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Schwartzkoff E, Burrows T, Bailey A, Sneddon E, Duncanson K. What are health professionals' perceptions of conducting routine growth assessments and lifestyle interventions? A qualitative study involving allied health professionals, nurses and doctors in rural and regional New South Wales. Aust J Prim Health 2023; 29:596-605. [PMID: 37380151 DOI: 10.1071/py22251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Allied health professionals, nurses and doctors within the New South Wales (NSW) public health system provide trusted health information to a large proportion of families across the state. This means they are well positioned to opportunistically assess and discuss child weight status with families. Prior to 2016, weight status was not routinely addressed in most NSW public health settings, however recent policy changes promote quarterly growth assessments for all children aged under 16years who attend these facilities. The Ministry of Health recommend health professionals use the 5 As framework, a consultation approach to encourage behaviour change, to identify and manage children with overweight or obesity. This study aimed to explore allied health professionals', nurses' and doctors' perceptions of conducting routine growth assessments and providing lifestyle support to families in a local health district in rural and regional NSW, Australia. METHODS This descriptive, qualitative study involved online focus groups and semi-structured interviews with health professionals. Audio recordings were transcribed and coded for thematic analysis, with rounds of data consolidation between research team members. RESULTS Allied health professionals, nurses and doctors who work in a variety of settings within a local health district of NSW participated in one of four focus groups (n =18 participants) or semi-structured interviews (n =4). The predominant themes related to: (1) health professionals' professional identity and their perceived scope of practice; (2) interpersonal qualities of health professionals; (3) the service delivery ecosystem in which health professionals worked. Diversity in attitudes and beliefs about routine growth assessments were not necessarily specific to discipline or setting. CONCLUSIONS Allied health professionals, nurses and doctors recognise the complexities involved in conducting routine growth assessments and providing lifestyle support to families. The 5 As framework used in NSW public health facilities to encourage behaviour change may not allow clinicians to address these complexities in a patient centred way. The findings of this research will be used to inform future strategies aimed at embedding preventive health discussions into routine clinical practice, and to support health professionals to identify and manage children with overweight or obesity.
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Affiliation(s)
- Emma Schwartzkoff
- Health Promotion, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; and School of Health Sciences (Nutrition and Dietetics), University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tracy Burrows
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Bailey
- Research and Knowledge Translation, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Eloise Sneddon
- Health Promotion, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Kerith Duncanson
- Heath Education and Training Institute (NSW Health), St Leonards, NSW 2067, Australia; and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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Thornberry TS, Bodziony VR, Gross DA. Provider Practice and Perceptions of Pediatric Obesity in Appalachian Kentucky. South Med J 2020; 112:553-559. [PMID: 31682734 DOI: 10.14423/smj.0000000000001031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study assessed providers' present practices and perceived needs in Appalachian Kentucky to identify the standard of care and implementation of expert recommendations for managing pediatric obesity. METHODS Questionnaire data were gathered from 28 providers at a pediatric obesity continuing medical education workshop in eastern Kentucky. We assessed current practices, perceived barriers to treatment, and needed resources for managing pediatric obesity. RESULTS Respondents reported mixed adherence to expert recommendations, with providers less frequently addressing family-reported barriers to change and assessing a family's readiness to change behaviors related to pediatric obesity. Respondents also reported service barriers related to patient motivation, lack of time with patients, and a lack of referral options. Finally, providers reported needing multiple community resources to better address pediatric obesity, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. CONCLUSIONS There remains a significant need for education and guidance regarding the implementation of expert recommendations for addressing pediatric obesity in Appalachian Kentucky. Providers reported needing multiple community resources, including improved physical education programs, access to community recreation centers, additional referral resources for multidisciplinary care, and additional training in motivational techniques. We discuss the implications for disseminating and implementing expert recommendations in rural eastern Kentucky, with an emphasis on the roles of behavioral health experts.
