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Cohen J, Alexander S, Signorelli C, Williams K, Sim KA, Chennariyil L, Baur LA. Clinician and healthcare managers' perspectives on the delivery of secondary and tertiary pediatric weight management services. J Child Health Care 2023; 27:128-144. [PMID: 34719287 DOI: 10.1177/13674935211052148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinician and healthcare managers' (HCMs) views on weight management service delivery are imperative for informing the nature of future services to treat children with obesity. This qualitative study used semi-structured focus groups and one-on-one semi-structured interviews. Participants were 27 clinicians (medical, nursing, or allied health) and nine HCMs (senior executives in the hospital) who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. Clinicians reported that using a combination of group and individual sessions improved engagement with families and reduced attrition rates. Clinicians and HCMs recommended integrating clinics into community centers and providing specific programs for sub-groups, such as children from culturally and linguistically diverse communities or children with developmental delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. To improve the likelihood of future funding for pediatric weight management clinics and to optimize models of care, centers must embed research into their practice. Addressing common barriers to current pediatric weight management services and designing future models of care based on key stakeholders' preferences is critical to achieving optimal care provision for this high-risk population.
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Affiliation(s)
- Jennifer Cohen
- Weight Management Services, 8538The Children's Hospital at Westmead, Westmead, NSW, Australia.,Discipline of Paediatrics, School of Women's & Children's Health, 7800The UNSW Sydney, Sydney, NSW, Australia
| | - Shirley Alexander
- Weight Management Services, 8538The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's & Children's Health, 7800The UNSW Sydney, Sydney, NSW, Australia.,Kids Cancer Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Kathryn Williams
- Charles Perkins Centre, 4334The University of Sydney, Camperdown, NSW, Australia.,Nepean Family Metabolic Health Service, 223690Nepean Blue Mountains Local Health District, Kingswood, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Kyra A Sim
- Charles Perkins Centre, 4334The University of Sydney, Camperdown, NSW, Australia.,Obesity Prevention and Management, 222415Sydney Local Health District, Camperdown, NSW, Australia
| | - Lenina Chennariyil
- Discipline of Paediatrics, School of Women's & Children's Health, 7800The UNSW Sydney, Sydney, NSW, Australia.,Department of Paediatrics, 36666Canterbury Hospital, Campsie, NSW, Australia
| | - Louise A Baur
- Weight Management Services, 8538The Children's Hospital at Westmead, Westmead, NSW, Australia.,Charles Perkins Centre, 4334The University of Sydney, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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2
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Mears R, Leadbetter S, Candler T, Sutton H, Sharp D, Shield JPH. Cross-sectional survey of child weight management service provision by acute NHS trusts across England in 2020/2021. BMJ Open 2022; 12:e061971. [PMID: 36356995 PMCID: PMC9670955 DOI: 10.1136/bmjopen-2022-061971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE With one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts across England, to identify breadth of service provision. DESIGN A cross-sectional survey. SETTING The survey was sent to acute NHS trusts (n=148) in England in 2020, via a freedom of information request. PARTICIPANTS Responses were received from 139 of 148 (94%) acute NHS trusts, between March 2020 to March 2021. OUTCOME MEASURES The survey asked each acute NHS trust whether they provide a weight management service for children living with obesity. For those trusts providing a service, data were collected on eligibility criteria, funding source, personnel involved, number of new patients seen per year, intervention duration, follow-up length and outcome measures. Service characteristics were reported using descriptive statistics. Service provision was analysed in the context of ethnicity and Index of Multiple Deprivation score of the trust catchment area. RESULTS From the 139 survey respondents, 23% stated that they provided a weight management service for children living with obesity. There were inequalities in the proportion of acute NHS trusts providing a service across the different regions of England, ranging from 4% (Midlands) to 36% (London). For trusts providing a service, there was variability in the number of new cases seen per year, eligibility criteria, funding source, intervention format and outcome measures collected. A multidisciplinary approach was not routinely provided, with only 41% of services reporting ≥3 different staff disciplines. CONCLUSION In 2020/2021, there were geographical inequalities in weight management service provision by acute NHS trusts for children living with obesity. Services provided lacked standardisation, did not routinely offer children multidisciplinary care and were insufficient in size to meet need.
