, guide training activities, and provide curricular materials needed to implement Fit Together. An interrupted time series design anchored in the Process Redesign Framework will be used to evaluate implementation and effectiveness outcomes in intervention sites. Implementation measures include semi-structured interviews with partners, before and after the implementation of Fit Together, and quantitative measures assessing several constructs within the Process Redesign Framework. The participants will be children 6-11 years old with obesity and their families (n=400). Effectiveness outcomes include a change in child body mass index and physical activity from baseline to 6 and 12 months, as compared with children receiving usual care. Findings will be used to inform the design of a dissemination strategy guided by the PCORI Dissemination Framework. DISCUSSION This project addresses the knowledge-to-action gap by developing evidence-based implementation tools that allow clinicians and communities to deliver effective pediatric obesity treatment recommendations. Future dissemination of these tools will allow more children who have obesity and their families to have access to effective, evidence-based care in diverse communities. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05455190 . Registered on 13 July 2022.
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Affiliation(s)
- Cody D. Neshteruk
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA
| | - Asheley C. Skinner
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Durham, NC USA
| | - Julie Counts
- grid.26009.3d0000 0004 1936 7961Duke Molecular Physiology Institute, Durham, NC USA
| | - Emily M. D’Agostino
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Leah Frerichs
- grid.10698.360000000122483208Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Janna Howard
- grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, NC USA
| | - Mary Story
- grid.26009.3d0000 0004 1936 7961Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University School of Medicine, Durham, NC USA
| | - Sarah C. Armstrong
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC USA
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11
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 202] [Impact Index Per Article: 202.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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12
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities. Pediatrics 2023; 151:190446. [PMID: 36622098 DOI: 10.1542/peds.2022-060643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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13
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions. Pediatrics 2023; 151:190447. [PMID: 36622110 DOI: 10.1542/peds.2022-060642] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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14
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Christison AL, Ariza AJ, Fernandez C, Kumar S, Novick MB, Santos M, Stratbucker WB, Sweeney BR, Vidmar A, Kirk S. Challenges and solutions to sustaining paediatric weight management programs in the United States. Clin Obes 2023; 13:e12577. [PMID: 36631245 DOI: 10.1111/cob.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
Paediatric weight management (PWM) programs in the United States (US) face challenges in providing sustainable multidisciplinary care for patients. The aim of this study was to report PWM program approaches to sustaining program delivery. A survey of 39 PWM programs was administered to identify challenges and solutions to program sustainability. Common and useful strategies for optimizing reimbursement for services included the use of applicable reimbursable diagnostic codes and management, billing for assessments and non-medical personnel services, and the use of hospital outpatient department clinic billing. Increasing clinical breadth and capacity was achieved by offering telemedicine and other services, such as psychotherapy, pharmacotherapy, and metabolic and bariatric surgery, as well as active management of schedules. Securing institutional and extramural funding was also reported. One of the positive changes during the pandemic was the fast adoption of telemedicine services. Although delivering sustainable evidence-based multidisciplinary PWM under the current US payment models has its challenges, PWM programs implement practical operational strategies to support this work.
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Affiliation(s)
- Amy L Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Adolfo J Ariza
- Department of Pediatrics, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Cristina Fernandez
- Department of General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, United States
- Children's Center for Healthy Lifestyles & Nutrition, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marsha B Novick
- Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Melissa Santos
- Pediatric Obesity Center, Connecticut Children's, Hartford, Connecticut, USA
| | - William B Stratbucker
- Department of Pediatrics, Helen Devos Children's Hospital and Michigan State University, Grand Rapids, Michigan, USA
| | - Brooke R Sweeney
- Department of General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, United States
- Children's Center for Healthy Lifestyles & Nutrition, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Alaina Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
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15
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Tester JM, Xiao L, Tinajero-Deck L, Juarez L, Rosas LG. Food Insecurity Influences Weight Trajectory in Children with Obesity. Child Obes 2022; 18:437-444. [PMID: 35171045 PMCID: PMC9634962 DOI: 10.1089/chi.2021.0311] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Social disadvantage is associated with children's risk of being overweight or obese, but little is known about how it impacts weight trajectory. This longitudinal analysis examines food insecurity and weight change over time among low-income children in a multidisciplinary weight management clinic. Methods: Food insecurity was assessed between 2008 and 2016 among 794 low-income patients (household income <$60k/year) who attended 3234 visits. Mixed-effects growth curve modeling was used to examine the association between baseline food security status and weight trajectory, using percentage of the 95th percentile for BMI (%BMIp95). Random effects (each child's growth curve) and fixed effects (food insecurity, starting age and %BMIp95, demographics, and months since the initial visit) were modeled, and interactions between food insecurity and elapsed time estimated the influence of food insecurity on weight trajectory. Results: Mean %BMIp95 was 129% (SD 24%), corresponding to severe obesity. Thirty percent of patients were food-insecure at baseline. After adjusting for other factors, monthly change in %BMIp95 was significantly smaller for food-insecure children compared to food-secure peers (difference in the coefficients for slope: 0.13, SE 0.05, p = 0.009). The modeled 12-month change in %BMIp95 was significant for food-secure children (-2.28, SE 0.76, p = 0.0026), but not for food-insecure children (-1.54, SE 1.22, p = 0.21). Conclusion: Household food insecurity was associated with a less optimal weight trajectory among children with obesity.