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Affiliation(s)
- Timothy S Thornberry
- From the Department of Psychology, Western Kentucky University, Bowling Green, the Department of Psychological and Brain Sciences, University of Louisville, Louisville, and the Northeast Kentucky Area Health Education Center, Morehead, Kentucky
| | - Valery R Bodziony
- From the Department of Psychology, Western Kentucky University, Bowling Green, the Department of Psychological and Brain Sciences, University of Louisville, Louisville, and the Northeast Kentucky Area Health Education Center, Morehead, Kentucky
| | - David A Gross
- From the Department of Psychology, Western Kentucky University, Bowling Green, the Department of Psychological and Brain Sciences, University of Louisville, Louisville, and the Northeast Kentucky Area Health Education Center, Morehead, Kentucky
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Novick MB, Wilson CT, Walker-Harding LR. Potential solutions for pediatric weight loss programs in the treatment of obesity in rural communities. Transl Behav Med 2020; 9:460-467. [PMID: 31094444 DOI: 10.1093/tbm/ibz030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pediatric obesity remains disproportionately more prevalent in rural communities; however, multidisciplinary, pediatric weight loss programs, which are often located in tertiary-care centers, may not be accessible to rural families. Limited models to specifically address pediatric obesity in rural communities exist. Therefore, innovative solutions are required for expanded treatment of pediatric obesity in rural communities. This article discusses potential solutions for multidisciplinary, tertiary-care pediatric weight loss programs to improve access and treatment of pediatric obesity in rural communities. A selected review of the literature suggests that strategies to overcome barriers to treatment in rural communities include telephone calls and telemedicine conferencing by obesity specialists from academic centers (obesity medicine specialists, endocrinologists, dietitians, and psychotherapists) as well as training local primary care providers in rural communities to screen, diagnose, and treat patients with obesity. Multidisciplinary, tertiary-care pediatric weight loss programs have a profound opportunity to impact the treatment of pediatric obesity in rural communities by training practicing rural primary care providers as well as strengthening their commitment to educate future generations of clinicians on the treatment of pediatric obesity through medical training including physician assistant, nurse practitioner, and pediatric and family medicine resident education and skill building. This article identifies potential mechanisms for expansive treatment of pediatric obesity in rural communities by multidisciplinary, tertiary-care weight loss programs and highlights areas of specific focus needed for future investigation.
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Affiliation(s)
- Marsha B Novick
- Departments of Pediatrics and Family & Community Medicine, Pediatric Multidisciplinary Weight Loss Program, Penn State Hershey Medical Center, Hershey, PA, USA
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Cygan H, Reed M, Lui K, Mullen M. The Chronic Care Model to Improve Management of Childhood Obesity. Clin Pediatr (Phila) 2018; 57:727-732. [PMID: 29019281 DOI: 10.1177/0009922817734357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
One-third of children in the United States are overweight or obese. Comorbidities continue into adulthood if a healthy weight is not established. While expert guidelines for management of this condition are recognized, provider adherence to guidelines is lacking. The purpose of this quality improvement project was to evaluate the effectiveness of the chronic care model (CCM) on improving primary care provider identification, prevention, and management of childhood overweight and obesity. A pre- and postintervention chart audit was completed to evaluate documentation of 20 assessment measures included in expert guidelines. A chi-square analysis was conducted to assess differences. Statistically significant improvements were found in documentation of parental obesity, family medical history, sleep assessment, endocrine assessment, and weight classification as a diagnosis. Use of the CCM had a positive impact on provider adherence to expert guidelines. Furthermore, not all aspects of the CCM must be used to see statistically significant improvements.
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Harrison SE, Greenhouse D. Dietary and Nutrition Recommendations in Pediatric Primary Care: A Call to Action. South Med J 2018; 111:12-17. [DOI: 10.14423/smj.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mikles SP, Wiltz JL, Reed-Fourquet L, Painter IS, Lober WB. Utilizing Standard Data Transactions and Public-Private Partnerships to Support Healthy Weight Within the Community. EGEMS (WASHINGTON, DC) 2017; 5:21. [PMID: 29930962 PMCID: PMC5994932 DOI: 10.5334/egems.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CONTEXT Obesity is a significant health issue in the United States that both clinical and public health systems struggle to address. Electronic health record data could help support multi-sectoral interventions to address obesity. Standards have been identified and created to support the electronic exchange of weight-related data across many stakeholder groups. CASE DESCRIPTION The Centers for Disease Control and Prevention initiated a public-private partnership including government, industry, and academic technology partners to develop workflow scenarios and supporting systems to exchange weight-related data through standard transactions. This partnership tested the transmission of data using this newly-defined Healthy Weight (HW) profile at multiple health data interoperability demonstration events. FINDINGS Five transaction types were tested by 12 partners who demonstrated how the standards and related systems support end-to-end workflows around managing weight-related issues in the community. The standard transactions were successfully tested at two Integrating the Healthcare Enterprise (IHE) Connectathon events through 86 validated tests encompassing 38 multi-partner transactions. DISCUSSION We have successfully demonstrated the transactions defined in the HW profile with a public-private partnership. These tested IT products and HW standards could be used to support a continuum of care around health related issues encompassing both health care and public health functions. CONCLUSION The use of the HW profile, including a set of transactions and identified standards to implement those transactions, in IT products is a helpful first step in leveraging health information technology to address weight-related issues in the United States. Future work is needed to expand the use of these standards and to assess their use in real world settings.
