Impaired health-related quality of life in preschoolers with obesity

Compared With Girls, Boys' Psychological Symptoms Are More Likely to Be Influenced by Lifestyle in Chinese Middle School Students

Purpose

To explore the relationship between Chinese middle school students' lifestyles and psychological symptoms and compare the differences between genders.

Method

Using the method of stratified cluster sampling, 14,356 students aged 13–18 years from 8 cities in China were selected as participants. The Multidimensional Sub-health Questionnaire of Adolescents was used to estimate psychological symptoms. Chi-square test and Logistic regression analysis were used to analyze the relationship between lifestyle and psychological symptoms.

Results

The psychological symptom detection rate of Chinese middle school students was 21.37%. The detection rate of psychological symptoms for boys was 22.1%, which was significantly higher than for girls (20.64%, χ² = 4.608, P < 0.05). According to the Logistic regression analysis, factors that have a positive correlation with the demonstration of psychological symptoms (P < 0.01) include: how the students go to school (by foot or on the vehicle) (OR = 1.16, 95% CI: 1.07–1.25); inadequate time for sleep (OR = 1.48, 95% CI: 1.28–1.72); video watching time ≥2 h/d (OR = 1.25, 95% CI: 1.13–1.39); never exercise (OR = 2.39, 95% CI: 2.07–2.76); never participate in extracurricular exercises (OR = 1.45, 95% CI: 1.27–1.66); have breakfast occasionally (OR = 1.35, 95% CI:1.22–1.50); never have breakfast (OR = 1.90, 95% CI: 1.62–2.24); always have snacks (OR = 1.27, 95% CI: 1.13–1.44); always drink sugared beverages (OR = 1.37, 95% CI: 1.22–1.55); picky with food occasionally (OR = 1.22, 95% CI: 1.11–1.33).

Conclusions

There was a positive correlation between unhealthy lifestyle and the occurrence of psychological symptoms, and boys are more easily influenced by lifestyles than girls.

Weight Stigma Model on Quality of Life Among Children in Hong Kong: A Cross-Sectional Modeling Study

We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life (QoL). We recruited 430 dyads of elementary school children [mean age = 10.07 years; n_boy = 241 (56.0%); n_overweight = 138 (32.1%)] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations.

Bardet-Biedl syndrome: Weight patterns and genetics in a rare obesity syndrome

BACKGROUND

Bardet-Biedl syndrome (BBS) is a rare genetic disorder that severely inhibits primary cilia function. BBS is typified by obesity in adulthood, but pediatric weight patterns, and thus optimal periods of intervention, are poorly understood.

OBJECTIVES

To examine body mass differences by age, gender, and genotype in children and adolescents with BBS.

METHODS

We utilized the largest international registry of BBS phenotypes. Anthropometric and genetic data were obtained from medical records or participant/family interviews. Participants were stratified by age and sex categories. Genotype and obesity phenotype were investigated in a subset of participants with available data.

RESULTS

Height and weight measurements were available for 552 unique individuals with BBS. The majority of birth weights were in the normal range, but rates of overweight or obesity rapidly increased in early childhood, exceeding 90% after age 5. Weight z-scores in groups >2 years were above 2.0, while height z-scores approached 1.0, but were close to 0.0 in adolescents. Relative to those with the BBS10 genotype, the BBS1 cohort had a lower BMI z-score in the 2-5 and 6-11 age groups, with similar BMI z-scores thereafter. Children with biallelic loss of function (LOF) genetic variants had significantly higher BMI z-scores compared to missense variants.

CONCLUSION

Despite normal birth weight, most individuals with BBS experience rapid weight gain in early childhood, with high rates of overweight/obesity sustained through adolescence. Children with LOF variants are disproportionally affected. Our findings support the need for earlier recognition and initiation of weight management therapies in BBS.

Influence of a One-Time Web-Based Provider Intervention on Patient-Reported Outcomes After the Well-Child Visit: A Feasibility Study

Purpose

Patient-centered care promotes positive health outcomes in pediatrics. We created a provider-focused intervention and implemented it in a pragmatic clustered randomized controlled trial to improve health-related quality of life (HRQOL) among pediatric patients.