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Affiliation(s)
- Ruth Mears
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Exercise Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Sofia Leadbetter
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Toby Candler
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Sutton
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Deborah Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P H Shield
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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3
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McMaster CM, Calleja E, Cohen J, Alexander S, Denney-Wilson E, Baur LA. Current status of multi-disciplinary paediatric weight management services in Australia. J Paediatr Child Health 2021; 57:1259-1266. [PMID: 33724622 DOI: 10.1111/jpc.15439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 01/13/2023]
Abstract
AIM To identify multi-disciplinary paediatric weight management services currently available in Australia and determine gaps in service provision for children and adolescents with obesity. METHODS Surveys were distributed to 17 identified Australian multi-disciplinary paediatric weight management services. A representative from each service was asked to complete an online survey regarding service and patient characteristics, assessment and management practices, and professional development approaches. RESULTS Representatives from 16 multi-disciplinary paediatric weight management services completed the survey. Fourteen services were based in major metropolitan cities and two in regional areas. Fourteen services provided care to pre-school aged children (0-4 years old), 15 to primary school aged children (5-12 years old) and 13 to high school aged children (13-18 years old). The number of patients seen per year per service ranged from 20 to 250 and duration of waiting lists ranged from 2 months to more than 12 months. CONCLUSIONS The current availability and accessibility of multi-disciplinary paediatric weight management services is inadequate to service Australian children and adolescents with obesity, particularly those with severe obesity and those in rural and remote communities. To better address the issue of paediatric obesity, establishment of additional multi-disciplinary services, training for health-care professionals and monitoring of the provision of evidence-based care is urgently needed.
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Affiliation(s)
- Caitlin M McMaster
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth Calleja
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jennifer Cohen
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Shirley Alexander
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, New South Wales, Australia.,Faculty of Health, University Technology Sydney, Broadway, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), University of Sydney, Camperdown, New South Wales, Australia.,Sydney Nursing School, University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Louise A Baur
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of Sydney Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia
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4
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Cohen J, Brennan AM, Alexander S, Henderson J, Graham C, Baur LA. Assessment of Clinicians' Views for Managing Children with Obesity in the Primary, Secondary, and Tertiary Settings. Child Obes 2019; 15:510-518. [PMID: 31381370 DOI: 10.1089/chi.2019.0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The aim of this study was to examine the perceptions of the assessment and management of children with obesity of primary, secondary, and tertiary care clinicians across two health districts in western Sydney and a specialty children's health network. Methods: Participants were 304 clinicians (medical, nursing, and allied health workers) in primary, secondary, and tertiary pediatric-level services. A questionnaire captured the training, assessment, and management approaches and perceived barriers to managing pediatric patients with obesity. Chi-squared tests and logistic regressions examined the differences in responses between clinicians. Results: Clinicians across all levels of health care had only moderate rates of training in obesity (48%), did not routinely measure tandem heights and weights (80%), and infrequently referred children to other services. Only 25% of clinicians frequently referred children to a weight management service (most frequently the dietitian). When comparing across health care settings, those in secondary-level services had higher rates of training (70%) and more frequently initiated treatment for obesity. Conclusion: Frequencies of routine identification and initiation of treatment for children with obesity are low among health professionals across health care settings, with some exceptions for secondary care clinicians. Greater and more intensive health professional training on the assessment and management of children with obesity is needed in Australia and may be a key factor in increasing health care for this common chronic condition.
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Affiliation(s)
- Jennifer Cohen
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia.,School of Women's and Children's Health, UNSW Medicine, University of NSW, Randwick, Australia
| | - Annie M Brennan
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Shirley Alexander
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia.,Auburn Clinical School, University of Notre Dame, Auburn, Australia
| | - Joanne Henderson
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Christie Graham
- Clinical Redesign, Sydney Children's Hospitals Network, Westmead and Randwick, Australia
| | - Louise A Baur
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
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5
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Chai LK, Collins CE, May C, Ashman A, Holder C, Brown LJ, Burrows TL. Feasibility and efficacy of a web-based family telehealth nutrition intervention to improve child weight status and dietary intake: A pilot randomised controlled trial. J Telemed Telecare 2019; 27:146-158. [PMID: 31364474 DOI: 10.1177/1357633x19865855] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Innovative eHealth solutions that improve access to child weight management interventions are crucial to address the rising prevalence of childhood obesity globally. The study aimed to evaluate the feasibility and preliminary efficacy of a 12-week online telehealth nutrition intervention to improve child weight and dietary outcomes, and the impact of additional text messages (SMS) targeted to mothers and fathers. METHODS Families with children aged 4 to 11 were randomised across three groups: Telehealth, Telehealth+SMS, or Waitlist control. Telehealth and Telehealth+SMS groups received two telehealth consultations delivered by a dietitian, 12 weeks access to a nutrition website and a private Facebook group. The Telehealth+SMS group received additional SMS. Feasibility was assessed through recruitment, retention, and intervention utilisation. Efficacy was assessed through changes in measured child body mass index (BMI), waist circumference and diet. RESULTS Forty-four (96%) and 36 (78%) families attended initial and second telehealth consultations, respectively. Thirty-six families (78%) completed week 12 assessments. Child BMI and waist circumference changes from baseline to week 12 were not statistically different within or between groups. Children in Telehealth+SMS had significantly reduced percentage energy from energy-dense nutrient-poor food (95% CI -21.99 to -0.03%E; p = .038) and increased percentage energy from healthy core food (95% CI -0.21 to 21.89%E; p = .045) compared to Waitlist control. DISCUSSION A family-focused online telehealth nutrition intervention is feasible. While the modest sample size reduced power to detect between-group changes in weight status, some improvements in child dietary intakes were identified in those receiving telehealth and SMS.