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Affiliation(s)
- Sean P Mikles
- Department of Biomedical Informatics and Medical Education, University of Washington
| | - Jennifer L Wiltz
- Centers for Disease Control and Prevention; United States Public Health Service
| | | | - Ian S Painter
- Department of Health Services, University of Washington
| | - William B Lober
- Schools of Nursing, Medicine, and Public Health, University of Washington
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SanGiovanni C, McElligott J, Morella K, Basco W. Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas. South Med J 2017; 110:480-485. [PMID: 28679018 DOI: 10.14423/smj.0000000000000672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed. METHODS Medicaid claims data from 2012 for children in three South Carolina counties, categorized as urban, rural high resource, and rural low resource, were used to identify those who had been diagnosed as being overweight/obese during any encounter. Logistic and Poisson regressions were performed to predict whether overweight/obese children in each county would receive an overweight/obesity visit diagnosis and to calculate the mean rate of total office visits with an overweight/obesity diagnosis in each county. RESULTS A total of 1233 children enrolled in Medicaid were diagnosed as being overweight/obese at any encounter in the designated counties. Well visits with overweight/obesity diagnosed varied significantly, with 42.6%, 28%, and 11% in urban, rural high-resource counties, and rural low-resource counties, respectively (P < 0.01). In the logistic regression rural high-resource children (adjusted odds ratio 0.58, 95% confidence interval 0.38-0.88) and rural low-resource children (adjusted odds ratio 0.16, 95% confidence interval 0.09-0.28) were less likely than urban children to be diagnosed as being overweight/obese at a well visit. All of the children had a low number of total office visits with overweight/obesity diagnosed. When comparing the counties, urban children (1.22 visits per year) had more visits than rural low-resource children (0.75 visits per year, P < 0.01) and rural high-resource children (0.89 visits per year, P < 0.01). CONCLUSIONS Overweight/obesity is underdiagnosed in rural children enrolled in Medicaid in South Carolina, which affects the number of children who receive help to manage their weight. Interventions to overcome barriers of diagnosis and management are necessary to address childhood obesity properly.
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Affiliation(s)
- Christine SanGiovanni
- From the Departments of Pediatrics and Public Health, Medical University of South Carolina, Charleston
| | - James McElligott
- From the Departments of Pediatrics and Public Health, Medical University of South Carolina, Charleston
| | - Kristen Morella
- From the Departments of Pediatrics and Public Health, Medical University of South Carolina, Charleston
| | - William Basco
- From the Departments of Pediatrics and Public Health, Medical University of South Carolina, Charleston
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Bennett EA, Kolko RP, Chia L, Elliott JP, Kalarchian MA. Treatment of Obesity Among Youth With Intellectual and Developmental Disabilities: An Emerging Role for Telenursing. West J Nurs Res 2017; 39:1008-1027. [PMID: 28349744 DOI: 10.1177/0193945917697664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Childhood obesity is a serious health issue, associated with medical comorbidity and psychosocial impairment that can persist into adulthood. In the United States, youth with intellectual and developmental disabilities are more likely to be obese than youth without disabilities. A large body of evidence supports the efficacy of family-based treatment of childhood obesity, including diet, physical activity, and behavior modification, but few interventions have been developed and evaluated specifically for this population. We highlight studies on treatment of obesity among youth with intellectual and developmental disabilities, including both residential/educational settings as well as outpatient/hospital settings. All interventions were delivered in-person, and further development of promising approaches and delivery via telenursing may increase access by youth and families. Nursing scientists can assume an important role in overcoming barriers to care for this vulnerable and underserved population.