Methods

A one-time (1-1.5-hour) webinar focusing on patient-centered care and motivational interviewing, using obesity screening as an example, was developed. Pediatric providers were recruited and randomized to either intervention (webinar) or control (usual care) arms. All well-child visits to these providers for a period of up to 5 months following webinar completion (or study enrollment for controls) were identified, and these family/patients were invited to complete a survey to assess HRQOL postvisit. Reported outcomes were compared between intervention and control participants using clustered t-tests, chi-squared tests and multiple linear regression models.

Results

We recruited 20 providers (10 intervention, 10 control) to the study; 469 parents/guardians and 235 eligible children seeing these providers completed the postvisit survey. Parents/guardians of 8-12-year-old children in the intervention group reported higher school functioning compared to controls (83.5 vs 75.8; P=0.023). There were no other differences in children's HRQOL between intervention and control groups.

Conclusions

A one-time, web-based provider intervention is feasible to implement in pediatrics. Modest evidence, requiring further study, indicates that instructing providers on patient-centered care in the well-child visit may improve aspects of pediatric HRQOL (ie, school functioning) compared to usual care. However, this was a brief intervention, with multiple outcomes tested and no evaluation of pre- and postintervention provider knowledge, thus additional study is needed.

Adiposity, cardiovascular, and health-related quality of life indicators and the reallocation of waking movement behaviors in preschool children with overweight and obesity: An isotemporal data analysis

Background

Isotemporal substitution evaluates hypothetical time replacement scenarios of physical movement on health, with few studies conducted among ethnically diverse preschool-aged populations. This study examines the reallocation of waking movement behaviors on adiposity, cardiovascular, and quality of life indicators among low-income, majority Hispanic preschool-aged youth (2–5 years) with overweight.

Methods

Participants wore an ActiGraph monitor (waist) and completed adiposity, cardiovascular, and health-related quality of life health assessments. Covariates included age, sex, ethnicity, and socioeconomic status. The isotemporal substitution approach was employed to address study aims.

Results

Complete data were available for 131 preschoolers. For boys, reallocating 5 minutes of stationary time with light intensity, moderate to vigorous intensity, or total physical activity showed a relation with beneficial reductions in adiposity indicators; for girls, these relations were statistically null. For boys and girls, reallocating 5 minutes of stationary time [-2.2 (95% CI: -3.7, -0.7) mmHg], light intensity [-2.1 (95% CI: -3.7, -0.7) mmHg], or moderate intensity activity [-2.7 (95% CI: -5.0, -0.4) mmHg] to vigorous intensity activity was related to favorable systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.0, -0.1) mmHg] or total physical activity [-0.2 (95% CI: -0.3, -0.01) mmHg] was related to lowered systolic blood pressure. Reallocating 5 minutes of stationary time to moderate to vigorous intensity activity [0.6 (95% CI: -1.1, -0.02) bpm] was related to lowered resting heart rate. No significant results for quality of life were found.

Conclusion

Reallocation of time from stationary time to other movement behaviors is associated with several favorable adiposity and cardiovascular health outcomes among preschool children with overweight and obesity.

Fitness as a Mediator of the Enhancement of Quality of Life after a 6-Months Exercise Program

Purpose: The study aimed to test whether improvement in fitness components, mediates the changes in Health-related Quality of Life (HRQoL) after exercise intervention in overweight and obese children. Methods and design: 170 obese and overweight children (121 exercise group and 49 control group) participated in a public exercise program based on sports practice for 6 months, 2 h per week. Anthropometry, physical fitness, and HRQoL were measured. Magnitude-based inferences and Cohen's effect size were performed to analyze the program effect. To know which physical fitness components mediated the improvement on children's HRQoL, multiple mediation analyses were performed. Results: the analysis showed a moderate effect on some fitness components and a moderate and small effect on HRQoL. The improvement of agility or cardiorespiratory fitness showed a significant indirect effect on the enhancements in some HRQoL dimensions. Conclusion: after a 6-months exercise program in overweight and obese children, all physical fitness components improved, being responsible for the improvement of the HRQoL, agility and cardiorespiratory fitness.

