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Wood C, Khalsa AS. Overview of BMI and Other Ways of Measuring and Screening for Obesity in Pediatric Patients. Pediatr Clin North Am 2024; 71:781-796. [PMID: 39343492 DOI: 10.1016/j.pcl.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Despite a long history of advances in measuring body size and composition, body mass index (BMI) has remained the most commonly used clinical measure. We explore the advantages and disadvantages of using BMI and other measures to estimate adipose tissue, recognizing that no measure of body size or adiposity has fulfilled the goal of differentiating health from disease. BMI and waist circumference remain widely-used clinical screening measures for appropriate risk stratification as it relates to obesity.
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Affiliation(s)
- Charles Wood
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke Center for Childhood Obesity Research, Duke University School of Medicine, 3116 N. Duke Street, Durham, NC 27704, USA.
| | - Amrik Singh Khalsa
- Division of Primary Care Pediatrics, Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
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Yudkin JS, Koym K, Hamad Y, Malthaner LQ, Burgess RM, Ortiz LN, Dhurjati N, Mitha S, Calvi G, Hill K, Brownell M, Wei E, Swartz K, Atem FD, Galeener CA, Messiah SE, Barlow SE, Allicock MA. Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework. Transl Behav Med 2024; 14:34-44. [PMID: 37632769 DOI: 10.1093/tbm/ibad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023] Open
Abstract
Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.
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Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kelsey Koym
- Texas Medical Center Library, Houston, TX, USA
| | - Yasmin Hamad
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Lauren Q Malthaner
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Rebecca Meredith Burgess
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Nalini Dhurjati
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sharmin Mitha
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Gabriela Calvi
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kristina Hill
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Elena Wei
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kyle Swartz
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Human-centered designed communication tools for obesity prevention in early life. Prev Med Rep 2023; 35:102333. [PMID: 37564121 PMCID: PMC10410241 DOI: 10.1016/j.pmedr.2023.102333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
Objective How we communicate about obesity is critical as treatment paradigms shift upstream. We previously identified parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. We engaged parents of children 0 to 24 months of age and pediatricians from Indianapolis, Indiana, USA in the co-design of messages and tools that can be used to facilitate parent/provider conversations about early life obesity prevention. Methods From April to June 2021, we conducted a series of co-design workshops with parents of children ages 0 to 24 months and pediatricians to identify their preferences for communicating obesity prevention in the setting of a pediatric well visit. Human-centered design techniques, including affinity diagraming and model building, were used to inform key elements of a communication model and communication strategy messages. These elements were combined and refined to create prototype tools that were subsequently refined using stakeholder feedback. Results Parent participants included 11 mothers and 2 fathers: 8 white, 4 black, and 1 Asian; median age 33 years with 38% reporting annual household incomes less than $50,000. Pediatricians included 7 female and 6 male providers; 69% white. Through an iterative process of co-design, we created an exam room poster that addresses common misconceptions about infant feeding, sleep and exercise, and a behavior change plan to foster parent/provider collaboration focused on achieving children's healthy weight. Conclusions Our hands-on, collaborative approach may ultimately improve uptake, acceptability and usability of early life obesity interventions by ensuring that parents remain at the center of prevention efforts.
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Affiliation(s)
- Erika R. Cheng
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10 St., Suite 2000, Indianapolis, IN 46220, United States
| | - Courtney Moore
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Lisa Parks
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Elsie M. Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St., Boston, MA 02114, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Boston, MA 02115, United States
| | - Sarah E. Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10 St., Suite 2000, Indianapolis, IN 46220, United States
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Aaron E. Carroll
- Indiana University School of Medicine, Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, 410 W. 10th St., Suite 2000, Indianapolis, IN, United States
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Serban CL, Putnoky S, Ek A, Eli K, Nowicka P, Chirita-Emandi A. Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment. Front Public Health 2021; 9:652491. [PMID: 34336760 PMCID: PMC8321411 DOI: 10.3389/fpubh.2021.652491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed. Trial Registration:ClinicalTrials.gov, NCT03800823; 11 Jan 2019.
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Affiliation(s)
- Costela Lacrimioara Serban
- Functional Sciences Department, "Victor Babes" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Salomeia Putnoky
- Microbiology Department, Centre for Studies in Preventive Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, Regional Center of Medical Genetics Timis, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Regional Center of Medical Genetics, "Louis Turcanu" Clinical Emergency Hospital for Children, Timişoara, Romania
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Shen YH, Liu Z, Li WH, Zhou S, Xu JH, Jiang C, Wang HJ. The Smartphone-Assisted Intervention Improved Perception of Nutritional Status among Middle School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165932. [PMID: 32824190 PMCID: PMC7459995 DOI: 10.3390/ijerph17165932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Misperception of nutritional status is common and hinders the progress of childhood obesity prevention. This study aimed to examine the effectiveness of a smartphone-assisted intervention to improve student and parental perception of students’ nutritional status (underweight, normal weight, overweight, obese). We conducted a parallel-group controlled trial with a non-randomized design in three junior middle schools of Beijing, China in 2019. One school was allocated to the intervention group and two schools to the control group. A total of 573 students (aged 13.1 ± 0.4 years) participated in the trial. The 3-month intervention included three components: health education sessions for students and parents, regular monitoring of students’ weight, and the provision of feedback via a smartphone application. Schools in the control group continued their usual practice. Primary outcomes included the student and parental accurate perception of students’ nutritional status. The percentage of students’ accurate perception of their own nutritional status in the intervention group increased from 49.0% to 59.2% from baseline to three months, whereas it decreased from 64.1% to 58.1% in the control group; the adjusted odds ratio (OR) between the two groups was 1.71 (95% confidence interval (CI): 1.13, 2.59). The intervention did not significantly improve parental perception of students’ nutritional status (p > 0.05). The study findings provided a brief approach for improving perception of nutritional status among middle school students.
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Affiliation(s)
- Yan-Hui Shen
- Department of School Health, Beijing Haidian District Center for Diseases Prevention and Control, Beijing 100095, China; (Y.-H.S.); (C.J.)
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China; (Z.L.); (W.-H.L.); (S.Z.); (J.-H.X.)
| | - Wen-Hao Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China; (Z.L.); (W.-H.L.); (S.Z.); (J.-H.X.)
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China; (Z.L.); (W.-H.L.); (S.Z.); (J.-H.X.)
| | - Jin-Hui Xu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China; (Z.L.); (W.-H.L.); (S.Z.); (J.-H.X.)
| | - Chu Jiang
- Department of School Health, Beijing Haidian District Center for Diseases Prevention and Control, Beijing 100095, China; (Y.-H.S.); (C.J.)
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China; (Z.L.); (W.-H.L.); (S.Z.); (J.-H.X.)
- Correspondence:
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