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Affiliation(s)
- June M. Tester
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
- Department of Pediatrics, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA, USA
| | - Lydia Tinajero-Deck
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
- Department of Pediatrics, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Lourdes Juarez
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA, USA
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16
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Ball GDC, Eaton A, Rathwell S, Peng C, Maximova K, Kokkvoll A, Zehnder E, Ho J, Perez A. Re-referring Children for Multidisciplinary Obesity Management. J Pediatr 2022; 244:101-106.e2. [PMID: 35074309 DOI: 10.1016/j.jpeds.2022.01.018] [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: 09/10/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To examine characteristics of children referred for obesity management based on referral frequency, child- and referrer-related variables associated with re-referral, and determine whether re-referral increased treatment initiation. STUDY DESIGN This population-level, retrospective analysis included all 2- to 17-year-olds referred for obesity management to 1 of 3 multidisciplinary clinics in Alberta, Canada between April 2013 and December 2017. Children were dichotomized based on referral frequency, specifically once only or more than once (re-referred). Data were retrieved from standardized referral forms and patient registries. Analyses included logistic regression and generalized estimating equations models. RESULT We analyzed data from 2745 children (47.2% female; mean age: 11.4 years; mean body mass index z score: 3.03) and 2705 physicians (60.2% female; 65.6% pediatricians). Overall, 300 (10.2%) children were re-referred with most (n = 276; 92.0%) being referred twice. Children were less likely to be re-referred if they were referred by a family physician (vs pediatrician) (aOR 0.62; 95% CI 0.46-0.84; P = .0018) or scheduled a clinic appointment following their index referral (aOR: 0.29; 95% CI 0.21-0.4; P < .001). Treatment initiation was higher in children who were referred once only (42.1%) vs their re-referred peers (18.0%; P < .0001); however, for children who were re-referred, they were more likely to initiate treatment following their second referral (aOR 2.3; 95% CI 1.22-4.31; P = .01). This improvement was not sustained on subsequent referrals (aOR 0.44; 95% CI 0.17-1.12; P = .08). CONCLUSIONS Few children were re-referred for pediatric obesity management; however, for those children who were re-referred, being re-referred once only increased the likelihood of treatment initiation.
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Andrea Eaton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Rathwell
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Chenhui Peng
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ane Kokkvoll
- Department of Pediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Emily Zehnder
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Josephine Ho
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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17
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Tucker JM, Stratbucker W, King EC, Cuda S, Negrete S, Sweeney B, Kumar S, Borzutzky C, Binns HJ, Kirk S. Characteristics of paediatric weight management in the United States: Associations with program retention and BMI outcomes in the paediatric obesity weight evaluation registry (POWER). Pediatr Obes 2022; 17:e12848. [PMID: 34498814 DOI: 10.1111/ijpo.12848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe characteristics of paediatric weight management (PWM) programs across the United States and evaluate associations with program-specific retention rates and body mass index (BMI) outcomes at 6 months. METHODS A program profile survey was administered to 33 programs within the Paediatric Obesity Weight Evaluation Registry (POWER) to assess program staffing, services, and treatment format. Patient retention and percent of the 95th BMI percentile (%BMIp95) changes were assessed for each program. RESULTS At 6 months program retention rates ranged from 15% to 74% (median: 41%), and program %BMIp95 changes ranged from -9.0 to +0.5 percentage points (median: -1.7). Percent of patients with ≥5 percentage-point decrease in %BMIp95 ranged from 17% to 71% across programs (median: 29%). No associations were detected between program characteristics and retention or %BMIp95 changes. CONCLUSIONS Six-month patient retention and BMI outcomes vary substantially in PWM programs across the United States. Yet, no associations were found between PWM treatment factors and these program-level patient outcomes.
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Affiliation(s)
- Jared M Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - William Stratbucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Suzanne Cuda
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Sylvia Negrete
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Brooke Sweeney
- General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Children's Center for Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Helen J Binns
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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18
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Binns HJ, Joseph M, Ariza AJ, Cuda SE, Skinner AC, Xu H, Tucker JM, Hampl SE, Santos M, Mayo S, King EC, Kirk S. Elevated blood pressure in youth in pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER). J Clin Hypertens (Greenwich) 2022; 24:122-130. [PMID: 35099099 PMCID: PMC8845448 DOI: 10.1111/jch.14423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 02/01/2023]
Abstract
Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3–17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95th percentile for body mass index (%BMIp95); %BMIp95 was used to group youth by obesity class (class 1, 100% to < 120% %BMIp95; class 2, 120% to < 140% %BMIp95; class 3, ≥140% %BMIp95; class 2 and class 3 are considered severe obesity). Logistic regression evaluated associations with high BP. Data of 7943 patients were analyzed. Patients were: mean 11.7 (SD 3.3) years; 54% female; 19% Black non‐Hispanic, 32% Hispanic, 39% White non‐Hispanic; mean %BMIp95 137% (SD 25). Overall, 48.9% had high BP at the baseline visit, including 60.0% of youth with class 3 obesity, 45.9% with class 2 obesity, and 37.7% with class 1 obesity. Having high BP was positively associated with severe obesity, older age (15–17 years), and being male. Nearly half of treatment‐seeking youth with obesity presented for PWM care with high BP making assessment and management of BP a key area of focus for PWM programs.
