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Wolframm IA, Douglas J, Pearson G. Changing Hearts and Minds in the Equestrian World One Behaviour at a Time. Animals (Basel) 2023; 13:ani13040748. [PMID: 36830535 PMCID: PMC9952075 DOI: 10.3390/ani13040748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Equestrianism is currently facing a range of pressing challenges. These challenges, which are largely based on evolving attitudes to ethics and equine wellbeing, have consequences for the sport's social licence to operate. The factors that may have contributed to the current situation include overarching societal trends, specific aspects of the equestrian sector, and factors rooted in human nature. If equestrianism is to flourish, it is evident that much needs to change, not the least, human behaviour. To this end, using established behaviour change frameworks that have been scientifically validated and are rooted in practice-most notably, Michie et al.'s COM-B model and Behaviour Change Wheel-could be of practical value for developing and implementing equine welfare strategies. This review summarises the theoretical underpinnings of some behaviour change frameworks and provides a practical, step-by-step approach to designing an effective behaviour change intervention. A real-world example is provided through the retrospective analysis of an intervention strategy that aimed to increase the use of learning theory in (educational) veterinary practice. We contend that the incorporation of effective behaviour change interventions into any equine welfare improvement strategy may help to safeguard the future of equestrianism.
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Affiliation(s)
- Inga A. Wolframm
- Applied Research Centre, Van Hall Larenstein University of Applied Sciences, Larensteinselaan 26-A, 6882 CT Velp, The Netherlands
- Correspondence:
| | - Janet Douglas
- World Horse Welfare, Anne Colvin House, Snetterton, Norwich NR16 2LR, UK
| | - Gemma Pearson
- The Horse Trust, Slad Lane, Princes Risborough, Buckinghamshire HP27 0PP, UK
- Easter Bush Campus, The University of Edinburgh, Midlothian EH25 9RG, UK
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Rodriguez LA, Gopalan A, Darbinian JA, Chandra M, Greenspan LC, Howell A, Lo JC. Identifying modifiable obesogenic behaviors among Latino adolescents in primary pediatric care. Prev Med Rep 2022; 29:101939. [PMID: 35942298 PMCID: PMC9356151 DOI: 10.1016/j.pmedr.2022.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Latino adolescents engage in more obesogenic behaviors, including sedentary behaviors and sugary drink consumption, than White adolescents. However, it is unclear whether engagement in obesogenic behaviors differs within the Latino population. Cross-sectional data were examined from Latino adolescents ages 13–17 with a well-child visit (2016–2019) in an integrated healthcare system. Adolescents self-reported on four daily obesogenic behaviors: 1) consuming < 5 servings of fruits/vegetables; 2) drinking > 1 juice/soda; 3) exercising/playing sports < 60 min; and 4) > 2 h screen time. A composite variable of ≥ 3 self-reported behaviors was constructed. Multivariable logistic regression was used to examine associations between obesogenic behaviors with age category (13–15 or 16–17 years), sex, household language preference (English/Spanish), neighborhood deprivation index (NDI quartiles), and body mass index (BMI). Among 77,514 Latino adolescents (mean age 14.7 ± 1.4; 50 % female), 23 % lived in Spanish-speaking households, 43 % resided in census tracts with the highest (most deprived) NDI quartile, and 45 % had an overweight or obese BMI. Older (vs younger) adolescents had higher odds of insufficient fruit/vegetable intake (OR 1.20; CI 1.17–1.24), greater sedentary behavior (OR 1.51; 1.46–1.56), and reporting > 2 h screen time (OR 1.07; 1.03–1.11). Adolescents in the 4th (vs 1st) NDI quartile (OR 1.34; 1.26–1.42) and those with obesity (vs healthy weight) (OR 1.55; 1.42–1.70 for class 3 obesity) had higher odds of ≥ 3 obesogenic behaviors. In conclusion, among Latino adolescents, older age, obesity, and living in more deprived neighborhoods were associated with greater obesogenic behaviors. Identifying adolescents more likely to engage in obesogenic behaviors can inform targeted lifestyle interventions.