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Affiliation(s)
- Li Kheng Chai
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Chris May
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Family Action Centre, The University of Newcastle, Callaghan, Australia
| | - Amy Ashman
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Carl Holder
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Leanne J Brown
- University of Newcastle Department of Rural Health, The University of Newcastle, North Tamworth Australia
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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6
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Cohen J, Alexander S, Critekos M, Garnett SP, Hayes AJ, Shaw T, Sim KA, Baur LA. The acceptability, effectiveness, and impact of different models of care for pediatric weight management services: protocol for a concurrent mixed-methods study. BMC Health Serv Res 2018; 18:417. [PMID: 29879963 PMCID: PMC5992636 DOI: 10.1186/s12913-018-3222-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/22/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pediatric obesity is a serious, but clinically neglected, chronic health problem. Despite the high prevalence, excess weight problems are rarely managed when children attend clinical services. It is recommended that obesity treatment uses a “chronic-care” approach to management, with different types and intensity of treatment dependent upon severity of obesity. There are several new secondary and tertiary weight management services being implemented within New South Wales (NSW), Australia in 2017/2018 with differing models of care. This study will ascertain what factors affect acceptability, reach, and participation, as well as measure the clinical effectiveness of these services. Methods This is a acceptability and effectiveness study building upon existing and planned secondary and tertiary level service delivery in several health districts. This study will recruit participants from seven different pediatric weight management services (PWMS) across five Local Health Districts in NSW, Australia. Using a mixed-methods approach we will document a range of process, impact and clinical outcome measures in order to better understand the context and the effectiveness of each PWMS model. The project development and implementation is guided by the Theoretical Domains Framework. Participants will include parents of children less than 18 years of age attending PWMS, clinicians working as part of PWMS and health service managers. Data will be captured using a combination of anthropometric measures, questionnaires, one-on-one semi-structured interviews and focus groups. Discussion Results from this study will assess the acceptability and effectiveness of different models of care for pediatric weight management. Such information is required to inform long-term sustainability and scalability of secondary and tertiary care services to the large number of families with children above a healthy weight.
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Affiliation(s)
- Jennifer Cohen
- Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia. .,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia.
| | - Shirley Alexander
- Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Michelle Critekos
- Clinical Quality and Safety, Centre for Population Health, NSW Ministry of Health, North Sydney, NSW, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Alison J Hayes
- Faculty of Medicine & health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Tim Shaw
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Kyra A Sim
- Boden Institute, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Louise A Baur
- Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Discipline of Child & Adolescent Health, The University of Sydney, Sydney, NSW, Australia
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7
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The adaptation and translation of the PEACH™ RCT intervention: the process and outcomes of the PEACH™ in the community trial. Public Health 2017; 153:154-162. [PMID: 29107197 DOI: 10.1016/j.puhe.2017.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/18/2017] [Accepted: 08/21/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the process and report selected outcomes of translating an effective child weight management initiative (PEACH™) from a randomised controlled trial intervention to a community health programme. STUDY DESIGN AND METHODS Pre-post study design utilising the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) evaluation framework. Adaptation of PEACH™ required significant promotional activity and consideration of legal, ethical and financial issues. PEACH™ components were revised and an evaluation design based on the RE-AIM framework was developed. Facilitator training workshops were made available to South Australian health or education professionals initially, then opened up to new graduates, interstate dietitians and others interested in professional development. Facilitators completed pretraining and post-training questionnaires and a third questionnaire following programme delivery. Data were collected from families by facilitators and returned to university staff for assessment of change (baseline to programme end) in body mass index (BMI) and waist circumference (WC) z-scores. RESULTS Changes to organisational and political environments prevented maximum programme reach and adoption. Nonetheless, data indicated that PEACH™ was effective at improving facilitators' confidence (P < 0.05) and children's (n = 37) BMI z-score (-0.17, 95% confidence interval [CI]: 0.03:0.30, P = 0.016), WC z-score (-0.14, 95% CI: -0.02:0.30, P = 0.09) and lifestyle behaviours. Collection of maintenance data was prevented due to time and financial constraints. CONCLUSIONS Translational research needs to develop ways to effectively and efficiently bridge the gap between behavioural research and practice to improve the adoption of evidence-based approaches to child weight management. Nutrition educators and researchers can drive these nutrition-focussed translational research efforts forward. Funding bodies and health service organisations are encouraged to provide financial and structural support for such activity.