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Affiliation(s)
- Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Madeline Joseph
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Adolfo J Ariza
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Suzanne E Cuda
- Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Asheley C Skinner
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jared M Tucker
- Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Sarah E Hampl
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Shawyntee Mayo
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Eileen C King
- Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shelley Kirk
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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19
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Skinner AC, Xu H, Christison A, Neshteruk C, Cuda S, Santos M, Yee JK, Thomas L, King E, Kirk S. Patient Retention in Pediatric Weight Management Programs in the United States: Analyses of Data from the Pediatrics Obesity Weight Evaluation Registry. Child Obes 2022; 18:31-40. [PMID: 34415779 DOI: 10.1089/chi.2021.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Meeting recommended provider contact hours in multicomponent pediatric weight management (PWM) programs is difficult when patient retention is low. Our objective was to examine associations between individual patient characteristics, program characteristics, and patient retention. Methods: Using the Pediatric Obesity Weight Evaluation Registry, a prospective longitudinal study of 32 PWM programs, we included children (≤18 years; n = 6502) enrolled for a full year. We examined associations between retention (any follow-up visit) and patient and program characteristics using multivariable models with site-clustering random effects. Results: Sixty-seven percent of children had at least one follow-up visit, whereas 12% had four or more visits. Compared with non-Hispanic white children, non-Hispanic black children were less likely to have a follow-up visit [adjusted odds ratio (aOR) = 0.79], whereas Hispanic children (any race) were more likely (aOR = 1.22). Children with Medicaid had similar retention to those with private insurance. Retention did not differ by age, gender, weight status, or comorbidities, nor by program characteristics. Conclusions: Few characteristics of PWM programs are clearly associated with retention, indicating that a variety of formats can support continued treatment and likely reflect the influence of unmeasured characteristics. Clearer ways to identify and overcome barriers for individual patients will be needed to improve retention in PWM.
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Affiliation(s)
- Asheley Cockrell Skinner
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Amy Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Suzanne Cuda
- Department of Pediatrics, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Melissa Santos
- Pediatric Obesity Center, Connecticut Children's, Hartford, CT, USA
| | - Jennifer K Yee
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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20
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Gehring ND, Kebbe M, Rathwell S, Perez A, Peng C, Zendher E, Ho J, Ball GDC. Physician-related predictors of referral for multidisciplinary paediatric obesity management: a population-based study. Fam Pract 2021; 38:576-581. [PMID: 33755099 DOI: 10.1093/fampra/cmab019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health. OBJECTIVE To determine predictors of referral to multidisciplinary paediatric obesity management. METHODS This retrospective, population-level study included physicians who could refer 2-17 years old with a body mass index ≥85th percentile to one of three multidisciplinary paediatric obesity management clinics in Alberta, Canada. Physician demographic and procedural data were obtained from Practitioner Claims and Provider Registry maintained by Alberta Health from January 2014 to December 2017. Physician characteristics were compared based on whether they did or did not refer children for obesity management. Univariable and multivariable logistic regression models analysed associations between physician characteristics and referral making. RESULTS Of the 3863 physicians (3468 family physicians, 395 paediatricians; 56% male; 49.3 ± 12.2 years old; 22.3 ± 12.6 years since graduation) practicing during the study period, 1358 (35.2%) referred at least one child for multidisciplinary paediatric obesity management. Multivariable regression revealed that female physicians (versus males) [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.46-1.93; P < 0.0001], paediatricians (versus family physicians) (OR: 4.89, 95% CI: 3.85-6.21; P < 0.0001) and urban-based physicians (versus non-urban-based physicians) (OR: 2.17, 95% CI: 1.79-2.65; P < 0.0001) were more likely to refer children for multidisciplinary paediatric obesity management. CONCLUSIONS Approximately one-third of family physicians and paediatricians referred children for multidisciplinary paediatric obesity management. Strategies are needed to improve referral practices for managing paediatric obesity, especially among male physicians, family physicians and non-urban-based physicians as they were less likely to refer children.
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Affiliation(s)
- Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Sarah Rathwell
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chenhui Peng
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Emily Zendher
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Josephine Ho
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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21
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Green TP, Binns HJ, Wu H, Ariza AJ, Perrin EM, Quadri M, Hornik CP, Cohen‐Wolkowiez M. Estimation of Body Fat Percentage for Clinical Pharmacokinetic Studies in Children. Clin Transl Sci 2021; 14:509-517. [PMID: 33142010 PMCID: PMC7993323 DOI: 10.1111/cts.12896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022] Open
Abstract
Obesity is a prevalent childhood condition and the degree of adiposity appears likely to be an important covariate in the pharmacokinetics (PKs) of many drugs. We undertook these studies to facilitate the evaluation and, where appropriate, quantification of the covariate effect of body fat percentage (BF%) on PK parameters in children. We examined two large databases to determine the values and variabilities of BF% in children with healthy body weights and in those with obesity, comparing the accuracy and precision of BF% estimation by both clinical methods and demographically derived techniques. Additionally, we conducted simulation studies to evaluate the utility of the several methods for application in clinical trials. BF% was correlated with body mass index (BMI), but was highly variable among both children with healthy body weights and those with obesity. Bio-impedance and several demographically derived techniques produced mean estimates of BF% that differed from dual x-ray absorptiometry by < 1% (accuracy) and a SD of 5% or less (precision). Simulation studies confirmed that when the differences in precision among the several methods were small compared with unexplained between-subject variability of a PK parameter, the techniques were of similar value in assessing the contribution of BF%, if any, as a covariate for that PK parameter. The combination of sex and obesity stage explained 68% of the variance of BF% with BMI. The estimation of BF% from sex and obesity stage can routinely be applied to PK clinical trials to evaluate the contribution of BF% as a potential covariate.
