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Seguin-Fowler RA, Graham ML, Demment M, Uribe ALM, Rethorst CD, Szeszulski J. Multilevel Interventions Targeting Obesity: State of the Science and Future Directions. Annu Rev Nutr 2024; 44:357-381. [PMID: 38885446 DOI: 10.1146/annurev-nutr-122123-020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
A seminal report, released in 2001 by the Institute of Medicine, spurred research on the design, implementation, and evaluation of multilevel interventions targeting obesity and related behaviors. By addressing social and environmental factors that support positive health behavior change, interventions that include multiple levels of influence (e.g., individual, social, structural) aim to bolster effectiveness and, ultimately, public health impact. With more than 20 years of multilevel obesity intervention research to draw from, this review was informed by published reviews (n = 51) and identified intervention trials (n = 103), inclusive of all ages and countries, to elucidate key learnings about the state of the science. This review provides a critical appraisal of the scientific literature related to multilevel obesity interventions and includes a description of their effectiveness on adiposity outcomes and prominent characteristics (e.g., population, setting, levels). Key objectives for future research are recommended to advance innovations to improve population health and reduce obesity.
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Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | - Meredith L Graham
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | - Margaret Demment
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | | | - Chad D Rethorst
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | - Jacob Szeszulski
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
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Colapelle J, St-Pierre J, Erdstein J, Lands LC. Reduced exercise capacity for muscle mass in adolescents living with obesity. Pediatr Pulmonol 2024; 59:1227-1235. [PMID: 38294147 DOI: 10.1002/ppul.26890] [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: 09/16/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Adolescents living with obesity (AlwO) can have limited exercise capacity. Exercise capacity can be predicted by a 2-factor model comprising lung function and leg muscle function, but no study has looked at cycling leg muscle function and its contribution to cycling exercise capacity in AlwO. METHODS Twenty-two nonobese adolescents and 22 AlwO (BMI > 95 percentile) were studied. Anthropometry, body composition (dual-energy X-ray absorptiometry), spirometry, 30-s isokinetic work capacity, and maximal exercise (cycle ergometry) were measured. RESULTS AlwO had greater total body mass, lean body mass, and lean leg mass (LLM). Lung function trended higher in AlwO. Leg 30-s work did not differ in absolute terms or per allometrically scaled LLM. Peak oxygen consumption did not differ between the groups in absolute terms or as percent predicted values (79.59 ± 14.6 vs. 82.3 ± 11.2% predicted control versus ALwO) but was lower in AlwO when expressed per kg body mass, kg lean body mass, scaled lean body mass, and LLM. Peak oxygen consumption related to both lung function and 30-s work, with no observed group effect. 30-s leg work related to the scaled LLM, with a small group effect. There was some correlation between leg work and time spent in moderate to vigorous physical activity in AlwO (rs = 0.39, p = .07). CONCLUSION AlwO have larger LLM and preserved exercise capacity, when expressed as percentage of predicted, but not per allometrically scaled LLM. Increasing time spent in moderate to vigorous activity may benefit AlwO.
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Affiliation(s)
- Juliano Colapelle
- Experimental Medicine, McGill University Experimental Medicine, Montréal, Quebec, Canada
| | - Julie St-Pierre
- General Pediatrics, Maison de Santé Prévention Clinique 180, McGill University Health Centre, Montréal, Quebec, Canada
| | - Julius Erdstein
- Department of Pediatrics, McGill University Health Centre Adolescent Medicine, Montréal, Quebec, Canada
| | - Larry C Lands
- Department of Pediatrics, McGill University Health Centre Pediatric Respiratory Medicine, Montréal, Quebec, Canada
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Sable C, Li JS, Tristani‐Firouzi M, Fagerlin A, Silver RM, Yandel M, Yost HJ, Beaton A, Dale J, Engel ME, Watkins D, Spurney C, Skinner AC, Armstrong SC, Shah SH, Allen N, Davis M, Hou L, Van Horn L, Labarthe D, Lloyd‐Jones D, Marino B. American Heart Association's Children's Strategically Focused Research Network Experience. J Am Heart Assoc 2023; 12:e028356. [PMID: 36974754 PMCID: PMC10122897 DOI: 10.1161/jaha.122.028356] [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] [Indexed: 03/29/2023]
Abstract
The American Heart Association's Strategically Focused Children's Research Network started in July 2017 with 4 unique programs at Children's National Hospital in Washington, DC; Duke University in Durham, North Carolina; University of Utah in Salt Lake City, Utah; and Lurie Children's Hospital/Northwestern University in Chicago, Illinois. The overarching goal of the Children's National center was to develop evidence-based strategies to strengthen the health system response to rheumatic heart disease through synergistic basic, clinical, and population science research. The overall goals of the Duke center were to determine risk factors for obesity and response to treatment including those that might work on a larger scale in communities across the country. The integrating theme of the Utah center focused on leveraging big data-science approaches to improve the quality of care and outcomes for children with congenital heart defects, within the context of the patient and their family. The overarching hypothesis of the Northwestern center is that the early course of change in cardiovascular health, from birth onward, reflects factors that result in either subsequent development of cardiovascular risk or preservation of lifetime favorable cardiovascular health. All 4 centers exceeded the original goals of research productivity, fellow training, and collaboration. This article describes details of these accomplishments and highlights challenges, especially around the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Norrina Allen