Child-care self-assessment to improve physical activity, oral health and nutrition for 2- to 4-year-olds: a feasibility cluster RCT

Background

The Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention has shown evidence of effectiveness in the USA but not been adapted or assessed for effectiveness in the UK.

Objectives

To evaluate the feasibility and acceptability of implementing NAP SACC in the UK.

Design

Adaptation and development of NAP SACC and feasibility cluster randomised controlled trial (RCT) including process and economic evaluations. Substudies assessed mediator questionnaire test–retest reliability and feasibility of food photography methods.

Setting

Nurseries, staff and parents in North Somerset, Cardiff, Gloucestershire and Bristol.

Participants

Development – 15 early years/public health staff and health visitors, 12 nursery managers and 31 parents. RCT – 12 nurseries and 31 staff, four partners and 168 children/parents. Mediator substudy – 82 parents and 69 nursery staff. Food photography substudy – four nurseries, 18 staff and 51 children.

Intervention

NAP SACC UK partners supported nurseries to review policies and practices and set goals to improve nutrition, oral health and physical activity (PA) over 5 months. Two workshops were delivered to nursery staff by local experts. A home component [website, short message service (SMS) and e-mails] supported parents. The control arm continued with usual practice.

Main outcome measures

Feasibility and acceptability of the intervention and methods according to prespecified criteria.

Data sources

Qualitative data to adapt the intervention. Measurements with children, parents and staff at baseline and post intervention (8–10 months after baseline). Interviews with nursery managers, staff, parents and NAP SACC UK partners; observations of training, workshops and meetings. Nursery environment observation, nursery Review and Reflect score, and resource log. Child height and weight, accelerometer-determined PA and sedentary time, screen time and dietary outcomes using the Child and Diet Evaluation Tool. Staff and parent questionnaires of knowledge, motivation and self-efficacy. Child quality of life and nursery, family and health-care costs. Food photography of everything consumed by individual children and staff questionnaire to assess acceptability.

Results

Thirty-two per cent (12/38) of nurseries and 35.3% (168/476) of children were recruited; no nurseries withdrew. The intervention was delivered in five out of six nurseries, with high levels of fidelity and acceptability. Partners found it feasible but had concerns about workload. The child loss to follow-up rate was 14.2%. There was suggestion of promise in intervention compared with control nurseries post intervention for snacks, screen time, proportion overweight or obese and accelerometer-measured total PA and moderate to vigorous PA. Many parental and nursery knowledge and motivation mediators improved. The average cost of delivering the intervention was £1184 per nursery excluding partner training, and the average cost per child was £27. Fourteen per cent of parents used the home component and the mediator questionnaire had good internal consistency and test–retest reliability. Photography of food was acceptable and feasible.

Limitations

Following nursery leavers was difficult. Accelerometer data, diet data and environmental assessment would have been more reliable with 2 days of data.

Conclusions

The NAP SACC UK intervention and methods were found to be feasible and acceptable to participants, except for the home component. There was sufficient suggestion of promise to justify a definitive trial.

Future work

A multicentre cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of NAP SACC UK has been funded by NIHR and will start in July 2019 (PHR NIHR 127551).

Trial registration

Current Controlled Trials ISRCTN16287377.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 13. See the NIHR Journals Library website for further project information. Funding was also provided by the North Somerset and Gloucestershire Councils, Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) (MR/KO232331/1), and the Elizabeth Blackwell Institute.

Cross-sectional analysis of physical activity in 2-4-year-olds in England with paediatric quality of life and family expenditure on physical activity

BACKGROUND

Many children do not meet the recommended level of daily physical activity, even with the widely acknowledged health benefits associated with being physically active. There is a need to establish factors related to physical activity in children so that public health interventions may be appropriately designed. We investigated the association between Pediatric Quality of Life Inventory (PedsQL), family expenditure on physical activity and objectively measured daily physical activity in 2-4-year-old children.