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8
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Evaluation of a Commercially Delivered Weight Management Program for Adolescents. J Pediatr 2017; 185:73-80.e3. [PMID: 28285749 DOI: 10.1016/j.jpeds.2017.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/14/2016] [Accepted: 01/13/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate a commercially available, structured short-term weight management program designed for adolescents with obesity delivered by nonhealth professionals. STUDY DESIGN A multisite parallel-group randomized controlled trial was conducted to evaluate a commercial 12-week lifestyle behavioral program in commercial weight management centers in Australia. Eligible participants (13-17 years, body mass index (BMI) z score ?1.282 with no presenting morbidities) were randomized (n?=?88) to intervention or wait-list, and the program was delivered by consultants at participating weight management centers. The primary outcome was change in BMI z score. Secondary outcomes included the psychometric variables quality of life, body-esteem, and self-esteem. Data was analyzed according to intention-to-treat principles. RESULTS Of 74 participants who consented to enter the study, 66 provided baseline anthropometric data and 12-week data were available for 55 individuals (74%). A significantly greater decrease in BMI z score in the intervention group (n?=?32) was observed when compared with the wait-list control group, mean difference (MD)?=??0.27?kg/m2; 95% CI, ?0.37,?0.17; P?<?.001). Participants allocated to receive the lifestyle intervention reported a greater improvement in body esteem (MD = 1.7, 95% CI, 0.3, 3.1; P?=?.02) and quality of life (MD?=?5.9, 95% CI, 0.9, 10.9; P?=?.02) compared with the wait-list control group. CONCLUSIONS A structured lifestyle intervention delivered by a commercial provider in an adolescent population can result in clinically relevant weight loss and improvements in psychosocial outcomes in the short term. Further research is required to evaluate long-term outcomes. TRIAL REGISTRATION International Clinical Trials Registry: ISRCTN13602313.
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9
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Kunin M, Allen AR, Nicolas C, Freed GL. Private general paediatric care availability in Melbourne. AUST HEALTH REV 2017; 41:63-67. [DOI: 10.1071/ah15218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
Objective The aims of the present study were to determine the actual availability of private general paediatric appointments in the Melbourne metropolitan region for children with non-urgent chronic illnesses and the cost of such care. Methods A ‘secret shopper’ method was used. Telephone calls were made to a random sample of 47 private paediatric clinics. A trained research assistant posed as a parent, requesting the first available appointment with a specific paediatrician. Data regarding appointment availability, total potential charges and net charges after the Medicare rebate were collected. Results Appointments were available in 79% (n = 37) of clinics, with 72% (n = 34) able to offer an appointment with the requested general paediatrician. The number of days until available appointments varied from same day appointments to a wait of 124 days, with an average wait of 33 days. Of practices that provided information about the appointment cost (n = 42), five bulk-billed for the consultation, whereas the remainder (n = 37) were fee-paying clinics. The potential maximum charge for an initial consultation in the fee-paying clinics ranged from A$177 to A$430, with an average cost of A$279. The potential maximum out-of-pocket cost for patients ranged from A$40 to A$222, with an average out-of-pocket cost of A$128. Conclusions Private paediatric care in the Melbourne metropolitan region is generally available. The out-of-pocket cost of private paediatric out-patient care may present a potential economic barrier for some families. What is known about the topic? In Australia, out-of-pocket expenses for private specialist care are not covered by private health insurance. There are no data available on the actual cost of private paediatric consultations that are based on real-time assessments. Data collected in 1998 suggested that the average waiting time for a first standard consultation with a general paediatrician in a private room was 14.1 days. There are no recent empirical data on appointment availability and waiting time for appointments with general paediatricians in Australia. What does this paper add? There is high availability of paediatric consultations in the private sector. Waiting times for an appointment vary considerably from same day appointments to a wait of 124 days, with an average wait of 33 days. The cost of a private paediatric consultation in Australia to the patient is considerable, with an average potential maximum up-front charge for an initial consultation of A$279 and an average potential maximum out-of-pocket cost of A$128. What are the implications for practitioners? Data on the availability and cost of private paediatric consultations are imperative to formulate evidence-informed policy and better understand variations in the availability of public and private care.
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10
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Kassim R, Harris MA, Leong GM, Heussler H. Reply to obstructive sleep apnoea in obese aboriginal and torres strait islander children. J Paediatr Child Health 2016; 52:786. [PMID: 27439647 DOI: 10.1111/jpc.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rubina Kassim
- Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | | | - Gary M Leong
- Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Helen Heussler
- Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
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11
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Garnett SP, Baur LA, Jones AMD, Hardy LL. Trends in the Prevalence of Morbid and Severe Obesity in Australian Children Aged 7-15 Years, 1985-2012. PLoS One 2016; 11:e0154879. [PMID: 27171503 PMCID: PMC4865229 DOI: 10.1371/journal.pone.0154879] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/20/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Children with severe obesity have greater risk of adverse health outcomes. The purpose of this study was to assess trends in the prevalence of morbid and severe obesity in Australian children between 1985 and 2012. Methods Secondary analysis of four national Australian cross-sectional surveys of measured height/weight in 7–15 year olds: Australian Health and Fitness Survey 1985 (n = 8,486), National Nutrition Survey 1995 (n = 1,541), the National Children’s Nutrition and Physical Activity Survey 2007 (n = 2,585) and the National Health Survey 2012 (n = 2,940). International Obesity Taskforce cut-point was used for morbid obesity (equivalent to a BMI ≥35kg/m2 at age 18 years). Severe obesity class 2 was defined as BMI ≥120% and <140% of the 95th percentile of the CDC 2000 growth charts or a BMI ≥35 and <40, and severe obesity class 3 as BMI ≥140% of the 95th percentile or a BMI ≥40. Results Between 1985 and 2012 the prevalence of morbid obesity increased from 0.2% to 1.8%, class 2 severe obesity from 0.3% to 2.0%, and class 3 from 0.1% to 0.5%. Children with morbid obesity represented 11.3% of children with obesity in 1985 and increased to 22.5% in 2012 (P = 0.005). Children with severe obesity represented 19.3% of children with obesity in 1985 and increased to 32.0% in 2012 (P = 0.016). The greatest increase was observed between 1995 and 2007. The proportion of children who were classified as morbidly or severely obese was not significantly different between 2007 and 2012, nor was it significantly different between age and sex groups. Conclusion Prevalence of morbid and severe obesity among children is low, but has significantly increased between 1985 and 2012. In contrast to overweight and obese children, children with morbid obesity require tertiary intervention. Failure to treat these children will have significant implications for the individual child and community.