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Affiliation(s)
- Thomas P. Green
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Helen J. Binns
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center on Obesity Management and PreventionStanley Manne Children's Research InstituteChicagoIllinoisUSA
- Department of Preventive MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Huali Wu
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Adolfo J. Ariza
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center on Obesity Management and PreventionStanley Manne Children's Research InstituteChicagoIllinoisUSA
| | - Eliana M. Perrin
- Duke Center for Childhood Obesity Research and Division of Primary CareDepartment of PediatricsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Maheen Quadri
- Department of PediatricsAnn & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Center on Obesity Management and PreventionStanley Manne Children's Research InstituteChicagoIllinoisUSA
| | - Christoph P. Hornik
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
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22
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Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic. Int J Obes (Lond) 2021; 45:1086-1094. [PMID: 33603129 DOI: 10.1038/s41366-021-00778-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Child and Adult Eating Behavior Questionnaires (CEBQ, AEBQ) are established measures of eating behaviors. However, no similar measure is available for adolescents. Prior research has validated the AEBQ in adult samples, and one study has explored using the measure with adolescents. However, no studies to date have examined the validity of the AEBQ in adolescent clinical populations. Furthermore, no studies have examined associations between the AEBQ and indicators of health status in adolescents. METHODS A total of 280 adolescents (12-17 years old, 60% female) seen in a pediatric weight management clinic completed the AEBQ at intake. Confirmatory factor analysis (CFA) was conducted with AEBQ items to evaluate the model fit of one-, two-, seven-, and eight-factor structures. Intercorrelations between scale scores from AEBQ Food Approach and Food Avoidance domains were calculated. Associations of AEBQ scales with body mass index (BMI) and binge-eating behaviors were examined using Spearman Rho correlations and independent t-tests. RESULTS CFAs revealed that the best fitting model was a seven-factor structure excluding the Hunger scale, although overall model fit was only marginally acceptable (X2 = 980.94, CFI = 0.925, TLI = 0.915, RMSEA = 0.074). Intercorrelation analyses indicated that all Food Approach scales were significantly associated with one another (r = 0.243-0.654); Food Avoidance scales were inconsistently correlated (r = 0.034-0.439). No AEBQ scales were correlated with BMI (r = -0.101-0.082). Stronger links were found with binge eating; higher frequency binge-related behaviors were associated with higher Food Approach scores. CONCLUSIONS The seven-factor structure of AEBQ demonstrates a marginally acceptable fit for treatment-seeking adolescents with obesity. The Food Approach scales demonstrated more convergent validity than the Food Avoidance scales. The Food Approach scales also exhibited some clinical utility for identifying patients with increased risk for binge eating, which is a common target for behavioral intervention. Implications for maximizing the AEBQ's potential for assessing eating behaviors in adolescents with obesity are discussed.
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23
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Lukenbill T, San Giovanni CB, Simpson A, Chew M, Basco W, Roberts J. Assessing anthropometric and laboratory outcomes of a paediatric telehealth weight management program. J Telemed Telecare 2021; 29:399-405. [PMID: 33563063 DOI: 10.1177/1357633x20986022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telehealth can expand quality care to patients unable to access specialty health services. The purpose of this study was to compare changes in body mass index (BMI) and laboratory values in patients visiting a weight management clinic for in-person versus telehealth counselling. METHODS A retrospective cohort study of active program participants from two to 22 years old was conducted. Change in BMI, BMI z-score, low-density lipoprotein (LDL), alanine aminotransferase (ALT), and glycated haemoglobin (HbA1c) levels were measured at each patient's initial and final visit for the study period, and the difference was analysed for significance. Change in BMI z-score was analysed for non-inferiority of the telehealth group using a delta of 0.15. RESULTS We evaluated 1019 of 1126 (90.5%) in-person patients and 58 of 75 (77.3%) of telehealth clinic patients. The mean initial BMI was 32.2 and 32.6 for the in-person and telehealth groups, respectively. There were mean decreases in BMI z-scores of 0.044 and 0.032 in the in-person and telehealth groups, respectively, P < 0.001 with a margin of 0.15. The changes in mean HbA1c (p = 0.59), mean LDL (p = 0.93), and a mean ALT (p = 0.09) were not significant, although only a minority of patients followed-up for lab draws, limiting interpretation of these results. DISCUSSION Attending a weight management clinic via telehealth was non-inferior to in-person visits for enacting a clinically significant change in BMI z-score, mitigating the effect of sample size on BMI z-score results. These findings give credibility to telehealth as a means of increasing access to paediatric weight management care.
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Affiliation(s)
- Timothy Lukenbill
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Annie Simpson
- Department of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Marshall Chew
- Department of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - William Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - James Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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24
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Borzutzky C, King E, Fox CK, Stratbucker W, Tucker J, Yee JK, Kumar S, Cuda S, Sweeney B, Kirk S, On Behalf Of The Power Work Group. Trends in prescribing anti-obesity pharmacotherapy for paediatric weight management: Data from the POWER Work Group. Pediatr Obes 2021; 16:e12701. [PMID: 32877010 DOI: 10.1111/ijpo.12701] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/11/2020] [Accepted: 06/20/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To better inform the field of obesity medicine, we set out to describe the current use of pharmacotherapy meant to improve patient weight status among a group of clinicians connected through the Paediatric Obesity Weight Evaluation Registry (POWER), as well as reasons behind clinicians' use or non-use of the medications. METHODS Paediatric weight management (PWM) programs participating in POWER were asked to complete a program profile survey in 2014 (n = 30) and 2017 (n = 33); questions about pharmacotherapy use were included. Descriptive statistics were used to identify: (a) the proportion of PWM programs offering obesity pharmacotherapy; (b) the medications most commonly prescribed; and (c) reasons among non-prescribers for not offering pharmacotherapy. RESULTS The 2014 and 2017 surveys were completed by 29 PWM programs (97%) and 30 PWM programs (91%), respectively. Twenty-one programs completed both surveys. In 2014, 10 (34%) programs reported offering pharmacologic agents specifically for weight control, whereas in 2017, 16 (53%) reported offering pharmacotherapy for a primary indication of weight loss. Metformin was reported as the most commonly used agent in 2014, and topiramate in 2017. Largest reported increases in use over time were for topiramate and phentermine. DISCUSSION Our survey results demonstrate that a majority of this group of PWM programs offered pharmacotherapy to promote weight loss in patients with complications or associated medical conditions. There was a trend indicating increasing use over time, despite the significant gap regarding pharmacotherapy use in the literature. CONCLUSIONS These data suggest the need for (a) additional robust paediatric drug trials to further develop the evidence base guiding use or non-use of pharmacotherapy in paediatric weight management, and (b) increased understanding of both facilitators and barriers to prescribing anti-obesity pharmacotherapy for youth with obesity.