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Kolko RP, Kass AE, Hayes JF, Levine MD, Garbutt JM, Proctor EK, Wilfley DE. Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial. J Pediatr Health Care 2017; 31:16-28. [PMID: 26873293 PMCID: PMC4980292 DOI: 10.1016/j.pedhc.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. METHOD Participants (N = 63) were randomized to live interactive training or Web-facilitated self-study training. Pretraining, post-training, and 1-month follow-up assessments evaluated training feasibility, acceptability, and impact (knowledge and skill via simulation). Moderator (previous experience) and predictor (content engagement) analyses were conducted. RESULTS Nearly all participants (98%) completed assessments. Both types of training were acceptable, with higher ratings for live training and participants with previous experience (ps < .05). Knowledge and skill improved from pretraining to post-training and follow-up in both conditions (ps < .001). Live training demonstrated greater content engagement (p < .01). CONCLUSIONS The training package was feasible, acceptable, and efficacious among nursing students. Given that live training had higher acceptability and engagement and online training offers greater scalability, integrating interactive live training components within Web-based training may optimize outcomes, which may enhance practitioners' delivery of pediatric obesity services.
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Affiliation(s)
- Rachel P. Kolko
- Department of Psychiatry, University of Pittsburgh
- Department of Psychology, Washington University in St. Louis
| | - Andrea E. Kass
- Department of Psychology, Washington University in St. Louis
- Department of Medicine, The University of Chicago
| | | | | | - Jane M. Garbutt
- Department of Medicine, Washington University School of Medicine
- Department of Pediatrics, Washington University School of Medicine
| | | | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine
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Robson SM, Bolling C, McCullough MB, Stough CO, Stark LJ. A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals. J Pediatr 2016; 177:262-266.e1. [PMID: 27453375 PMCID: PMC5037027 DOI: 10.1016/j.jpeds.2016.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine referral by primary care providers (PCPs) of preschool children with obesity (≥95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT), and identify reasons for not referring children. STUDY DESIGN In phase I, 3 experts in obesity, psychology, and nutrition completed an open card sort and classified PCPs' reasons for declining referral into groups based on similarity of reasons. Categories were then defined and labeled. In phase II, 2 independent sorters placed each decline into 1 of the categories defined in phase I. RESULTS PCPs referred 78% of eligible children to the RCT. Compared with children declined for referral, referred children had a significantly higher weight (48.4 lb vs 46.1 lb; P < .001) and BMI percentile (97.6 vs 97.0; P < .001). Eleven categories for decline were identified in phase I. In phase II, excellent reliability was obtained between each independent sorter and the phase I categories, and also between the 2 independent sorters (κ values, 0.72-1.0). The most common reason for declining was "family not a good fit" (23.6%), followed by "doesn't believe weight is a problem" (13.9%), "family would not be interested" (12%), and "doesn't believe measurement is accurate" (11.5%). Appropriately, exclusionary criteria of the RCT was a reason as well (11.8%). CONCLUSION The availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in previous studies. However, concerns about the family's response or interest in a weight management program remained barriers, as did PCPs' perceptions about obesity in young children. TRIAL REGISTRATION ClinicalTrials.gov:NCT01546727.
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Affiliation(s)
- Shannon M. Robson
- University of Delaware, Newark, Delaware, USA,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Lori J. Stark
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Shue CK, Whitt JK, Daniel L, Shue CB. Promoting conversations between physicians and families about childhood obesity: evaluation of physician communication training within a clinical practice improvement initiative. HEALTH COMMUNICATION 2015; 31:408-416. [PMID: 26362560 DOI: 10.1080/10410236.2014.963785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Childhood obesity rates have incrementally increased since the 1980s, sparking calls for initiatives focused on addressing this public health concern. In response, the family medicine residency clinic profiled in this research designed, executed, and evaluated a practice improvement initiative focused on physician communication behaviors and clinic processes that impact the management of unhealthy pediatric weight. The results of the evaluation effort demonstrated increased physician knowledge of communication principles, improvements in weight management counseling rates, and opportunities for health delivery system changes to promote the effective clinical management of unhealthy pediatric weight.