METHODS

Cross-sectional study with a sample of 81 UK preschool children taking part in the NAPSACC UK feasibility randomized controlled trial. Descriptive statistics are presented. We undertook Student t-tests to establish differences in physical activity by gender, age, parental education and nursery versus non-nursery days. Mixed effects linear regressions were used to model the association between minutes spent physically activity, minutes spent in moderate-to-vigorous (MVPA) physical activity and PedsQL scores (physical and psychosocial) and family expenditure on physical activity.

RESULTS

Most children (88.9%) did not engage in the recommended 180 min daily physical activity. There was mean (SD) of 141.9 (33.1) daily minutes of physically activity and 22.2 min per day (SD = 9.9) of MVPA. Boys and older children were more physically active. Children were more active on nursery days. There was no difference in physical activity by parental education. Half of the sample parents (50.6%) spent less than £9.00 weekly on their pre-schooler's physical activity. Children within the highest tertile of PedsQL physical functioning scores had higher levels of MVPA (3.6, 95% CI: - 1.3-8.4, p-value 0.15), although confidence intervals crossed the null in the adjusted model. We found no evidence of an association between positive PedsQL psychosocial scores, or higher parental expenditure on physical activity, with the physical activity variables.

CONCLUSIONS

Children in this sample were not meeting the recommended 180 min of daily physical activity. The 2-4-year-olds were most active on nursery days. There is no evidence of an association between better PedsQL physical scores and higher levels of MVPA. There was no evidence of an association between expenditure on physical activity and time spent physically active. Further examination in larger representative datasets is needed.

Multidisciplinary obesity treatment program improved health-related quality of life and positively correlated with anthropometric and body composition but not with cardiorespiratory fitness parameters in adolescents

PURPOSE

The aim of the present study was to verify the effects of a 16-week multidisciplinary obesity treatment program (MOTP) on health-related quality of life (HRQoL) in adolescents with weight excess. In addition, we verified a possible association between changes on HRQoL and anthropometric, body composition, and cardiorespiratory fitness (CRF) parameters.

METHODS

Two hundred four adolescents aged from 15 to 18 years were distributed in control group (CG) and intervention group (IG). They underwent a 16-week MOTP composed by nutritional, psychological, and health-related physical activity group sessions. Moreover, they performed physical exercise sessions three times per week during the whole 16-week program. Data on HRQoL, body composition, CRF and anthropometry were collected using standard protocols and validated questionnaires.

RESULTS

The MOTP promoted significant enhancements in all HRQoL domains, except for the school domain in IG. Furthermore, positive correlations between HRQoL and body weight (BW), body fat (BF), waist circumference (WC), and body mass index (BMI) z-score were verified. Higher scores of HRQoL might be achieved by improving these variables.

CONCLUSIONS

The 16-week MOTP was effective to improve HRQoL in adolescents with weight excess. This improvement has a positive correlation with enhancements in BW, BMI z-score, WC, and BF. Nevertheless, these findings have not reached a consensus on literature and still need to be further enlightened.

Does anthropometric and fitness parameters mediate the effect of exercise on the HRQoL of overweight and obese children/adolescents?

BACKGROUND

There is sufficient evidence about the effects of physical exercise programs on health-related quality of life (HRQoL) in obese and overweight children.

OBJECTIVES

The purpose of this study was to observe the effects on physical fitness and HRQoL in overweight and obesity children and their parents and find out whether the effect of intervention on anthropometric and physical fitness parameters mediated the improvements found in the proxies' perception of participant quality of life.

METHODS

151 overweight and obese children (106 intervention and 45 control) participated in a public exercise program. Anthropometrics characteristics, physical fitness, and HRQoL (EQ-5D-Y) were measured. Analysis of Covariance and effect size were performed to analyze the improvement. Mediation analyzed with bootstrap to observe whether anthropometric or physical fitness improvements mediate of the changes in the proxies' assessment of HRQoL.

RESULTS

Significant improvements were found in waist circumference, physical fitness, and HRQoL. The improvement of waist circumference showed a significant indirect effect on the change in the proxy perception of quality of life.

CONCLUSION

The reduction of waist circumference mediates the change on proxies' perception of quality of life and not by the improvement in physical fitness.