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Affiliation(s)
- Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - William Stratbucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Jared Tucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Jennifer K Yee
- Division of Endocrinology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA.,The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, Torrance, California, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne Cuda
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Brooke Sweeney
- General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.,University of Missouri Kansas City, Kansas City, Missouri, USA.,Children's Center for Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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25
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Darenskaya MA, Kolesnikova LI, Rychkova LV, Kravtsova OV, Semenova NV, Kolesnikov SI. Relationship between lipid metabolism state, lipid peroxidation and antioxidant defense system in girls with constitutional obesity. AIMS MOLECULAR SCIENCE 2021. [DOI: 10.3934/molsci.2021009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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26
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Abstract
PURPOSE OF REVIEW This review examines the current evidence about the ways in which food insecurity relates to obesity in children and adolescents, examining diet and diet-related behaviors, and taking into consideration the role of stress. RECENT FINDINGS While living with food insecurity impacts stress and diet-related behaviors in children and adolescents, it is not clear whether food insecurity is associated with obesity above and beyond the influence of poverty. However, strategies to mitigate food insecurity and obesity are inherently connected, and recent examples from clinical practice (e.g., screening for food insecurity among patients) and advocacy (e.g., policy considerations regarding federal food programs such as the Supplemental Nutrition Assistance Program, or SNAP) are discussed. Food insecurity and obesity coexist in low-income children and adolescents in the USA. The COVID-19 pandemic exerts disproportionate burden on low-income children and families, magnifying their vulnerability to both food insecurity and pediatric obesity.
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Affiliation(s)
- June M Tester
- Division of Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, Oakland, 94609, CA, USA.
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, 550 16th Street, 4th Floor Box 0110, San Francisco, CA, USA.
| | - Lisa G Rosas
- Epidemiology and Population Health, Stanford University, School of Medicine, Stanford, CA, USA
| | - Cindy W Leung
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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27
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Cueto V, Wang CJ, Sanders LM. Impact of a Mobile App-Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study. JMIR Mhealth Uhealth 2019; 7:e14458. [PMID: 31730041 PMCID: PMC6884716 DOI: 10.2196/14458] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/12/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001). Conclusions Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.
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Affiliation(s)
- Victor Cueto
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.,Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - C Jason Wang
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.,Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, CA, United States
| | - Lee Michael Sanders
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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28
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Wittmeier K, Brockman GH, Garcia AP, Woodgate RL, Ball GDC, Wicklow B, Sellers E, Jong G', Sibley KM. Access to Multidisciplinary Care for Pediatric Weight Management: Exploring Perspectives of the Health Care Team within Canada and the United States. Child Obes 2019; 15:363-370. [PMID: 31099587 DOI: 10.1089/chi.2019.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before the program ends. Parents and youth have reported difficulties in accessing services as an important barrier to starting or completing programming. The purpose of this study was to understand barriers and identify potential solutions related to access to care from the perspective of health care team members from Canada and the United States. Methods: Qualitative description method guided the study design. Participants were health care team members, purposefully recruited through Canadian and US-based pediatric weight management program registries. Telephone interviews were conducted with participants between February and May 2017. Interviews were transcribed verbatim and analyzed using content analysis. Results: Eighteen individuals from 16 sites participated (n = 8 Canada, n = 8 United States). Access barriers and potential solutions were related to: (1) referral and eligibility, (2) wait lists and program capacity, (3) logistics and costs, and (4) stigma and weight bias. Barriers were similar between Canadian and US sites, with the exception of cost-related barriers. Conclusions: Health care providers from Canada and the United States reported multiple societal, organizational, service, and family-level barriers to accessing multidisciplinary pediatric weight management care. Proposed solutions suggest that service providers can play a key role alongside families to improve access to appropriate care. Further research is needed to demonstrate the feasibility and effectiveness of proposed solutions.