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Affiliation(s)
- Carolyn K Shue
- a Department of Communication Studies , Ball State University
| | - Justin K Whitt
- b IU Health Ball Memorial Hospital Family Medicine Residency Center
| | - Linda Daniel
- b IU Health Ball Memorial Hospital Family Medicine Residency Center
| | - Christian B Shue
- b IU Health Ball Memorial Hospital Family Medicine Residency Center
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Reyes I. An Evaluation of the Identification and Management of Overweight and Obesity in a Pediatric Clinic. J Pediatr Health Care 2015; 29:e9-14. [PMID: 26036620 DOI: 10.1016/j.pedhc.2015.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
With the rise in overweight and obesity in children, it is imperative for health care providers to routinely address appropriate body mass index for children during primary care visits. The purposes of this project were to determine if overweight and obese children are accurately being identified and to evaluate provider adherence to American Academy of Pediatrics guidelines for the management of obesity. A retrospective chart review was completed for all children ages 2, 6, and 10 years who presented for a well-child visit from January 1, 2011, through June 30, 2011. Based on a review of 255 charts, 21.6% of patients were overweight and 18.4% were obese according to standards of the Centers for Disease Control and Prevention. Of these children, 34% were properly documented as being either overweight or obese, and documentation was lacking for the remaining 66%. Of the children correctly identified as being overweight or obese, only 11% and 26%, respectively, were counseled on therapeutic lifestyle changes, including diet and exercise. This review provides evidence that providers have opportunities to intervene early with well-child examinations and that providers have great room for improvement on counseling overweight and obese children.
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Dixon WE, Dalton WT, Berry SM, Carroll VA. Improving the accuracy of weight status assessment in infancy research. Infant Behav Dev 2014; 37:428-34. [PMID: 24956502 DOI: 10.1016/j.infbeh.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
Both researchers and primary care providers vary in their methods for assessing weight status in infants. The purpose of the present investigation was to compare standing-height-derived to recumbent-length-derived weight-for-length standardized (WLZ) scores, using the WHO growth curves, in a convenience sample of infants who visited the lab at 18 and 21 months of age. Fifty-eight primarily White, middle class infants (25 girls) from a semi-rural region of southern Appalachia visited the lab at 18 months, with 45 infants returning 3 months later. We found that recumbent-length-derived WLZ scores were significantly higher at 18 months than corresponding standing-height-derived WLZ scores. We also found that recumbent-length-derived WLZ scores, but not those derived from standing height measures, decreased significantly from 18 to 21 months. Although these differential results are attributable to the WHO database data entry syntax, which automatically corrects standing height measurements by adding 0.7 cm, they suggest that researchers proceed cautiously when using standing-height derived measures when calculating infant BMI z-scores. Our results suggest that for practical purposes, standing height measurements may be preferred, so long as they are entered into the WHO database as recumbent length measurements. We also encourage basic science infancy researchers to include BMI assessments as part of their routine assessment protocols, to serve as potential outcome measures for other basic science variables of theoretical interest.
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Affiliation(s)
- Wallace E Dixon
- Department of Psychology, East Tennessee State University, United States.
| | - William T Dalton
- Department of Psychology, East Tennessee State University, United States
| | - Sarah M Berry
- Department of Psychology, East Tennessee State University, United States
| | - Vincent A Carroll
- Department of Psychology, East Tennessee State University, United States
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Aldrich H, Gance-Cleveland B, Schmiege S, Dandreaux D. School-based health center providers' treatment of overweight children. J Pediatr Nurs 2014; 29:521-7. [PMID: 24947663 DOI: 10.1016/j.pedn.2014.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 11/18/2022]
Abstract
This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (N=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p<0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.
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Affiliation(s)
- Heather Aldrich
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | | | - Sarah Schmiege
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Danielle Dandreaux
- Center for Improving Health Outcomes in Children, Teens, and Families, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.
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Quelly SB. Childhood obesity prevention: a review of school nurse perceptions and practices. J SPEC PEDIATR NURS 2014; 19:198-209. [PMID: 24612520 DOI: 10.1111/jspn.12071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/24/2014] [Accepted: 01/28/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this review is to examine key school nurse perceptions that may promote or deter school nurse involvement in childhood obesity prevention (COP) practices. CONCLUSIONS Ten research articles were identified through a systematic review of the literature. School nurse participation in COP is inconsistent, and this variation is not well understood. Some variations in COP practices may be explained by differences in self-efficacy, perceived benefits, and perceived barriers. PRACTICE IMPLICATIONS Efforts are needed to develop and implement interventions and policies to modify those perceptions that may promote school nurse active engagement in COP practices.