TRIAL REGISTRATION

ISRCTN97887613.

Preschoolers' health-related quality of life following the implementation of a childcare physical activity intervention

Being active offers many physical and emotional benefits contributing to a higher health-related quality of life (HRQoL); however, this relationship remains unexplored among preschoolers (aged 2.5-5 years). This study examined the impact of the Supporting Physical Activity in the Childcare Environment (SPACE), which was an intervention implemented using a cluster randomized controlled trial on preschoolers' HRQoL. Childcare centres were randomly allocated to the experimental (n = 11) or control (n = 11) conditions, and preschoolers' HRQoL was measured using the parent-report Pediatric Quality of Life Inventory 4.0 (3 subscales: physical, psychosocial, and total HRQoL) at baseline, post-intervention (i.e., week 8), and 6- and 12-month follow-up. A linear mixed-effects model was used to determine if preschoolers in the experimental condition displayed an increased HRQoL post-intervention and at follow-up compared with preschoolers in the control condition. Preschoolers (n = 234) with HRQoL data at baseline and one additional time-point were retained for analyses. Body mass index was not found to impact significantly on the intervention, and no statistically significant interaction effects were found for any of the 3 HRQoL variables. In conclusion, the SPACE intervention had no impact on preschoolers' HRQoL. Given the scarcity of research in this population, additional exploration is necessary to better understand the potential impact of physical activity participation on preschoolers' HRQoL.

Barriers to Recruitment in Pediatric Obesity Trials: Comparing Opt-in and Opt-out Recruitment Approaches

Objective

To compare the efficacy of opt-in versus opt-out recruitment methods in pediatric weight management clinical trials.

Methods

Recruitment of preschoolers and school-age children across two obesity randomized controlled trials (RCTs) were compared using the same opt-in recruitment approach (parents contact researchers in response to mailings). Opt-in and opt-out strategies (parents send decline postcard in response to mailings if they do not want to participate) were then compared across two preschool obesity RCTs.

Results

Opt-in strategies yielded a significantly lower overall recruitment rate among preschoolers compared with school-age children. Among preschoolers, an opt-out strategy demonstrated a significantly higher overall recruitment rate compared with an opt-in strategy with the main advantage in the number of families initially contacted.

Conclusions

Opt-out recruitment strategies may be more effective in overcoming the barriers of recruitment in the preschool age-group because it does not rely on parent recognition of obesity.

Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2- and 3-Year-Old Children

INTRODUCTION

This exploratory study examined maternal attitudes, normative beliefs, subjective norms, and meal selection behaviors of mothers of 2- and 3-year-old children.

METHODS

Guided by the Theory of Reasoned Action, we had mothers complete three surveys, two interviews, and a feeding simulation exercise. Data were analyzed using descriptive and bivariate statistics and multivariate linear regression.

RESULTS

A total of 31 mothers (50% Latino, 34% Black, 46.9% ≤ high school education, 31.3% poor health literacy) of 32 children (37.5% overweight/obese) participated in this study. Maternal normative beliefs (knowledge of U.S. Department of Agriculture recommendations) did not reflect actual U.S. Department of Agriculture recommendations. Collectively, regression models explained 13% (dairy) to 51% (vegetables) of the variance in behavioral intent, with normative belief an independent predictor in all models except grain and dairy.

DISCUSSION

Meal selection behaviors, on average, were predicted by poor knowledge of U.S. Department of Agriculture recommendations. Dietary guidance appropriate to health literacy level should be incorporated into well-child visits.

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment

PURPOSE

The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity.

METHODS

Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS).

RESULTS

Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001).

CONCLUSIONS

Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS.

TRIAL REGISTRATION

Clinicaltrials.gov, ID-no.: NCT02013843.