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Affiliation(s)
- Kristy Wittmeier
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Gwenyth H Brockman
- 3George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Arnaldo Perez Garcia
- 4Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roberta L Woodgate
- 2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,5College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoff D C Ball
- 6Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Brandy Wicklow
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sellers
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Geert 't Jong
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathryn M Sibley
- 3George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,7Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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29
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Kumar S, King EC, Christison AL, Kelly AS, Ariza AJ, Borzutzky C, Cuda S, Kirk S, Ali L, Armstrong S, Binns H, Brubaker J, Cristison A, Fox C, Gordon C, Hendrix S, Hes D, Jenkins L, Joseph M, Heyrman M, Liu L, McClure A, Hofley M, Negrete S, Novick M, O'Hara V, Rodrue J, Santos M, Stoll J, Stratbucker W, Sweeney B, Tester J, Walka S, deHeer H, Wallace S, Walsh S, Wittcopp C, Weedn A, Yee J, Grace B. Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER. J Pediatr 2019; 208:57-65.e4. [PMID: 30853195 DOI: 10.1016/j.jpeds.2018.12.049] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US. STUDY DESIGN This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling. RESULTS We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors. CONCLUSIONS Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity. TRIAL REGISTRATION ClinicalTrials.gov: NCT02121132.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Amy L Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Adolfo J Ariza
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Claudia Borzutzky
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA; Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, CA
| | - Suzanne Cuda
- Department of Pediatrics, Pediatric Weight Management, Children's Hospital of San Antonio, Baylor College of Medicine, Houston, TX
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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30
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Gross AC, Kaizer AM, Kelly AS, Rudser KD, Ryder JR, Borzutzky CR, Santos M, Tucker JM, Yee JK, Fox CK. Long and Short of It: Early Response Predicts Longer-Term Outcomes in Pediatric Weight Management. Obesity (Silver Spring) 2019; 27:272-279. [PMID: 30677263 PMCID: PMC6352906 DOI: 10.1002/oby.22367] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to examine whether 1-month BMI improvement is predictive of superior 6- and 12-month BMI changes in a national sample of youth in pediatric weight management treatment. METHODS Participants were 4- to 18-year-olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation. RESULTS Primary analyses were completed with 687 participants (mean age 12.2 years). One-month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, -2.05 vs. 0.05; %BMI, -5.81 vs. 0.23; P < 0.001 for all) and 12 months (BMI, -1.87 vs. 0.30; %BMI, -5.04 vs. 1.06; P < 0.001 for all). The odds of success for 1-month responders were 9.64 (95% CI: 5.85-15.87; P < 0.001) times that of nonresponders at 6 months and 5.24 (95% CI: 2.49-11.02; P < 0.001) times that of nonresponders at 12 months. CONCLUSIONS In treatment-seeking youth with obesity, early BMI reduction was significantly associated with greater long-term BMI reduction. Nonresponders may benefit from early treatment redirection or intensification.
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Affiliation(s)
- Amy C Gross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alexander M Kaizer
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Claudia R Borzutzky
- Department of Pediatrics, Keck School of Medicine of USC, Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Melissa Santos
- The Pediatric Obesity Center, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Jared M Tucker
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, Michigan, USA
| | - Jennifer K Yee
- Department of Pediatrics, Division of Endocrinology, Harbor-UCLA Medical Center, The Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Claudia K Fox
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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31
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Imoisili OE, Goodman AB, Dooyema CA, Harrison MR, Belay B, Park S. Screening and Referral for Childhood Obesity: Adherence to the U.S. Preventive Services Task Force Recommendation. Am J Prev Med 2019; 56:179-186. [PMID: 30573333 PMCID: PMC10863670 DOI: 10.1016/j.amepre.2018.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The U.S. Preventive Services Task Force recommends clinicians screen children aged 6 years or older for obesity and offer or refer children with obesity to intensive weight management programs. This study explores clinician awareness of weight management programs meeting the recommendation, adherence to the recommendation of screening and referral, and associations between provider and practice characteristics and weight management program referrals. METHODS This cross-sectional study used data from the DocStyles survey 2017, a web-based panel survey, analyzed in 2017. Among 1,023 clinicians who see pediatric patients, this study examined clinician awareness of weight management programs in their communities that met the recommendation, practice of screening for childhood obesity, and referral to weight management programs. Multivariable logistic regression estimated associations between the demographic and practice characteristics of clinicians and weight management program referrals. RESULTS Only 24.6% of surveyed clinicians were aware of a weight management program that met the U.S. Preventive Services Task Force recommendation in their community; of those aware, 88.9% referred patients to these weight management programs. Most (83.6%) clinicians screened children for obesity in ≥75% of visits. Overall, 53.5% of clinicians provided referrals to weight management programs. Referral was higher among female clinicians and clinicians serving mostly middle-income patients. Providers without teaching hospital privileges had lower odds of referral. CONCLUSIONS Adherence to clinical recommendations is essential to curbing the childhood obesity epidemic. Only one in four surveyed clinicians were aware of weight management programs in their community meeting U.S. Preventive Services Task Force criteria. Half of clinicians referred pediatric patients with obesity to a weight management program. Results suggest efforts are needed to increase awareness of, and referral to, weight management programs meeting the recommendation.
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Affiliation(s)
- Omoye E Imoisili
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan R Harrison
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Vidmar AP, Fink C, Torres B, Manzanarez B, Mittelman SD, Wee CP, Borzutzky C. Energy Management for Personalized Weight Reduction (EMPOWER) Program: Three-Year Outcome Data. ADVANCES IN CLINICAL ENDOCRINOLOGY AND METABOLISM 2019; 2:47-54. [PMID: 32699839 PMCID: PMC7375743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current consensus guidelines for management of pediatric obesity recommend clinic-based, family-centered, multi-disciplinary interventions. It is well reported that these programs often only lead to modest improvements in BMI status. The individual factors that differentiate which patient's BMI status will improve vs. worsen remains understudied. A retrospective cohort study was conducted to evaluate the outcomes of EMPOWER clinic and identify the participant specific characteristics that predicted BMI status improvement in this population. METHODS Youth who completed at least 6 visits in EMPOWER were included. Paired t-test was utilized to evaluate the mean change in zBMI, modified BMIz and %BMIp95 from baseline to 6th visit, and multivariate mixed effect models were utilized to analyze effect of baseline characteristics on change in BMI status. RESULTS 92 participants were included in the analysis, 87% with severe obesity and 66% Hispanic. At the 6th visit, there was a significant reduction in zBMI (-0.09 SD, p <0.001) and modified BMIz (-0.0003 SD, p = 0.04) with a small reduction in %BMIp95 (-1.15 %, p = 0.20). Lower BMI status (p < 0.001) and absence of a comorbidity (p < 0.05) at baseline were predictors of BMI status improvement whereas age, gender, ethnicity, family history of obesity and insurance status were not significant predictors. CONCLUSIONS Given that implementation of the current guidelines for management of obesity in pediatrics only results in modest BMI status reduction, further investigation is required to understand how the determinants of obesity-related health outcomes can guide development of more innovative, effective interventions for this high risk population.