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Matthew Davis
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Lifang Hou
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Linda Van Horn
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Darwin Labarthe
- Northwestern University Feinberg School of MedicineChicagoILUSA
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D'Agostino EM, Zhang S, Day SE, Konty KJ, Armstrong S, Skinner A, Neshteruk CD. The longitudinal association between asthma severity and physical fitness among new York City public school youth. Prev Med 2023; 170:107486. [PMID: 36931475 DOI: 10.1016/j.ypmed.2023.107486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Severe persistent childhood asthma is associated with low physical activity and may be associated with poor physical fitness. Research on the asthma severity-fitness association longitudinally and across sociodemographic subgroups is needed to inform fitness interventions targeting youth with asthma. We evaluated the relationship between asthma severity (categorized as severe, mild, or no asthma) and subsequent fitness in New York City (NYC) public school youth enrolled in grades 4-12 using the NYC Fitnessgram dataset (2010-2018). Longitudinal mixed models with random intercepts were fit to test the association between asthma severity and one-year lagged fitness z-scores by clustering repeated annual observations at the student level. Models were adjusted for sex, race/ethnicity, grade level, poverty status, time, and stratified by sociodemographic factors. The analytic sample included 663,137 students (51% male; 31% non-Hispanic Black, 40% Hispanic; 55% in grades 4-8, 70% high poverty; 87%, 11% and 1% with no, mild, and severe asthma, respectively). Students with severe asthma and mild asthma demonstrated -0.19 (95% CI, -0.20 to -0.17) and - 0.10 (95% CI, -0.11 to -0.10), respectively, lower fitness z-scores in the subsequent year relative to students without asthma. After stratifying by demographics, the magnitude of the asthma severity-fitness relationship was highest for non-Hispanic white vs. all other racial/ethnic subgroups, and was similar across sex, grade level, and household poverty status. Overall, we observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. Future research should examine how neighborhood-level factors impact the asthma severity-fitness relationship across racial/ethnic subgroups.
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Affiliation(s)
- Emily M D'Agostino
- Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America.
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, United States of America
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University Medical School, Durham, NC, United States of America; Duke Global Health Institute, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Asheley Skinner
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
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Neshteruk CD, Day SE, Konty KJ, Armstrong SC, Skinner AC, D’Agostino EM. Severe obesity and fitness in New York City public school youth, 2010-2018. BMC Public Health 2023; 23:345. [PMID: 36797700 PMCID: PMC9933284 DOI: 10.1186/s12889-023-15267-w] [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: 09/08/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Obesity is associated with poorer youth fitness. However, little research has examined the magnitude of this relationship in youth with severe obesity. Therefore, we sought to determine the relationship between increasing weight status and fitness within a sample of children and adolescents from New York City public schools. METHODS This study utilized longitudinal data from the NYC Fitnessgram dataset years 2010-2018. Height and weight along with fitness were measured annually during physical education classes. Severity of obesity was defined using body mass index relative to the 95th percentile and then categorized into classes. A composite measure of fitness was calculated based on scores for three fitness tests: aerobic capacity, muscular strength, and muscular endurance. To examine the weight status-fitness relationship, repeated measures mixed models with random-intercepts were constructed. Stratified models examined differences by demographic factors. RESULTS The sample included 917,554 youth (51.8% male, 39.3% Hispanic, 29.9% non-Hispanic Black, 14.0%, 4.6%, and 1.6% class I, II and III obesity, respectively). Compared to youth with healthy weight, increasing severity of obesity was associated with decreased fitness: overweight (β = - 0.28, 95% CI:-0.29;-0.28), class I obesity (β = - 0.60, 95% CI:-0.60; - 0.60), class II obesity (β = - 0.94, 95% CI:-0.94; - 0.93), and class III obesity (β = - 1.28; 95% CI:-1.28; - 1.27). Stratified models showed the association was stronger among male and non-Hispanic White youth. CONCLUSION Findings revealed that more severe obesity was associated with lower fitness. Future research is needed to develop targeted interventions to improve fitness in youth with obesity.
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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
| | - Sophia E. Day
- grid.238477.d0000 0001 0320 6731New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY USA
| | - Kevin J. Konty
- grid.238477.d0000 0001 0320 6731New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY 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, Duke University, Durham, North Carolina USA ,grid.26009.3d0000 0004 1936 7961Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina 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, Duke University, Durham, North Carolina 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, North Carolina USA
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