A Pilot Study of Parent Mentors for Early Childhood Obesity

Objective. To assess the feasibility of a parent mentor model of intervention for early childhood obesity using positive deviance-based methods to inform the intervention. Methods. In this pilot, randomized clinical trial, parent-child dyads (age: 2-5) with children whose body mass index (BMI) was ≥95th percentile were randomized to parent mentor intervention or community health worker comparison. The child's height and weight were measured at baseline, after the six-month intervention, and six months after the intervention. Feasibility outcomes were recruitment, participation, and retention. The primary clinical outcome was BMI z-score change. Results. Sixty participants were enrolled, and forty-eight completed the six-month intervention. At baseline, the BMI z-score in the parent mentor group was 2.63 (SD = 0.65) and in the community health worker group it was 2.61 (SD = 0.89). For change in BMI z-score over time, there was no difference by randomization group at the end of the intervention: -0.02 (95% CI: -0.26, 0.22). At the end of the intervention, the BMI z-score for the parent mentor group was 2.48 (SD = 0.58) and for the community health worker group it was 2.45 (SD = 0.91), both reduced from baseline, p < 0.001. Conclusion. The model of a parent mentor clinical trial is feasible, and both randomized groups experienced small, sustained effects on adiposity in an obese, Hispanic population.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

Health-Related Quality of Life in a Community Sample of Preschool-Age Children with and without Obesity

While mothers seeking obesity treatment for preschoolers report poorer child health-related quality of life (HRQOL) than mothers of healthy-weight peers, little is known about this relationship in non-clinical preschoolers. Eighty-six mothers of 3-5-year-olds completed the parent-proxy PedsQL. HRQOL scores for children with obesity and without were compared. No significant differences were found between groups for any PedsQL subscales, nor did differences reach established Minimally Clinically Important Differences. Mothers of preschoolers with obesity from the community did not report poorer HRQOL. If parents do not view their child's HRQOL as impacted by weight status, they may be unlikely to seek treatments.

A randomized clinical trial of the effects of parent mentors on early childhood obesity: Study design and baseline data

BACKGROUND

Few effective community-based interventions exist for early childhood obesity. Parent mentors have been successful as an intervention for other conditions, but have not been used in childhood obesity. We designed an intervention for early childhood obesity using parent mentors and a positive outlier approach to assess potential efficacy, feasibility, and acceptability.

METHODS

This trial enrolled obese (≥ 95th BMI percentile for age and gender) 2-5-year-old children in a Head Start program and their parents, with allocation to either parent mentors trained in positively deviant behaviors regarding childhood obesity, or community health workers delivering health education on obesity-related behaviors. The primary outcome is body mass index z-score change at the six-month follow-up assessment. Secondary outcomes include feeding behaviors and practices, health-related quality of life, dietary intake, and participation levels.

RESULTS

We enrolled three parent mentors and 60 parent-child dyads. The population is 100% Hispanic; 44% of parents speak Spanish as their primary language and 45% were not high-school graduates. Children had a reported median vegetable and fruit intake of 0.3 and 1.1 cups per day, respectively, at baseline, and a median daily screen time of three hours. There was no intergroup difference in quality-of-life scores at baseline. Retention has been high, at 90% in three months.

CONCLUSIONS

In this randomized trial of the effects of parent mentors on early childhood obesity, parent-child dyads from an underserved, Hispanic population were successfully enrolled through a partnership with a Head Start organization, with a high retention rate.

Examining General Versus Condition-Specific Health-Related Quality of Life Across Weight Categories in an Adolescent Sample

This study examined health-related quality of life (HRQoL) across weight categories in adolescents using both a general and a condition-specific measure sensitive to fatigue symptoms. Participants (N = 918) completed the Pediatric Quality of Life (PedsQL) Inventory and PedsQL Multidimensional Fatigue Scale measures. Actual height and weight were used to calculate body mass index for age and sex percentiles and assign weight categories. No interaction effects between total HRQoL and weight category and gender were found; however, main effects were found for both weight category and gender. Future research should examine the impact of using different measures to assess HRQoL outcomes across weight categories.

Item-level informant discrepancies across obese-overweight children and their parents on the PedsQL™ 4.0 instrument: an iterative hybrid ordinal logistic regression

PURPOSE

Child obesity has become a major health concern worldwide. In order to provide successful intervention strategies, it is necessary to understand how obese-overweight children and their parents perceive obesity and its consequences on child's health-related quality of life (HRQoL). This study aimed to assess measurement equivalence of the PedsQL™ 4.0 across obese-overweight children and their parents.