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Affiliation(s)
- Susan B Quelly
- College of Nursing, University of Central Florida, Orlando, Florida, USA
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Sebiany AM. Primary care physicians' knowledge and perceived barriers in the management of overweight and obesity. J Family Community Med 2014; 20:147-52. [PMID: 24672270 PMCID: PMC3957166 DOI: 10.4103/2230-8229.121972] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To determine the level of knowledge of primary health care physicians and the barriers perceived in the management of overweight and obesity in the Eastern Province of Saudi Arabia. Setting: Primary health care centers in Dammam and Al-Khobar cities, Saudi Arabia. Design: A cross-sectional study. Materials and Methods: One hundred and forty-nine physicians were surveyed. Data were collected with a specially made anonymous, self-administrated, structured questionnaire with a Cronbach alpha reliability of 0.85, and content validity by five experts was used to measure the knowledge and barriers from several different aspects of care provided by primary health care centers to the overweight and obese. Results: One hundred and thirty (87%) physicians responded. More than two-thirds of the respondents considered themselves as key players in the management of obesity. However, only one-third believed that they were well prepared to treat obesity. Eighty-three per cent of the respondents had a negative attitude toward the concept of overweight and obesity. It was noted that 76.9% of physicians advised patients to control their weight with sport and exercise together with low calorie diet. Sixty percent of the respondents used body mass index to diagnose obesity. Seventy-two percent of respondents did not use weight reduction medications to treat obesity. Lack of training, poor administrative support, and time constraints were identified as barriers in managing overweight and obesity. Conclusion: Respondents were aware of the magnitude of overweight and obesity as a major public health problem in Saudi Arabia, and they were also aware of the correct definition of overweight and obesity, as well as its effect in increasing mortality. Better training is required to improve some areas of awareness and management of the conditions.
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Affiliation(s)
- Abdulaziz M Sebiany
- Department of Family and Community Medicine, College of Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
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Dalton WT, Schetzina KE, McBee MT, Maphis L, Fulton-Robinson H, Ho AL, Tudiver F, Wu T. Parent report of child's health-related quality of life after a primary-care-based weight management program. Child Obes 2013; 9:501-8. [PMID: 24152081 PMCID: PMC3868295 DOI: 10.1089/chi.2013.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) has been recognized as an important target and health outcome in obesity research. The current study aimed to examine HRQoL in overweight or obese children after a 10-week primary-care-based weight management program, Parent-Led Activity and Nutrition for Healthy Living, in southern Appalachia. METHODS Sixty-seven children (ages 5-12 years) and their caregivers were recruited from four primary care clinics, two of which were randomized to receive the intervention. Caregivers in the intervention groups received two brief motivational interviewing visits and four group sessions led by providers as well as four phone follow-ups with research staff. Caregivers completed the PedsQL and demographic questionnaires at baseline and at 3, 6, and 12 months postintervention. Child height and weight were collected to determine standardized BMI. RESULTS Caregivers of children receiving the weight control intervention reported no statistically significant improvements in child total HRQoL, as compared to the control group, across the course of treatment (β=0.178; 95% confidence interval, -0.681, 1.037; p=0.687). Additionally, no statistically significant improvements were found across other HRQoL domains. CONCLUSIONS Future studies examining HRQoL outcomes in primary care may consider treatment dose as well as methodological factors, such as utilization of multiple informants and different measures, when designing studies and interpreting outcomes.
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Affiliation(s)
- William T. Dalton
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Karen E. Schetzina
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Matthew T. McBee
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Laura Maphis
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Hazel Fulton-Robinson
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Ai-Leng Ho
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Fred Tudiver
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Tiejian Wu
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN.,Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
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Home Food Environment, Dietary Intake, and Weight among Overweight and Obese Children in Southern Appalachia. South Med J 2013; 106:550-7. [DOI: 10.1097/smj.0000000000000008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Sports psychologists play an important role in enhancing performance among athletes. In conjunction with team physicians, they can also shed light on psychological disorders common in athletes, such as mood and eating disorders, and overtraining syndrome. Sports psychologists can also lend their expertise to assist with injury prevention and recovery and compliance issues. Sports psychology has a role in helping to reverse the growing obesity epidemic among school-aged children. These professionals, working with coaches, can increase children's levels of physical activity. Cognitive-behavioral techniques could lead to enhanced enjoyment, increased participation, improved school performance, and a reduction in obesity.