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Affiliation(s)
- Sarah P. Garnett
- Institute of Endocrinology and Diabetes and Kids Research Institute at the Children's Hospital at Westmead, Sydney, Australia
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Louise A. Baur
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aimee M. D. Jones
- Institute of Endocrinology and Diabetes and Kids Research Institute at the Children's Hospital at Westmead, Sydney, Australia
| | - Louise L. Hardy
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
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12
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Redfern J, Enright G, Raadsma S, Allman-Farinelli M, Innes-Hughes C, Khanal S, Khanal S, Lukeis S, Rissel C, Gyani A. Effectiveness of a behavioral incentive scheme linked to goal achievement: study protocol for a randomized controlled trial. Trials 2016; 17:33. [PMID: 26775262 PMCID: PMC4715870 DOI: 10.1186/s13063-016-1161-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is a concern in Australia and across the world. Community-based weight management programs are an important response to address childhood obesity. However, the scientific literature suggests that their effectiveness could potentially be enhanced by providing a structured incentive scheme. This proposal aims to determine the effectiveness of enhanced goal setting linked to a structured incentive scheme designed to improve the sustained health and wellbeing of overweight/obese children within the context of an existing community-based program. METHODS/DESIGN This study is a cluster randomized controlled trial delivered within the context of the existing NSW "Go4Fun" program with a 10-week and 6- and 12-month follow-up (n = 40 sites, 570 participants) that compares the effectiveness of small changes to the program in which children were asked to set goals (supported by text messages) and were given rewards for achieving them (intervention). This will be compared to the standard/existing program (control), which did not have the same structured incentive program. Data will be collected for all participants at baseline, end of program, and at 6 and 12 months. The primary outcome is a mean change in body mass index (BMI) z score at the 12-month follow-up. Secondary outcomes include anthropometric measures (body weight, height, and waist circumference) and behavioral measures collected via validated questionnaires. A process evaluation (comprising surveys and focus groups) to determine acceptability and sustainability and to inform downstream translation will also be conducted. DISCUSSION This study will inform policy and program delivery as well as the broader evidence base regarding goal achievement and incentive schemes directed at children's health-related behaviors and will provide evidence that is likely to be transferrable across a range of health conditions. TRIAL REGISTRATION ACTRN12615000558527 registered on 29 May 2015.
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Affiliation(s)
- Julie Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Level 10, King George V Building, Missenden Road, Camperdown, Sydney, NSW, Australia.
| | - Gemma Enright
- Department of Premier and Cabinet, Sydney, Australia.
| | - Simon Raadsma
- Department of Premier and Cabinet, Sydney, Australia.
| | | | | | - Santosh Khanal
- NSW Office of Preventive Health, Ministry of Health, Sydney, Australia.
| | - Santash Khanal
- NSW Office of Preventive Health, Ministry of Health, Sydney, Australia.
| | | | - Chris Rissel
- NSW Office of Preventive Health, Ministry of Health, Sydney, Australia.
| | - Alex Gyani
- Department of Premier and Cabinet, Sydney, Australia.
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13
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Clifford SA, Gold L, Mensah FK, Jansen PW, Lucas N, Nicholson JM, Wake M. Health-care costs of underweight, overweight and obesity: Australian population-based study. J Paediatr Child Health 2015; 51:1199-206. [PMID: 26059311 DOI: 10.1111/jpc.12932] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
AIM Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. PARTICIPANTS Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. OUTCOME Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. PREDICTOR biennial BMI measurements over the same period. RESULTS Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. CONCLUSIONS Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.