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Affiliation(s)
- Luis A. Rodriguez
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- Corresponding author at: Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
| | - Anjali Gopalan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- The Permanente Medical Group, Oakland, CA, United States
| | - Jeanne A. Darbinian
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Malini Chandra
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Louise C. Greenspan
- The Permanente Medical Group, Oakland, CA, United States
- Kaiser Permanente San Francisco, Department of Pediatrics, San Francisco, CA, United States
| | - Amanda Howell
- Health Engagement Consulting Services, The Permanente Medical Group, Oakland, CA, United States
| | - Joan C. Lo
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- The Permanente Medical Group, Oakland, CA, United States
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Putter KC, Jackson B, Thornton AL, Willis CE, Goh KMB, Beauchamp MR, Benjanuvatra N, Dimmock JA, Budden T. Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization. BMC Public Health 2022; 22:1534. [PMID: 35953799 PMCID: PMC9373481 DOI: 10.1186/s12889-022-13956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-based lifestyle interventions (FBLIs) are an important method for treating childhood weight problems. Despite being recognized as an effective intervention method, the optimal structure of these interventions for children's overweight and obesity has yet to be determined. Our aim was to better understand participants' (a) implementation of behaviour strategies and long-term outcomes, (b) perceptions regarding the optimal structure of FBLIs, and (c) insights into psychological concepts that may explain the success of these programs. METHODS Purposive sampling was used to recruit participants. We conducted focus groups as well as one-to-one interviews with parents (n = 53) and children (n = 50; aged 7-13, M = 9.4 yr, SD = 3.1) three months following their involvement in a 10-week, multi-component, FBLI involving education and activities relating to healthy nutrition, physical activity, and behavior modification. Using an interpretivist approach, a qualitative study design was employed to examine participant experiences. RESULTS We identified three higher-order categories: (a) participants' program experiences and perceptions (b) lifestyle changes post-program, and (c) recommendations for optimizing family-based programs. Themes identified within these categories included (a) support and structure & content, (b) diet and physical activity, and (c) in-program recommendations and post-program recommendations. CONCLUSIONS We identified several challenges that can impair lasting behavior change (e.g., physical activity participation) following involvement in a FBLI. On optimizing these programs, participants emphasized fun, interactive content, interpersonal support, appropriate educational content, and behavior change techniques. Concepts rooted in motivational theory could help address calls for greater theoretical and mechanistic insight in FBLIs. Findings may support research advancement and assist health professionals to more consistently realize the potential of these interventions.
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Affiliation(s)
- Kaila C Putter
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), The University of Western, Perth, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Ashleigh L Thornton
- Division of Paediatrics, Faculty of Health and Medical Sciences, The University of Western, Perth, Australia.,Kids Rehab WA, Perth Children's Hospital, Nedlands, Australia
| | - Claire E Willis
- Sports & Exercise Science, La Trobe University, Melbourne, Australia
| | - Kong Min Bryce Goh
- School of Human Sciences (Exercise and Sport Science), The University of Western, Perth, Australia
| | - Mark R Beauchamp
- School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Nat Benjanuvatra
- School of Human Sciences (Exercise and Sport Science), The University of Western, Perth, Australia
| | - James A Dimmock
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Timothy Budden
- School of Human Sciences (Exercise and Sport Science), The University of Western, Perth, Australia. .,Telethon Kids Institute, Perth, WA, Australia.
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Sharma N, Asaf A, Vaivada T, Bhutta ZA. Delivery Strategies Supporting School-Age Child Health: A Systematic Review. Pediatrics 2022; 149:186937. [PMID: 35503326 DOI: 10.1542/peds.2021-053852l] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
CONTEXT School-aged children (SAC; 5-9 years) remain understudied in global efforts to examine intervention effectiveness and scale up evidence-based interventions. OBJECTIVE This review summarizes the available evidence describing the effectiveness of key strategies to deliver school-age interventions. DATA SOURCES We searched Medline, PsycINFO, Campbell Collaboration, and The Cochrane Library during November 2020. STUDY SELECTION Systematic reviews and meta-analyses that: target SAC, examine effective delivery of well-established interventions, focus on low- and middle-income countries (LMICs), were published after 2010, and focus on generalizable, rather than special, populations. DATA EXTRACTION Two reviewers conducted title and abstract screening, full-text screening, data extraction, and quality assessments. RESULTS Sixty reviews met the selection criteria, with 35 containing evidence from LMICs. The outcomes assessed and the reported effectiveness of interventions varied within and across delivery strategies. Overall, community, school, and financial strategies improved several child health outcomes. The greatest evidence was found for the use of community-based interventions to improve infectious disease outcomes, such as malaria control and prevention. School-based interventions improved child development and infectious disease-related outcomes. Financial strategies improved school enrollment, food security, and dietary diversity. LIMITATIONS Relatively few LMIC studies examined facility, digital, and self-management strategies. Additionally, we found considerable heterogeneity within and across delivery strategies and review authors reported methodological limitations within the studies. CONCLUSIONS Despite limited research, available information suggests community-based strategies can be effective for the introduction of a range of interventions to support healthy growth and development in SAC. These also have the potential to reduce disparities and reach at-risk and marginalized populations.