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Affiliation(s)
- AP Vidmar
- Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA,The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA,Correspondence: Alaina P Vidmar, The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA, Tel: (323) 3613385; Fax: (323) 3611301;
| | - C Fink
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA
| | - B Torres
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA
| | - B Manzanarez
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA
| | - SD Mittelman
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA,Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - CP Wee
- CTSI Biostatics Core, Saban Research Institute, Los Angeles, USA
| | - C Borzutzky
- The Diabetes & Obesity Program, Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, USA
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Working toward precision medicine approaches to treat severe obesity in adolescents: report of an NIH workshop. Int J Obes (Lond) 2018; 42:1834-1844. [PMID: 30283078 DOI: 10.1038/s41366-018-0231-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
Adolescent severe obesity is a prevalent, chronic, and serious disease with few effective and safe treatment options. To address this issue, a National Institutes of Health-sponsored workshop entitled "Developing Precision Medicine Approaches to the Treatment of Severe Obesity in Adolescents," was convened, bringing together a multidisciplinary group of experts to review the current state of the science and identify (1) what is known regarding the epidemiology and biopsychosocial determinants of severe obesity in adolescents, (2) what is known regarding effectiveness of treatments for severe obesity in adolescents and predictors of response, and (3) gaps and opportunities for future research to develop more effective and targeted treatments for adolescents with severe obesity. Major topical areas discussed at the workshop included: appropriate BMI metrics, valid measures of phenotypes and predictors, mechanisms associated with the development of severe obesity, novel treatments informed by biologically and psychosocially plausible mechanisms, biopsychosocial phenotypes predicting treatment response, standardization of outcome measures and results reporting in research, and improving clinical care. Substantial gaps in knowledge were identified regarding the basic behavioral, psychosocial, and biological mechanisms driving the development of severe obesity and the influence of these factors on treatment response. Additional exploratory and observational studies are needed to better understand the heterogeneous etiology of severe obesity and explain the high degree of variability observed with interventions. Tailored treatment strategies that may be developed by achieving a better understanding of individual differences in genetic endowment, clinical, metabolic, psychological, and behavioral phenotypes, and response to environmental exposures need to be tested. It is anticipated that these recommendations for future research, including strategies to enhance methodological rigor, will advance precision medicine approaches to treat severe obesity in adolescents more effectively.
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Hawkins MJ, Wiggins SA, Struwe L. A retrospective review of patient outcomes in the pediatric HEROES weight management program. Appl Nurs Res 2018; 43:18-23. [PMID: 30220358 DOI: 10.1016/j.apnr.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/14/2018] [Accepted: 06/23/2018] [Indexed: 11/26/2022]
Abstract
Pediatric obesity is a public health concern in the U.S. The purpose of this study was to describe the impact of a pediatric stage 3 and 4 weight management program. Program aims measured: change in biometric values using BMI z-scores; intervention attrition rate; and health-related quality of life (HRQOL) from admission through the initial six months of the program. The program evaluation included a retrospective review of 884 electronic records. Of the 698 children that met the inclusion criteria, 468 completed at least one follow-up visit within the baseline to 6 month time period. Overall 66.38% of the 468 maintained program involvement at the 6 month evaluation. Of the 468 who completed the 6 months, 192 children/families participated in the clinic only program and 276 participated both in the clinic and a 12 week contract education/fitness and exercise intervention. The completion rate for the contract intervention was 7.3%. All children demonstrated a decrease in BMI z-scores. There were no statistically significant differences (p = 0.276) in the BMI z-change scores from baseline to 6 months in the clinic only program; those who did not complete the education/fitness and exercise intervention, and those who completed the education/fitness and exercise intervention. Children demonstrated a statistically significant improvement in their overall HRQOL scale score (p = 0.001) from baseline to the 6 month evaluation. The results indicate the impact of attrition and HRQOL in weight management programs. Further research is needed to develop and strengthen the effectiveness of weight management interventions.
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Affiliation(s)
- Mary Jane Hawkins
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA.
| | - Shirley A Wiggins
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA; University of Nebraska Medical Center, College of Nursing, 1230 O Street, Suite 131 P.O. 880220, Lincoln, NE, 68588-0220, USA.
| | - Leeza Struwe
- Niedfelt Nursing Research Center, University of Nebraska Medical Center, 1230 O Street, Suite 131, P.O. 880220, College of Nursing, Lincoln, NE, 68588-0220, USA.
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The CANadian Pediatric Weight management Registry (CANPWR): lessons learned from developing and initiating a national, multi-centre study embedded in pediatric clinical practice. BMC Pediatr 2018; 18:237. [PMID: 30025530 PMCID: PMC6053829 DOI: 10.1186/s12887-018-1208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/02/2018] [Indexed: 01/25/2023] Open
Abstract
Background There is increasing recognition of the value of “real-world evidence” in evaluating health care services. Registry-based, observational studies conducted in clinical settings represent a relevant model to achieve this directive. Starting in 2010, we undertook a longitudinal, observational study (the CANadian Pediatric Weight management Registry [CANPWR]), which is embedded in 10 multidisciplinary, pediatric weight management clinics across Canada. The objective of this paper was to share the lessons our team learned from this multi-centre project. Methods Data sources included a retrospective review of minutes from 120 teleconferences with research staff and investigators, notes taken during clinical site visits made by project leaders, information from quality control processes to ensure data accuracy and completeness, and a study-specific survey that was sent to all sites to solicit feedback from research team members (n = 9). Through an iterative process, the writing group identified key themes that surfaced during review of these information sources and final lessons learned were developed. Results Several key lessons emerged from our research, including the (1) value of pilot studies and central research coordination, (2) need for effective and regular communication, (3) importance of consensus on determining outcome measures, (4) challenge of embedding research within clinical practice, and (5) difficulty in recruiting and retaining participants. The sites were, in spite of these challenges, enthusiastic about the benefits of participating in multi-centre collaborative studies. Conclusion Despite some challenges, multi-centre observational studies embedded in pediatric weight management clinics are feasible and can contribute important, practical insights into the effectiveness of health services for managing pediatric obesity in real-world settings. Electronic supplementary material The online version of this article (10.1186/s12887-018-1208-6) contains supplementary material, which is available to authorized users.