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Affiliation(s)
- Susan A Clifford
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Gold
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Pauline W Jansen
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Child & Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nina Lucas
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Parenting Research Centre, Melbourne, Victoria, Australia.,School of Sociology, College of Arts and Social Sciences, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jan M Nicholson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Parenting Research Centre, Melbourne, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
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14
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Hardy LL, Mihrshahi S, Gale J, Nguyen B, Baur LA, O'Hara BJ. Translational research: are community-based child obesity treatment programs scalable? BMC Public Health 2015; 15:652. [PMID: 26169687 PMCID: PMC4499906 DOI: 10.1186/s12889-015-2031-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/07/2015] [Indexed: 12/05/2022] Open
Abstract
Background Community-based obesity treatment programs have become an important response to address child obesity; however the majority of these programs are small, efficacy trials, few are translated into real-world situations (i.e., dissemination trials). Here we report the short-term impact of a scaled-up, community-based obesity treatment program on children’s weight and weight-related behaviours disseminated under real world conditions. Methods Children age 6–15 years with a body mass index (BMI) ≥85th percentile with no co-morbidities, and their parents/carers participated in a twice weekly, 10-week after-school child obesity treatment program between 2009 and 2012. Outcome information included measures of weight and weight-related behaviours. Analyses were adjusted for clustering and socio-demographic variables. Results Overall, 2,812 children participated (54.2 % girls; Mage 10.1 (2.0) years; Mattaendance 12.9 (5.9) sessions). Beneficial changes among all children included BMI (−0.65 kg/m2), BMI-z-score (−0.11), waist circumference (−1.8 cm), and WtHtr (−0.02); self-esteem (+2.7units), physical activity (+1.2 days/week), screen time (−4.8 h/week), and unhealthy foods index (−2.4units) (all p < 0.001). Children who completed ≥75 % of the program were more likely to have beneficial changes in BMI, self-esteem and diet (sugar sweetened beverages, lollies/chocolate, hot chips and takeaways) compared with children completing <75 % of the program. Conclusions This is one of the few studies to report outcomes of a government-funded, program at scale in a real-world setting, and shows that investment in a community-based child obesity treatment program holds potential to produce short-term changes in weight and weight-related behaviours. The findings support government investment in this health priority area, and demonstrate that community-based models of child obesity treatment are a promising adjunctive intervention to health service provision at all levels of care.
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Affiliation(s)
- Louise L Hardy
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Seema Mihrshahi
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Joanne Gale
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Binh Nguyen
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Louise A Baur
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia. .,Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead Clinical School, Westmead, NSW, Australia.
| | - Blythe J O'Hara
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.
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15
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Chisholm K, Alexander S, Barzi F. Tertiary-level management of overweight and obese children and adolescents: Does intensive dietetic intervention have a positive impact on weight control? Nutr Diet 2014. [DOI: 10.1111/1747-0080.12139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kerryn Chisholm
- Nutrition and Dietetics Department; Camperdown New South Wales Australia
| | | | - Federica Barzi
- The Kid's Research Institute; The Children's Hospital at Westmead; NSW Australia
- The George Institute for Global Health; Camperdown New South Wales Australia
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16
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Welsby D, Nguyen B, O'Hara BJ, Innes-Hughes C, Bauman A, Hardy LL. Process evaluation of an up-scaled community based child obesity treatment program: NSW Go4Fun®. BMC Public Health 2014; 14:140. [PMID: 24512080 PMCID: PMC3923092 DOI: 10.1186/1471-2458-14-140] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/07/2014] [Indexed: 11/25/2022] Open
Abstract
Background Community-based obesity treatment programs for children that have a large program reach are a priority. To date, most programs have been small efficacy trials whose findings have yet to be up-scaled and translated into real-world settings. This paper reports on the process evaluation of a government-funded, translated obesity treatment program for children in Australia. It describes the characteristics and reach of children participating in the New South Wales (NSW) Ministry of Health Go4Fun® program. Methods Delivered across the state of NSW (Australia) by Local Health Districts (LHDs), Go4Fun® is a community-based, multidisciplinary family obesity treatment program adapted from the United Kingdom Mind Exercise Nutrition Do it (MEND) program that targets weight-related behaviours. Children aged 7-13 years with a BMI ≥85th percentile and no co-morbidities were eligible at no cost. Parents/carers self-refer via a toll-free phone number, text messages, online registration or via secondary referrals. LHDs deliver a 16 to 20-session program based on length of school term, holidays and recruitment challenges. Both parent/carer and child attend bi-weekly after school sessions. Parent-reported socio-demographic and measured child weight characteristics are presented using descriptive statistics. Differences between completers (attended at least 75% of sessions) and non-completers were assessed using chi-square tests, independent sample t-tests and adjusted odds ratios. Analyses were adjusted for clustering of programs. Results Between 2009 and 2012, a total of 2,499 children (54.8% girls; mean age [SD]: 10.2 [1.7 years]) participated in the Go4Fun® program. Children were mainly from low-middle socioeconomic status (76.5%), resided in major cities (63.3%), and 5.7% were Aboriginal. At baseline, 96.5% of children were overweight or obese. Mean BMI-z-score was 2.07 (0.41) and 94.5% had a waist-to-height ratio ≥0.5. More than half (57.9%) completed at least 75% of sessions. Amongst completers (N = 1,446), girls (56.8%; p = 0.02), non-Aboriginal children (95.9%; p < 0.01) and children residing in less socially disadvantaged areas (25.9%; p = 0.02) were significantly more likely to complete the program. Conclusions The Go4Fun® program successfully reached the targeted population of overweight/obese children at socioeconomic disadvantage and is a rare example of an up-scaled translational program.