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Affiliation(s)
- Vincent Morelli
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA.
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Vine M, Hargreaves MB, Briefel RR, Orfield C. Expanding the role of primary care in the prevention and treatment of childhood obesity: a review of clinic- and community-based recommendations and interventions. J Obes 2013; 2013:172035. [PMID: 23710345 PMCID: PMC3655557 DOI: 10.1155/2013/172035] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/20/2013] [Indexed: 12/24/2022] Open
Abstract
Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.
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Affiliation(s)
- Michaela Vine
- Mathematica Policy Research, 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA.
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21
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Vannucci A, Wilfley DE. Behavioral Interventions and Cardiovascular Risk in Obese Youth: Current Findings and Future Directions. CURRENT CARDIOVASCULAR RISK REPORTS 2012; 6:567-578. [PMID: 23336013 PMCID: PMC3546817 DOI: 10.1007/s12170-012-0272-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The identification and early intervention of pediatric obesity is critical to reducing cardiovascular disease (CVD). Family-based behavioral interventions have consistently demonstrated efficacy in reducing adiposity and CVD risk factors (i.e., blood pressure, cholesterol, fasting glucose levels, insulin resistance, metabolic syndrome). Even modest weight loss in severely obese youth can lead to sustained improvement in CVD risk factors. However, weight regain following treatment cessation remains a challenge in the contemporary obesogenic environment. Intensive family-based interventions spanning socioenvironmental contexts (i.e., home, peer, community) show promise in sustaining weight loss in the long-term. Despite having effective treatments for pediatric obesity and CVD risk factors, families rarely have access to these programs and so increasing the role of healthcare providers in screening and referral efforts is imperative. Moving forward, it is also essential to establish communication and cooperative networks across sectors build sustainable prevention and intervention programs and to provide cohesive health messages.
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Affiliation(s)
- Anna Vannucci
- Uniformed Services University of the Health Sciences Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814 ;
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22
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Conway P, Haller IV, Lutfiyya MN. School-Aged Overweight and Obese Children in Rural America. Dis Mon 2012; 58:639-50. [DOI: 10.1016/j.disamonth.2012.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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23
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Hare ME, Coday M, Williams NA, Richey PA, Tylavsky FA, Bush AJ. Methods and baseline characteristics of a randomized trial treating early childhood obesity: the Positive Lifestyles for Active Youngsters (Team PLAY) trial. Contemp Clin Trials 2012; 33:534-49. [PMID: 22342450 DOI: 10.1016/j.cct.2012.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 02/02/2012] [Accepted: 02/04/2012] [Indexed: 12/22/2022]
Abstract
There are few effective obesity interventions directed towards younger children, particularly young minority children. This paper describes the design, intervention, recruitment methods, and baseline data of the ongoing Positive Lifestyles for Active Youngsters (Team PLAY) study. This randomized controlled trial is designed to test the efficacy of a 6-month, moderately intense, primary care feasible, family-based behavioral intervention, targeting both young children and their parent, in promoting healthy weight change. Participants are 270 overweight and obese children (ages 4 to 7 years) and their parents, who were recruited from a primarily African American urban population. Parents and children were instructed in proven cognitive behavioral techniques (e.g. goal setting, self-talk, stimulus control and reinforcement) designed to encourage healthier food choices (more whole grains, fruits and vegetables, and less concentrated fats and sugar), reduce portion sizes, decrease sweetened beverages and increase moderate to vigorous physical activity engagement. The main outcome of this study is change in BMI at two year post enrollment. Recruitment using reactive methods (mailings, TV ads, pamphlets) was found to be more successful than using only a proactive approach (referral through physicians). At baseline, most children were very obese with an average BMI z-score of 2.6. Reported intake of fruits and vegetables and minutes of moderate to vigorous physical activity engagement did not meet national recommendations. If efficacious, Team PLAY would offer a model for obesity treatment directed at families with young children that could be tested and translated to both community and primary care settings.
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Affiliation(s)
- Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States.