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Affiliation(s)
- Naeha Sharma
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ayesha Asaf
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Center of Excellence in Women and Child Health, Institute for Global Health & Development, Aga Khan University Hospital, Karachi, Pakistan
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Faith MS, Cochran WC, Diewald L, Hoffer K, Moore R, Berkowitz RI, Hauer CA, Stettler-Davis N, Tripicchio G, Rukstalis MR. Group lifestyle modification vs. lifestyle newsletters for early childhood obesity: Pilot study in rural primary care. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.jbct.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ho TJH, Cheng LJ, Lau Y. School-based interventions for the treatment of childhood obesity: a systematic review, meta-analysis and meta-regression of cluster randomised controlled trials. Public Health Nutr 2021; 24:3087-3099. [PMID: 33745501 PMCID: PMC9884753 DOI: 10.1017/s1368980021001117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/27/2021] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity. DESIGN Eight databases were searched from inception till 30 May 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random effects model. Overall effect was evaluated using Hedges' g, and heterogeneity was assessed using Cochran's Q and I2. SETTING Cluster randomised controlled trials (cluster-RCT) delivered in school. PARTICIPANTS Children and adolescents (6-18 years of age) with overweight and obesity. RESULTS Twelve cluster-RCT from seven countries with 1755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced BMI and BMI z-scores with a medium effect (g = 0·52). Subgroup analyses showed greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41·2 % of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency. CONCLUSIONS School-based interventions are a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCT with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).
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Affiliation(s)
- Tarcisus Jian Hui Ho
- School Health Service, Health Promotion Board, 3 Second Hospital Ave, Singapore168937, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Afonso L, Rodrigues R, Castro J, Parente N, Teixeira C, Fraga A, Torres S. A Mobile-Based Tailored Recommendation System for Parents of Children with Overweight or Obesity: A New Tool for Health Care Centers. Eur J Investig Health Psychol Educ 2020; 10:779-794. [PMID: 34542511 PMCID: PMC8314285 DOI: 10.3390/ejihpe10030057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/10/2023] Open
Abstract
Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children's age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children's eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents' perceptions of the child's weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann-Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child's excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child's weight with additional strategies.
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Affiliation(s)
- Lisa Afonso
- Faculty of Psychology and Educational Sciences and Center for Psychology, University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal;
- Correspondence:
| | - Rui Rodrigues
- Faculty of Engineering, University of Porto, and INESC TEC, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal;
| | - Joana Castro
- Maia-Valongo Health Centre Group, Avenida Luís de Camões, n.º 290, 3.º Andar, 4474-004 Maia, Portugal; (J.C.); (N.P.); (C.T.); (A.F.)
| | - Nuno Parente
- Maia-Valongo Health Centre Group, Avenida Luís de Camões, n.º 290, 3.º Andar, 4474-004 Maia, Portugal; (J.C.); (N.P.); (C.T.); (A.F.)
| | - Carina Teixeira
- Maia-Valongo Health Centre Group, Avenida Luís de Camões, n.º 290, 3.º Andar, 4474-004 Maia, Portugal; (J.C.); (N.P.); (C.T.); (A.F.)
| | - Ana Fraga
- Maia-Valongo Health Centre Group, Avenida Luís de Camões, n.º 290, 3.º Andar, 4474-004 Maia, Portugal; (J.C.); (N.P.); (C.T.); (A.F.)
| | - Sandra Torres
- Faculty of Psychology and Educational Sciences and Center for Psychology, University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal;
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Kebbe M, Farmer A, Dyson MP, Scott SD, McHugh TLF, Lappa S, Rajani H, Ladha T, Islam B, Jacoby L, Nasir F, Talwar K, Wincott JL, Zhang M, Ball GDC. Feasibility, user experiences, and preliminary effect of Conversation Cards for Adolescents© on collaborative goal-setting and behavior change: protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2019; 5:149. [PMID: 31890261 PMCID: PMC6918564 DOI: 10.1186/s40814-019-0533-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 11/22/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Adolescents and providers can benefit from practical tools targeting lifestyle modification for obesity prevention and management. We created Conversation Cards for Adolescents© (CCAs), a patient-centered communication and behavior change tool for adolescents and providers to use in clinical practice. The purpose of our study is to (i) assess the feasibility of CCAs in a real-world, practice setting to inform full-scale trial procedures, (ii) assess user experiences of CCAs, and (iii) determine the preliminary effect of CCAs on changing behavioral and affective-cognitive outcomes among adolescents. METHODS Starting in early 2019, this prospective study is a nested mixed-methods, theory-driven, and pragmatic pilot randomized controlled trial with a goal to enroll 50 adolescents (13-17 years old) and 9 physicians practicing at the Northeast Community Health Centre in Edmonton, Alberta, Canada. Adolescents will collaboratively set one S.M.A.R.T. (specific, measurable, attainable, realistic, timely) goal with their physician to implement over a 3-week period; however, only those randomized to the experimental group will use CCAs to inform their goal. Outcome assessments at baseline and follow-up (3 weeks post-baseline) will include behavioral, affective-cognitive, and process-related outcomes. DISCUSSION In examining the feasibility, user experiences, and preliminary effect of CCAs, our study will add contributions to the obesity literature on lifestyle modifications among adolescents in a real-world, practice setting as well as inform the scalability of our approach for a full-scale effectiveness randomized controlled trial on behavior change. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03821896.