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Affiliation(s)
| | | | | | | | | | - Louise L Hardy
- Physical Activity Nutrition Obesity Research Group, Level 2, Medical Foundation Building K25, University of Sydney, Sydney, NSW 2006, Australia.
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17
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Shrewsbury VA, Baur LA, Nguyen B, Steinbeck KS. Transition to adult care in adolescent obesity: a systematic review and why it is a neglected topic. Int J Obes (Lond) 2013; 38:475-9. [PMID: 24247372 DOI: 10.1038/ijo.2013.215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/06/2013] [Accepted: 10/20/2013] [Indexed: 12/11/2022]
Abstract
Transition in pediatric health care involves the purposeful, planned movement of patients from pediatric to adult services. Following the significant increases in long-term survival of chronic childhood diseases in the 1980s, transition has taken on an increasing importance in the management of these chronic diseases. In Australia, there is a conspicuous lack of programs/guidelines for transitioning adolescents with obesity. The authors sought to determine if this is an international phenomenon that should be addressed. This study aimed to identify what formal transition services or guidelines exist internationally for adolescents with overweight/obesity. Two systematic reviews of the published and 'gray' literature were implemented via searches of relevant databases, search engines and websites. The primary review eligibility criteria were documents published between 1982 and 2012 including any aspect of transitioning adolescents with overweight/obesity from pediatric to adult weight management services. The secondary review included current clinical practice guidelines/statements on pediatric obesity management published between 1992 and 2012, and transition recommendations contained within. Non-English language documents were excluded. Relevant text from eligible documents was systematically identified and extracted, and a qualitative synthesis of the data was prepared. Overall, 2272 unique records were identified from the literature searches. Three eligible articles were identified by the primary review. The secondary review identified 24 eligible guidelines/statements. In total, six of the identified documents contained information on transition in adolescent obesity-the most detailed documents provided only a brief statement recommending that transition from pediatric to adult weight management services should take place. In conclusion, internationally there is an absence of published intervention programs/policies, and brevity of clinical guidance and expert opinion, on the transition of adolescents with obesity making this a priority research area. Consideration is given to the reasons why transition in adolescent obesity is a neglected topic.
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Affiliation(s)
- V A Shrewsbury
- Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - L A Baur
- 1] University of Sydney Clinical School, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia [2] Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - B Nguyen
- University of Sydney Clinical School, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - K S Steinbeck
- 1] Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia [2] Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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18
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Campbell M, Bryson HE, Price AMH, Wake M. Childhood obesity in secondary care: national prospective audit of Australian pediatric practice. Acad Pediatr 2013; 13:168-76. [PMID: 23498083 DOI: 10.1016/j.acap.2012.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/10/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In many countries, pediatricians offer skilled secondary care for children with conditions more challenging than can readily be managed in the primary care sector, but the extent to which this sector engages with the detection and management of obesity remains largely unexplored. This study aimed to audit the prevalence, diagnosis, patient, and consultation characteristics of obesity in Australian pediatric practices. METHODS This was a national prospective patient audit in Australia. During the course of 2 weeks, members of the Australian Paediatric Research Network prospectively recorded consecutive outpatient consultations by using a brief standardized data collection form. Measures included height, weight, demographics, child and parent health ratings, diagnoses, referrals, investigations, and consultation characteristics. We compared the prevalence of pediatrician-diagnosed and measured obesity (body mass index ≥95th percentile) and top-ranked diagnoses, patient, and consultation characteristics in (a) obese and nonobese children, and (b) obese children with and without a diagnosis. RESULTS A total of 198 pediatricians recorded 5466 consultations with 2-17 year olds, with body mass index z-scores calculated for 3436 (62.9%). Of the 12.6% obese children, only one-third received an "overweight/obese" diagnosis. Obese children diagnosed as overweight/obese were heavier, older, and in poorer health than those not diagnosed and incurred more Medicare (government-funded health system) cost and referrals. CONCLUSIONS Obesity is infrequently clinically diagnosed by Australian pediatricians and measurement practices vary widely. Further research could focus on supporting and normalizing clinical obesity activities from which pediatricians and parents could see clear benefits.