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Abstract
To effectively intervene with the overweight and obese youth, it is imperative that primary care providers and behavioral interventionists work in concert to help families implement healthy behaviors across socioenvironmental domains. In this article, the authors review current office-based counseling practices and provide evidence-based recommendations for addressing weight status and strategies for encouraging behavior change with children and families, primarily by increasing social support. By providing such collaborative targeted efforts, consistent health messages and support are delivered across children's everyday contexts, thereby helping the youth to achieve successful implementation of eating and activity behaviors and sustainable weight loss outcomes.
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Affiliation(s)
- Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, Missouri 63110, Phone: 314-286-2079, Fax: 314-286-2091
| | - Andrea E. Kass
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, Missouri 63110, Phone: 314-286-2113, Fax: 314-286-2091
| | - Rachel P. Kolko
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, Missouri 63110, Phone: 314-286-0253, Fax: 314-286-2091
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Hayden MR, Joginpally T, Salam M, Sowers JR. Childhood and adolescent obesity in cardiorenal metabolic syndrome and Type 2 diabetes: a clinical vignette and ultrastructure study. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/dmt.11.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dalton WT, Schetzina KE, Holt N, Fulton-Robinson H, Ho AL, Tudiver F, McBee MT, Wu T. Parent-Led Activity and Nutrition (PLAN) for healthy living: design and methods. Contemp Clin Trials 2011; 32:882-92. [PMID: 21777701 PMCID: PMC3335199 DOI: 10.1016/j.cct.2011.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 06/03/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022]
Abstract
Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5-11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices.
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Affiliation(s)
- William T. Dalton
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Karen E. Schetzina
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Nicole Holt
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Hazel Fulton-Robinson
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Ai-Leng Ho
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Fred Tudiver
- Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Mathew T. McBee
- Frank Porter Graham Child Development Institute, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Tiejian Wu
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
- Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Walker SE, Smolkin ME, O'Leary MLL, Cluett SB, Norwood VF, DeBoer MD, Gurka MJ. Predictors of Retention and BMI Loss or Stabilization in Obese Youth Enrolled in a Weight Loss Intervention. Obes Res Clin Pract 2011; 6:e330-e339. [PMID: 23181148 PMCID: PMC3501750 DOI: 10.1016/j.orcp.2011.08.157] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 08/23/2011] [Accepted: 08/30/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE: To evaluate predictors for intervention dropout and successful reduction of metabolic syndrome risk factors among obese children enrolled in a short-term, clinic-based weight-loss intervention. DESIGN, SETTING, SUBJECTS: Retrospective database review of 1080 children 8 months-17 y.o. seen a a pediatric obesity clinic. INTERVENTIONS: Behavior modification counseling to induce change in dietary and exercise choices. MAIN OUTCOME MEASURES: 1). Pre-/post-intervention change in body mass index (BMI), waist circumference, blood pressure, glucose, insulin, and cholesterol (LDL, HDL, & total). 2) Predictors of successful decrease in BMI and clinic drop-out. ANALYSIS: Paired t-tests for pre-/post-intervention comparisons. Linear regression to assess predictors of success and predictors of drop-out, with adjustment for age, gender, race, insurance status, and service area. RESULTS: Among children evaluated, adolescent females were most likely to achieve successful decrease in BMI, insulin level, and LDL cholesterol post-intervention. Nearly 40% of children dropped out early in the intervention. Predictors of drop out included age <6y, public insurance status, follow-up scheduled during summer months, and residence in a tertiary service area. CONCLUSIONS: Clinic-based weight loss interventions can lead to successful improvements in BMI and other metabolic parameters in pediatric populations and may be more likely among adolescent females than in younger children or males. Drop-out is common, particularly among younger children, children with public insurance and children scheduled for follow-up in the summer. Identification of these drop-out predictors in individual patients may help in targeting children likely to succeed in short-term, clinic-based, weight-loss interventions.
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Affiliation(s)
- Shetarra E. Walker
- Division of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
| | - Mark E. Smolkin
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - M. Layla L. O'Leary
- Children's Fitness Clinic, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
- Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
| | - Susan B. Cluett
- Children's Fitness Clinic, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
- Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
| | - Victoria F. Norwood
- Children's Fitness Clinic, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
- Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
| | - Mark D. DeBoer
- Division of Endocrinology, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
- Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
| | - Matthew J. Gurka
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
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