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Fox CK, Kaizer AM, Ryder JR, Rudser KD, Kelly AS, Kumar S, Gross AC. Cardiometabolic risk factors in treatment-seeking youth versus population youth with obesity. Obes Sci Pract 2018; 4:207-215. [PMID: 29951211 PMCID: PMC6009991 DOI: 10.1002/osp4.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although obesity affects approximately one in five youths, only a fraction is treated in pediatric weight management clinics. Characteristics distinguishing youth with obesity who seek weight management treatment from those who do not are largely unknown. Yet identification of specific health characteristics which differentiate treatment-seeking from non-treatment seeking youth with obesity may shed light on underlying motivations for pursuing treatment. OBJECTIVES Compare the cardiometabolic profiles of an obesity treatment-seeking sample of youth to a population-based sample of youth with obesity, while controlling for body mass index (BMI). METHODS This cross-sectional study included participants, ages 12-17 years, with obesity from the Pediatric Obesity and Weight Evaluation Registry (POWER) and National Health and Nutrition Examination Survey, representing the treatment-seeking and population samples, respectively. Mean differences were calculated for systolic and diastolic blood pressure percentiles, total cholesterol, low-density and high-density lipoprotein-cholesterol, triglycerides, fasting glucose, glycated hemoglobin and alanine aminotransferase, while adjusting for age, sex, race/ethnicity, insurance status, and multiple of the 95th BMI percentile. RESULTS The POWER and National Health and Nutrition Examination Survey cohorts included 1,823 and 617 participants, respectively. The POWER cohort had higher systolic blood pressure percentile (mean difference 17.4, 95% confidence interval [14.6, 20.1], p < 0.001), diastolic blood pressure percentile (21.8 [19, 24.5], p < 0.001), triglycerides (42.3 [28, 56.5], p < 0.001) and alanine aminotransferase (7.5 [5.1, 9.8], p < 0.001) and lower fasting glucose (-6.9 [-8.2, -5.6], p < 0.001) and high-density lipoprotein-cholesterol (-2.3 [-3.8, -0.9], p < 0.002). There were no differences in total cholesterol or low-density lipoprotein-cholesterol or clinical differences in glycated hemoglobin. CONCLUSION For a given BMI, obesity treatment-seeking youth are more adversely affected by cardiometabolic risk factors than the general population of youth with obesity. This suggests that treatment-seeking youth may represent a distinct group that is at particularly high risk for the development of future cardiometabolic disease.
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Affiliation(s)
- C. K. Fox
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
| | - A. M. Kaizer
- Department of BiostatisticsUniversity of MinnesotaMinneapolisUSA
| | - J. R. Ryder
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
| | - K. D. Rudser
- Department of BiostatisticsUniversity of MinnesotaMinneapolisUSA
| | - A. S. Kelly
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
| | | | - A. C. Gross
- Department of PediatricsUniversity of MinnesotaMinneapolisUSA
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Hoffman J, Frerichs L, Story M, Jones J, Gaskin K, Apple A, Skinner A, Armstrong S. An Integrated Clinic-Community Partnership for Child Obesity Treatment: A Randomized Pilot Trial. Pediatrics 2018; 141:peds.2017-1444. [PMID: 29237800 DOI: 10.1542/peds.2017-1444] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Effective treatment of childhood obesity remains elusive. Integration of clinical and community systems may achieve effective and sustainable treatment. However, the feasibility and effectiveness of this integrated model are unknown. METHODS We conducted a randomized clinical trial among children aged 5 to 11 presenting for obesity treatment. We randomized participants to clinical care or clinical care plus community-based programming at a local parks and recreation facility. Primary outcomes were the change in child BMI at 6 months and the intensity of the program in treatment hours. Secondary outcomes included health behaviors, fitness, attrition, and quality of life. RESULTS We enrolled 97 children with obesity, and retention at 6 months was 70%. Participants had a mean age of 9.1 years and a mean baseline BMI z score of 2.28, and 70% were living in poverty. Intervention participants achieved more treatment hours than controls (11.4 vs 4.4, SD: 15.3 and 1.6, respectively). We did not observe differences in child BMI z score or percent of the 95th percentile at 6 months. Intervention participants had significantly greater improvements in physical activity (P = .010) and quality of life (P = .008). CONCLUSIONS An integrated clinic-community model of child obesity treatment is feasible to deliver in a low-income and racially diverse population. As compared with multidisciplinary treatment, the integrated model provides more treatment hours, improves physical activity, and increases quality of life. Parks and recreation departments hold significant promise as a partner agency to deliver child obesity treatment.
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Affiliation(s)
| | - Leah Frerichs
- Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | | | - Jason Jones
- Durham Parks and Recreation, Durham, North Carolina
| | | | | | - Asheley Skinner
- Clinical Research Institute, Duke University, Durham, North Carolina
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Affiliation(s)
- Amy L. Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Sandeep K. Gupta
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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