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Affiliation(s)
- M. Kebbe
- Department of Pediatrics, Faculty of Medicine & Dentistry, 4-515 Edmonton Clinic Health Academy, University of Alberta, 11405 – 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - A. Farmer
- Department of Agricultural, Food, and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta Canada
| | - M. P. Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, 4-515 Edmonton Clinic Health Academy, University of Alberta, 11405 – 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - S. D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - T. L. F. McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta Canada
| | - S. Lappa
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - H. Rajani
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - T. Ladha
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - B. Islam
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - L. Jacoby
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - F. Nasir
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - K. Talwar
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - J. L. Wincott
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - M. Zhang
- Northeast Community Health Centre, Edmonton, Alberta Canada
| | - G. D. C. Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, 4-515 Edmonton Clinic Health Academy, University of Alberta, 11405 – 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
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Garg P, Eastwood J, Liaw ST. A Realist Synthesis of Literature Informing Programme Theories for Well Child Care in Primary Health Systems of Developed Economies. Int J Integr Care 2019; 19:5. [PMID: 31367204 PMCID: PMC6659757 DOI: 10.5334/ijic.4177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Well-child Care is the provision of preventative health care services for children and their families. The approach, however, to the universal provision of those services is contentious. METHODS We undertook a realist synthesis to enhance understanding of the theoretical mechanisms driving Well-child Care by searching for published and grey literature from multiple databases. FINDINGS Well-child Care is re-conceptualised as an integrated program delivered in the continuum of pregnancy, infancy and childhood. Depending on the context, Well-child Care can be a policy, a strategy, or an actual clinical practice that promotes child and family health. The main mechanisms include: role, training and continuity of health providers; administrators' views of the return of investment on achieved outcomes; access to services by families; and the adaptation of programs to meet the dynamic needs of stakeholders. Evidence indicates that for most outcomes, Well-child Care is best delivered in partnerships between community health, social care, and early childhood education sectors. CONCLUSIONS We conclude that Well-child Care policy and program leaders should shift their focus to the integration of: human and physical resources; policy instruments; and shared agreement on outcomes measures across health, social and education sectors. In addition, countries should work towards strengthening universal early education programs and parents' health literacy regarding child development, health and safety.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, AU
- Specialist Disability Health Team, South Western Sydney Local Health District, NSW, AU
- South Western Sydney Local Health District, NSW, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
| | - John Eastwood
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
- School of Public Health, University of Sydney, Sydney, NSW, AU
- School of Public Health, Griffith University, Gold Coast, QLD, AU
- Department of Community Paediatrics, Sydney Local Health District, Croydon, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
| | - Siaw-Teng Liaw
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
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Lew MS, L'Allemand D, Meli D, Frey P, Maire M, Isenschmid B, Tal K, Molinari B, Auer R. Evaluating a childhood obesity program with the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Prev Med Rep 2019; 13:321-326. [PMID: 30792947 PMCID: PMC6369326 DOI: 10.1016/j.pmedr.2019.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022] Open
Abstract
Primary care providers can use behavioral lifestyle interventions to effectively treat children with overweight and obesity, but implementing these interventions is challenging. Most childhood obesity intervention evaluation studies focus on effectiveness. Few studies describe implementation. Our goal was to evaluate critical components of a childhood obesity intervention in primary care. We conducted a pilot implementation study of an existing structured lifestyle intervention in the Canton of Bern, Switzerland from 2013 to 2015. The intervention consisted of 10 sessions, led by a primary care physician. It included children aged 6–8 years old, with BMI over the 90th age-adjusted percentile. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework to describe the pilot implementation study. We stratified description of RE-AIM components at the patient- and physician-level. For Reach: 864 children were screened; 65 were overweight; 394 physicians were invited to participate in the study. For Effectiveness: BMI z-score significantly decreased (−5.6%, p = 0.01). For Adoption: 14 participating physicians treated 26 patients. Implementation: the mean number of consultations was 8. For Maintenance: 9 (35%) children discontinued the intervention; 7 (50%) of physicians continued to apply at least one component of the intervention. The summarized components of the program within the RE-AIM framework suggest the program was successful. Stakeholders can use our results if they intend to disseminate and evaluate similar interventions in different settings. We describe the implementation process of a childhood obesity intervention. This might help stakeholders implement similar interventions in their setting. Using RE-AIM makes it easier to compare implementation of similar programs.