METHODS

The items in the PedsQL™ 4.0 were analysed for differential item functioning (DIF) across obese-overweight children and their parents using an iterative hybrid ordinal logistic regression/item response theory approach. The sample included 647 overweight-obese children and their parents, who completed child and parent reports of the PedsQL™ 4.0, respectively.

RESULTS

Overall, 17 out of 23 (74%) items were flagged with DIF across two groups: eight items exhibited uniform DIF and nine items non-uniform DIF. In addition, parents of obese children rated the child's HRQoL significantly lower than their children in all domains of the PedsQL™ 4.0, and this finding did not change whether or not items with uniform DIF were included.

CONCLUSIONS

Although obese-overweight children and their parents interpret items of the PedsQL™ 4.0 in a conceptually different manner, removing or retaining DIF items in the subscales had no significant effects on group differences. Accordingly, it appears that observed differences in HRQoL scores across child and parent reports are a true difference and not a reflection of measurement artefact.

Changes in parent motivation predicts changes in body mass index z-score (zBMI) and dietary intake among preschoolers enrolled in a family-based obesity intervention

OBJECTIVES

To examine whether changes in parent motivation over the course of a pediatric obesity intervention are significantly associated with long-term changes in treatment outcomes. 

METHODS

 Study hypotheses were tested with a secondary data analysis of a randomized controlled trial (N = 42). Study analyses tested whether baseline to posttreatment change in total score for a self-report parent motivation measure (Parent Motivation Inventory [PMI]) was significantly associated with baseline to 6-month follow-up changes in body mass index z-score (zBMI), dietary variables, and physical activity. 

RESULTS

 Increases in PMI were significantly associated with decreased zBMI, decreased consumption of sugar-sweetened beverages and sweets, and increased consumption of artificially sweetened beverages. 

CONCLUSIONS

 Given that increases in parent motivation were associated with some treatment benefits, future research should evaluate the impact of directly assessing and targeting parent motivation on weight outcomes for preschoolers participating in a weight management program.

A multidisciplinary intervention programme has positive effects on quality of life in overweight and obese preschool children

AIM

Up to 18.1% of Dutch children aged 3-5 are overweight and up to 3.3% are obese, with higher levels in girls. This study assessed the effect of a multidisciplinary intervention programme on health-related quality of life (HRQoL) in this patient group.

METHODS

We randomised 75 children to a multidisciplinary intervention, comprising dietary advice, exercise sessions and psychological counselling for parents or the standard care programme, providing healthy lifestyle advice. The parents completed quality of life and child health questionnaires at baseline and after 16 weeks and 12 months.

RESULTS

At 16 weeks, children in the intervention group experienced more bodily pain and less mental health than the standard care group, but at 12 months, this difference disappeared and they showed a more positive change in HRQoL than the standard care group, especially for the physical domain. When we combined both groups, a decreased BMIz-score over 12 months was associated with increased global health and reduced visceral fat correlated with increased general health.

CONCLUSION

At 12 months, a multidisciplinary intervention programme for overweight and obese children aged 3-5 years had beneficial effects on HRQoL, especially for the physical domain. Reduced obesity parameters correlated with several increased HRQoL parameters.

A pilot randomized controlled trial of a behavioral family-based intervention with and without home visits to decrease obesity in preschoolers

OBJECTIVE

Tested two family-based behavioral treatments for obesity in preschool children, one meeting the Expert Committee guidelines for Stage 3 obesity intervention criteria (LAUNCH-clinic) and one exceeding Stage 3 (LAUNCH with home visit [LAUNCH-HV]), compared with a Stage 1 intervention, pediatrician counseling (PC).

METHODS

In all, 42 children aged 2-5 years with a body mass index (BMI) percentile of ≥95th were randomized. A total of 33 met intent-to-treat criteria. Assessments were conducted at baseline, Month 6 (posttreatment), and Month 12 (6-month follow-up). 