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Affiliation(s)
- Michele Campbell
- Centre for Community Child Health, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia
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19
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Spurrier NJ, Volkmer RE, Abdallah CA, Chong A. South Australian four-year-old Aboriginal children: residence and socioeconomic status influence weight. Aust N Z J Public Health 2012; 36:285-90. [DOI: 10.1111/j.1753-6405.2012.00872.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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20
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Makkes S, Halberstadt J, Renders CM, Bosmans JE, van der Baan-Slootweg OH, Seidell JC. Cost-effectiveness of intensive inpatient treatments for severely obese children and adolescents in the Netherlands; a randomized controlled trial (HELIOS). BMC Public Health 2011; 11:518. [PMID: 21718471 PMCID: PMC3141469 DOI: 10.1186/1471-2458-11-518] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive combined lifestyle interventions are the recommended treatment for severely obese children and adolescents, but there is a lack of studies and their cost-effectiveness. The objective of this study is to compare the cost-effectiveness of two intensive one-year inpatient treatments and usual care for severely obese children and adolescents. METHODS/DESIGN Participants are 40 children aged 8-13 and 40 adolescents aged 13-18 with severe obesity (SDS-BMI ≥ 3.0 or SDS-BMI ≥ 2.3 with obesity related co-morbidity). They will be randomized into two groups that will receive a comprehensive treatment program of 12 months that focuses on nutrition, physical activity and behavior change of the participant and their parents. The two programs are the same in total duration (12 months), but differ in inpatient treatment duration. Group A will participate in a 6 month intensive inpatient treatment program during weekdays, followed by six monthly return visits of 2 days. Group B will participate in a 2 month intensive inpatient treatment program during weekdays, followed by biweekly return visits of 2 days during the next four months, followed by six monthly return visits of 2 days. Several different health care professionals are involved, such as pediatricians, dieticians, psychologists, social workers, nurses and physiotherapists. Results will also be compared to a control group that receives usual care. The primary outcome is SDS-BMI. Secondary outcomes include quality of life using the EQ-5D and cardiovascular risk factors. Data will be collected at baseline and after 6, 12 and 24 months. An economic evaluation will be conducted alongside this study. Healthcare consumption will be based on actual resource use, using prospective data collection during 2 years through cost diaries. Quality Adjusted Life Years (QALYs) will be calculated using the EQ-5D. DISCUSSION This study will provide useful information on the effectiveness and cost-effectiveness of inpatient treatment in severely obese children and adolescents. Valuable information on long term effects, after 2 years, is also included. TRIAL REGISTRATION Netherlands Trial Register (NTR): NTR1678.
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Affiliation(s)
- Sabine Makkes
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | | | - Jacob C Seidell
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
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Truby H, Baxter K, Elliott S, Warren J, Davies P, Batch J. Adolescents seeking weight management: who is putting their hand up and what are they looking for? J Paediatr Child Health 2011; 47:2-4. [PMID: 20500431 DOI: 10.1111/j.1440-1754.2010.01740.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe the characteristics of adolescents seeking treatment for obesity via the 'Eat Smart' feasibility study; an intensive 12 week dietitian-led weight management programme with an emphasis on lifestyle change. It was designed to test the feasibility of a structured low-fat diet compared with a semi-structured reduced carbohydrate plan compared with a model of 'standard care'- an unstructured low fat approach. When compared with non-participants, participants were predominantly female and lived in lower socioeconomic areas. When given the choice of dietary approach, 50% elected reduced dietary carbohydrate, 43% structured low fat and 7% chose 'standard care'. Modest weight loss was achieved over 12 weeks, with both the structured low fat and reduced carbohydrate formats. Families showed a strong preference for structured eating plans, in particular seeking assistance with correct portion size. The current standard model of unstructured advice was both unpopular and relatively unsuccessful.
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Affiliation(s)
- Helen Truby
- Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia.
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22
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New directions in childhood obesity research: how a comprehensive biorepository will allow better prediction of outcomes. BMC Med Res Methodol 2010; 10:100. [PMID: 20969745 PMCID: PMC2984501 DOI: 10.1186/1471-2288-10-100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 10/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is associated with the early development of diseases such as type 2 diabetes and cardiovascular disease. Unfortunately, to date, traditional methods of research have failed to identify effective prevention and treatment strategies, and large numbers of children and adolescents continue to be at high risk of developing weight-related disease. AIM To establish a unique 'biorepository' of data and biological samples from overweight and obese children, in order to investigate the complex 'gene × environment' interactions that govern disease risk. METHODS The 'Childhood Overweight BioRepository of Australia' collects baseline environmental, clinical and anthropometric data, alongside storage of blood samples for genetic, metabolic and hormonal profiles. Opportunities for longitudinal data collection have also been incorporated into the study design. National and international harmonization of data and sample collection will achieve required statistical power. RESULTS Ethical approval in the parent site has been obtained and early data indicate a high response rate among eligible participants (71%) with a high level of compliance for comprehensive data collection (range 56% to 97% for individual study components). Multi-site ethical approval is now underway. CONCLUSIONS In time, it is anticipated that this comprehensive approach to data collection will allow early identification of individuals most susceptible to disease, as well as facilitating refinement of prevention and treatment programs.
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