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Affiliation(s)
- Mei Sien Lew
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Dagmar L'Allemand
- Pädiatrische Endokrinologie/Diabetologie, Fachbereich Jugendmedizin, Ostschweizer Kinderspital, St. Gallen, Switzerland
| | | | - Peter Frey
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Micheline Maire
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Bettina Isenschmid
- Kompetenzzentrum für Essverhalten, Adipositas und Psyche, Spital Zofingen, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Beatrice Molinari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Community Medicine and Primary Care, University of Lausanne, Switzerland
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11
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Cheung PC, Gazmararian JA, Kramer MR, Drews-Botsch CD, Welsh JA. Impact of an American board of pediatrics maintenance of certification (MOC) on weight-related counseling at well-child check-ups. PATIENT EDUCATION AND COUNSELING 2019; 102:113-118. [PMID: 30170823 PMCID: PMC6289845 DOI: 10.1016/j.pec.2018.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The Healthy Weight Counseling Maintenance of Certification (MOC) program integrates pediatrician training and clinic changes to promote use of evidence-based, diet and physical activity (PA) health messages and counseling strategies. This interrupted time series study assessed the impact of this MOC program on provision of weight-related counseling. METHODS We randomly selected 10-15 well-child visit charts at three time points before and three time points after 102 Georgia pediatricians began the MOC in 2012-2015. Linear binomial regression compared the frequency of behavior-change goal setting and health messaging documentation (fruit/vegetable consumption, sugar-sweetened beverage consumption, out-of-home food consumption, PA, and screen time) before and after MOC participation. RESULTS At baseline, pediatricians documented behavior-change goals with 44% of patients, with an additional 49% of patients having documented goals after their pediatrician started the MOC (99.5% confidence interval [CI]: 21-77%). Similarly, absolute increases in the proportion of patients with documentation for sugar-sweetened beverage consumption (adjusted prevalence difference [aPD]: 37%; 99.5% CI: 13-62%) and out-of-home eating were observed (aPD: 38%; 99.5% CI: 12-64%). CONCLUSION The Healthy Weight Counseling MOC is associated with increased and sustained use of evidence-based health messages and counseling strategies. PRACTICE IMPLICATIONS Continuing education and facilitation of system changes help improve physicians' weight-related counseling.
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Affiliation(s)
- Patricia C Cheung
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Carolyn D Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Jean A Welsh
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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12
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Busch AM, Hubka A, Lynch BA. Primary Care Provider Knowledge and Practice Patterns Regarding Childhood Obesity. J Pediatr Health Care 2018; 32:557-563. [PMID: 30042051 DOI: 10.1016/j.pedhc.2018.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to evaluate current childhood obesity management by providers and improve management of pediatric obesity through a provider-focused educational intervention. METHODS We surveyed family medicine and pediatric providers regarding documentation and intervention, knowledge gaps, and educational needs for childhood obesity. An educational program was implemented regarding detection, documentation, and follow-up/referral of pediatric obesity and comorbid conditions. We reviewed charts for 50 overweight or obese children before and after intervention. RESULTS The survey identified lack of time (73%) and perception of parents (77%) as the most frequent provider barriers to pediatric obesity care. Provider referrals increased from 6% to 16% after intervention, and laboratory testing increased from 14% to 26%. No changes were noted in discussion of weight status, diagnosis/documentation, or billing. CONCLUSION Provider education can improve appropriate ordering of laboratory studies and referrals for overweight children. Different intervention approaches may improve billing and documentation practices for pediatric obesity.
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13
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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14
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Thang C, Whitley M, Izadpanah N, DeUgarte D, Slusser W. Retrospective Review of Comorbid Conditions in a Multidisciplinary Pediatric Weight Management Clinic. Clin Pediatr (Phila) 2018; 57:815-820. [PMID: 28990428 DOI: 10.1177/0009922817734205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective medical chart review was conducted of patients enrolled in the Fit for Healthy Weight Clinic (Fit Clinic). At initial evaluation, comorbidities were identified by the patient and pediatrician. The number of comorbidities increased with age among patients. In reviewing the differences among the number of identified comorbidities among grade school age and adolescent patients, increases of 30% were observed in gastrointestinal-associated, 23% in psychiatric, 18% in endocrine, 16% in cardiovascular, and 14% in respiratory comorbidities. Fit Clinic patients already manifest many known obesity-related comorbidities as evidenced in identified conditions and abnormal laboratory values. The elevated blood pressures, blood glucose, and cholesterol levels raise concern for the future development of coronary artery disease and type 2 diabetes mellitus. With an average of five obesity-related comorbidities, Fit Clinic patients already have more comorbidities than what is evidenced in large US population-based studies, demonstrating that solely addressing body mass index is not sufficient.
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Affiliation(s)
- Christine Thang
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA
| | - Margaret Whitley
- 2 RAND Corporation, Santa Monica, CA, USA.,3 University of California, Irvine, CA, USA
| | | | - Daniel DeUgarte
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA
| | - Wendy Slusser
- 1 Mattel Children's Hospital University of California Los Angeles, CA, USA.,5 University of California Los Angeles Fielding School of Public Health, CA, USA
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15
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Management of Childhood Obesity and Overweight in Primary Care Visits: Gaps Between Recommended Care and Typical Practice. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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16
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O’Donnell JE, Foskett-Tharby R, Gill PS. General practice views of managing childhood obesity in primary care: a qualitative analysis. JRSM Open 2017; 8:2054270417693966. [PMID: 28620503 PMCID: PMC5464385 DOI: 10.1177/2054270417693966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore general practice staff views of managing childhood obesity in primary care. DESIGN A qualitative study to elicit the views of clinical and non-clinical general practice staff on managing childhood obesity. SETTING Interviews were conducted at 30 general practices across England. These practices were interviewed as part of the Quality and Outcomes Framework Pilot Study. PARTICIPANTS A total of 52 staff from 30 practices took part in a semi-structured interview. MAIN OUTCOME MEASURES Key themes were identified through thematic analysis of transcripts using an inductive approach. RESULTS Three themes were identified: lack of contact with well children, sensitivity of the issue, and the potential impact of general practice. Identifying overweight children was challenging because well children rarely attended the practice. Interviewees felt ill equipped to solve the issue because they lacked influence over the environmental, economic and lifestyle factors underpinning obesity. They described little evidence to support general practice intervention and seemed unaware of other services. Raising the issue was described as sensitive. CONCLUSION General practice staff were unconvinced that they could have a significant role in managing childhood obesity on a large scale. Participants believed schools have more contact with children and should coordinate the identification and management of overweight children. Future policy could recommend a minor role for general practice involving opportunistically identifying overweight children and signposting to obesity services.