RESULTS

 LAUNCH-HV demonstrated a significantly greater decrease on the primary outcome of change in BMI z-score (BMIz) pre- to posttreatment compared with PC (p = .007), whereas LAUNCH-clinic was not significantly different from PC (p = .08). Similar results were found for secondary outcomes. 

CONCLUSIONS

 LAUNCH-HV, but not LAUNCH-clinic, significantly reduced BMIz compared with PC by posttreatment, indicating the need for intensive behavioral intervention, including home visitation, to address weight management in obese preschool children.

Quality of life in overweight and obese children and adolescents: a literature review

PURPOSE

The purpose of the study is to present a literature review on quality-of-life (QOL) assessment in overweight or obese children and adolescents in order to identify the most affected dimensions and better understand associated factors.

METHODS

The ERIC, FRANCIS, MEDLINE, PsycARTICLES, PsycINFO, and Academic Search Premier databases were searched for articles reporting cross-sectional QOL studies in obese children and adolescents published in English before January 2013. The reference lists of retained articles were also screened.

RESULTS

Among the 34 articles retained for the analysis, only three did not report lower QOL among obese youth. Clinical populations appeared to be more affected than the general population. Several variables were associated with QOL such as self-image, bullying, bodily pain, quality of food intake, physical activity, screen time, parents' educational level, and weight status.

CONCLUSIONS

Identifying variables associated with lower QOL in obese children and adolescents offers new perspectives for prevention and care. Further research is needed to better elucidate these findings. Better understanding QOL is a key element essential for the treatment for childhood and adolescent obesity.

Childhood obesity: a review of increased risk for physical and psychological comorbidities

BACKGROUND

Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities.

OBJECTIVE

The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally.

METHODS

PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities.

RESULTS

The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems.

CONCLUSIONS

The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical.

Three- and five-year follow-up of a combined inpatient-outpatient treatment of obese children and adolescents

Aim. “The combined DAK therapy for obesity in children and adolescents” combines a 6-week inpatient with a 10.5-month outpatient treatment. The aim of the study is to evaluate whether the therapeutic achievements are maintained two and four years after intervention. Method. All subjects who had participated in the 12-month program in 2004/2005 were included in the follow-up study. Body weight, height, and physical fitness were assessed through direct measurements, behaviour, and quality of life by self-report questionnaires. Statistical analysis is based on an intention-to-treat analysis. Results. The response rate after three years was 63.4% and 42.2% after five years. Within three years, participants reduced their BMI-SDS significantly by 0.20 (SD 0.49) and by 0.15 (SD 0.51) within five years. Significant positive changes could be observed with respect to the participants eating behaviour. Similarly, the food intake, particularly the consumption of calorie-reduced beverages, increased significantly while that of nonrecommended foods decreased. Improvement was also seen in the subjective quality of life as well as several aspects of self-perception. Conclusion. Compared to baseline data, significant reduction of BMI-SDS and positive changes of health-related behaviours could be observed even three and five years after the start of the initial program.

Self-rated and parent-rated quality of life (QoL) for community-based obese and overweight children

AIMS

To determine the effects of being obese or overweight on quality of life (QoL) of children from a community-based sample and to compare their self-ratings of QoL with their parents' ratings for their children's QoL.

METHODS

Dyads of 8- to 12-year-old children [60 obese, 34 overweight and 127 normal weight (N = 221)] and their parents or caregivers were recruited from southern Taiwan. QoL was assessed by both parent proxy ratings and child self-ratings using the Pediatric Quality of Life Inventory (PedsQL) questionnaire.

RESULTS

Obese children reported significantly lower QoL than did their normal-weight counterparts (83 ± 15 vs. 88 ± 10; p = 0.04). Obese children rated their QoL lower than did their parents in all (Cohen's d = -0.38 to -0.22) but the school domain. Overweight children's and normal-weight children's self-reported QoL was not significantly different, nor were they different from parent-reported QoL.

CONCLUSIONS

Community-based obese children reported a lower QoL than did normal-weight children; however, their parents seemed unaware of their children's decreased QoL. Caution is required when using only parent proxy reports to assess the QoL of obese children. More effort is needed in Taiwan to improve parents' understanding of their obese children's QoL.