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Affiliation(s)
- Jennifer E O’Donnell
- National Collaborating Centre for Indicator Development (Institute of Applied Health Research) University of Birmingham, Edgbaston B15 2TT UK
| | - Rachel Foskett-Tharby
- National Collaborating Centre for Indicator Development (Institute of Applied Health Research) University of Birmingham, Edgbaston B15 2TT UK
| | - Paramjit S Gill
- National Collaborating Centre for Indicator Development (Institute of Applied Health Research) University of Birmingham, Edgbaston B15 2TT UK
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17
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Camp NL, Robert RC, Nash JE, Lichtenstein CB, Dawes CS, Kelly KP. Modifying Provider Practice To Improve Assessment of Unhealthy Weight and Lifestyle in Young Children: Translating Evidence in a Quality Improvement Initiative for At-Risk Children. Child Obes 2017; 13:173-181. [PMID: 28121467 DOI: 10.1089/chi.2016.0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We designed a quality improvement (QI) project to address the high prevalence of childhood overweight and obesity (OW/OB) in our patient population and the inconsistencies among primary care providers in recognizing and addressing OW/OB. METHODS We used mixed methods data collection approach to evaluate a QI project, the Childhood Healthy Behaviors Intervention (CHBI), to improve provider obesity prevention practice in two low-income, predominantly African American pediatric primary care clinics. Electronic record data were extracted from all 2-9 year well visits pre- and postintervention for frequency of appropriate diagnostic coding of OW/OB. We reviewed a random sample of records for details of health habit assessment and counseling documentation. Focused interviews were conducted to elicit provider responses regarding impressions of the intervention. RESULTS The preintervention sample of records (n = 267) was extracted from 18 providers and the postsample (n = 253) from 19 providers. Providers showed improvement in the recognition of OW/OB with appropriate diagnostic coding (52% pre, 68% post), improvement in assessment of health habits informed by the habit survey (0% pre, 76% post), improvement in counseling of healthy behaviors (86% pre, 92% post), and improvement in goal setting of healthy behaviors (12% pre, 70% post). CONCLUSIONS Our findings suggest that implementing a time efficient primary care intervention with brief provider training can improve provider recognition of OW/OB, as well as improve provider behavior targeted at childhood obesity prevention. This project contributes needed QI evidence on interventions to prevent and address OW/OB in primary care settings and calls for further work to strengthen implementation in similar contexts.
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Affiliation(s)
- Nadine L Camp
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,2 School of Nursing, The Catholic University of America , Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Rebecca C Robert
- 2 School of Nursing, The Catholic University of America , Washington, DC
| | - Jessica E Nash
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Cara B Lichtenstein
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Candice S Dawes
- 1 Goldberg Center for Community Pediatric Health , Children's National Health System, Washington, DC.,3 School of Medicine and Health Sciences, The George Washington University , Washington, DC
| | - Katherine Patterson Kelly
- 4 Department of Nursing Research and Quality Outcomes, Children's National Health System , Washington, DC
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18
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Gabrielli S, Dianti M, Maimone R, Betta M, Filippi L, Ghezzi M, Forti S. Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children. JMIR Mhealth Uhealth 2017; 5:e48. [PMID: 28408361 PMCID: PMC5408135 DOI: 10.2196/mhealth.7080] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/21/2017] [Accepted: 03/14/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nutrition and diet apps represent today a popular area of mobile health (mHealth), offering the possibility of delivering behavior change (BC) interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular among consumers. Approaching the apps development process from a multidisciplinary and user-centered design (UCD) perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions. OBJECTIVE The aim of this study was to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with families. METHODS The design of the nutrition education intervention was based on a multidisciplinary UCD approach, involving a team of BC experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 families of overweight children (aged 7-12 years) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app's usage patterns during the intervention and of participants' feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention. RESULTS Design sessions with the contribution of pediatricians and nutritionists helped define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents' awareness about children's eating behavior and lifestyle. The 6 families participating in the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but analysis of their interaction and feedback showed the need for improving some of the app features related to the BC techniques "monitoring of the behavior" and "information provision." CONCLUSIONS The UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support health promotion interventions in primary care.
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Affiliation(s)
- Silvia Gabrielli
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
| | - Marco Dianti
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
| | - Rosa Maimone
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
| | | | | | | | - Stefano Forti
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
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19
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Sim LA, Lebow J, Wang Z, Koball A, Murad MH. Brief Primary Care Obesity Interventions: A Meta-analysis. Pediatrics 2016; 138:peds.2016-0149. [PMID: 27621413 DOI: 10.1542/peds.2016-0149] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear. OBJECTIVE To determine the effect of brief, primary care interventions for pediatric weight management on BMI. DATA SOURCES Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies. STUDY SELECTION Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years. DATA EXTRACTION Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools. RESULTS A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98). LIMITATIONS Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured. CONCLUSIONS BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.
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Affiliation(s)
| | - Jocelyn Lebow
- Departments of Psychiatry and Psychology, and.,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Zhen Wang
- Evidence-Based Practice Center and Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Afton Koball
- Gundersen Lutheran Health System, Department of Behavioral Health, LaCrosse, Wisconsin
| | - M Hassan Murad
- Evidence-Based Practice Center and Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
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20
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Chen JL, Kwan M. Short-Term Efficacy and Correlates of Change in Health Weight Management Program for Chinese American Children. Clin Pediatr (Phila) 2016; 55:463-9. [PMID: 26149851 DOI: 10.1177/0009922815592608] [Citation(s) in RCA: 8] [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
A pretest and posttest study design was used to test a healthy weight management intervention with overweight and/or obese Chinese American children. Children attended 8-weekly small group sessions while parents attended a single 2-hour parent workshop. Children had their weight, height, blood pressure, waist and hip circumference, and fast lipids data assessed and completed several questions questionnaires regarding food choices, self-efficacy, and knowledge at baseline, 2 months, and 6 months. Parents completed questionnaires regarding demographic, acculturation level and family environment. We found significant reduction of body mass index, waist/hip ratio, systolic blood pressure and improvement of child's eating style, physical activity knowledge, self-efficacy, and children's quality of life at 6-month follow-up. In addition, significant improvement of high-density lipoprotein cholesterol and decrease in triglyceride were found at 6-month follow-up. Improvement of nutrition self-efficacy and decreased stimulus environment were associated with decreased body mass index in overweight and obese Chinese American children.
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Affiliation(s)
- Jyu-Lin Chen
- University of California San Francisco, San Francisco, CA, USA
| | - Monica Kwan
- North East Medical Services, San Francisco, CA, USA
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21
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Gall K, van Zutven K, Lindstrom J, Bentley C, Gratwick-Sarll K, Harrison C, Lewis V, Mond J. Obesity and emotional well-being in adolescents: Roles of body dissatisfaction, loss of control eating, and self-rated health. Obesity (Silver Spring) 2016; 24:837-42. [PMID: 26880693 DOI: 10.1002/oby.21428] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/16/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Weak or inconsistent association between obesity and impairment in emotional well-being in population-based samples has led to efforts to identify mediating variables. This study examined the relative importance of body dissatisfaction (BD), loss of control (LOC) eating, and self-rated health (SRH) in mediating the association between obesity and impairment in emotional well-being in a school-based sample of adolescents (boys, n = 437; girls, n = 950). METHODS Moderated mediation analysis was employed to assess the relative importance of the putative mediating variables and moderation of mediation effects by sex following the methods suggested by Hayes and coworkers. RESULTS BD and SRH, but not LOC eating, were found to mediate the association between obesity and impairment in emotional well-being. Stronger mediation effects were observed for BD than for SRH. None of these results was moderated by sex. CONCLUSIONS The findings suggest that it may be important to target BD in obesity prevention and treatment programs in order to reduce the adverse impact of excess body weight on young people's emotional well-being.
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Affiliation(s)
- Kelly Gall
- Department of Psychology, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Kim van Zutven
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joanna Lindstrom
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Caroline Bentley
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kassandra Gratwick-Sarll
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Carmel Harrison
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Vivienne Lewis
- Department of Psychology, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Jonathan Mond
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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22
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Norman G, Huang J, Davila EP, Kolodziejczyk JK, Carlson J, Covin JR, Gootschalk M, Patrick K. Outcomes of a 1-year randomized controlled trial to evaluate a behavioral 'stepped-down' weight loss intervention for adolescent patients with obesity. Pediatr Obes 2016; 11:18-25. [PMID: 25702630 PMCID: PMC4544661 DOI: 10.1111/ijpo.12013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/09/2014] [Accepted: 12/19/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stepped-care approaches to weight loss have shown some success among adults. A 'stepped-down' version of the stepped-care approach to adolescent weight loss has never been evaluated. OBJECTIVES We conducted a one-year randomized controlled trial to compare a stepped-down weight loss intervention versus enhanced usual care (EUC). METHODS Study participants were obese adolescents age 11-13 (N = 106, 51% girls, and 82% Hispanic) recruited from primary care clinics in San Diego, California. The stepped-down intervention was delivered through clinician and health educator counseling (in-person and by phone) and mailed content. The intervention consisted of four-month 'steps' beginning with the most intensive contact followed by reduced contact if treatment goals were met. The EUC group received an initial physician visit, one session with a health counselor, and monthly mailed materials. Body mass index (BMI kg/m(2) ) was measured at baseline, 4, 8, and 12 months. Mixed-model regression analyses were stratified by sex. RESULTS Results indicated a clinically significant treatment effect for boys on BMI (p < 0.001) but not girls. No between group differences were found for adiposity and biometric outcomes. Only 13% of intervention participants succeeded in stepping down from step 1 to step 2 or step 3. CONCLUSIONS A stepped-down approach to weight loss showed some evidence of efficacy for weight loss in boys but not girls. The findings suggest the program as designed was not intensive enough to result in weight loss in this population segment.
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Affiliation(s)
- G. Norman
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - J. Huang
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - E. P. Davila
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - J. K. Kolodziejczyk
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - J. Carlson
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - J. R. Covin
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - M. Gootschalk
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
| | - K. Patrick
- Department of Family and Preventive Medicine; University of California, San Diego; La Jolla California USA
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Serra-Paya N, Ensenyat A, Castro-Viñuales I, Real J, Sinfreu-Bergués X, Zapata A, Mur JM, Galindo-Ortego G, Solé-Mir E, Teixido C. Effectiveness of a Multi-Component Intervention for Overweight and Obese Children (Nereu Program): A Randomized Controlled Trial. PLoS One 2015; 10:e0144502. [PMID: 26658988 PMCID: PMC4684233 DOI: 10.1371/journal.pone.0144502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/17/2015] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Treatment of childhood obesity is a complex challenge for primary health care professionals. OBJECTIVES To evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake. METHODS Randomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-intervention. RESULTS At the end of the study period, both groups achieved a similar decrease in body mass index (BMIsd) compared to baseline. Nereu Program participants (n = 54) showed greater increases in moderate-intense physical activity (+6.27% vs. -0.61%, p<0.001) and daily fruit servings (+0.62 vs. +0.13, p<0.026), and decreased daily soft drinks consumption (-0.26 vs. -0.02, p<0.047), respectively, compared to the counselling group (n = 59). CONCLUSIONS At the end of the 8-month intervention, participants in the Nereu Program group showed improvement in physical activity and dietary behaviours, compared to the counselling group. TRIAL REGISTRATION ClinicalTrials.gov NCT01878994.
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Affiliation(s)
- Noemi Serra-Paya
- Asociación Nereu, Alimentación Saludable y Ejercicio Físico, Región Sanitaria de Lleida, Lleida, España
- Escuela Superior de Ciencias de la Salud, TecnoCampus Mataró. Universidad Pompeu Fabra, Barcelona, España
- Facultad de Enfermería, Universidad de Lleida, Lleida, España
| | - Assumpta Ensenyat
- National Institute for Physical Education of Catalonia (INEFC) of Lleida, University of Lleida, Lleida, Spain
| | - Iván Castro-Viñuales
- Asociación Nereu, Alimentación Saludable y Ejercicio Físico, Región Sanitaria de Lleida, Lleida, España
| | - Jordi Real
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol. USR-IDIAP Jordi Gol, Lleida, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Sant Cugat, Barcelona
| | | | - Amalia Zapata
- Facultad de Enfermería, Universidad de Lleida, Lleida, España
- Nutrition Department, University of Lleida, Lleida, Spain
| | - Jose María Mur
- Asociación Nereu, Alimentación Saludable y Ejercicio Físico, Región Sanitaria de Lleida, Lleida, España
| | - Gisela Galindo-Ortego
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol. USR-IDIAP Jordi Gol, Lleida, Spain
- Centre d'Atenció Primària Primer de Maig. Institut Català de la Salut, Lleida, Spain
| | - Eduard Solé-Mir
- Department of Paediatrics Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Departament de Medicina, Universitat de Lleida, Lleida, Spain
| | - Concepció Teixido
- Centre d'Atenció Primària Primer de Maig. Institut Català de la Salut, Lleida, Spain
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Sigman-Grant M, Hayes J, VanBrackle A, Fiese B. Family Resiliency: A Neglected Perspective in Addressing Obesity in Young Children. Child Obes 2015; 11:664-73. [PMID: 26447935 DOI: 10.1089/chi.2014.0107] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Traditional research primarily details child obesity from a risk perspective. Risk factors are disproportionately higher in children raised in poverty, thus negatively influencing the weight status of low-income children. Borrowing from the field of family studies, the concept of family resiliency might provide a unique perspective for discussions regarding childhood obesity, by helping to identify mediating or moderating protective mechanisms that are present within the family context. METHODS A thorough literature review focusing on (1) components of family resiliency that could be related to childhood obesity and (2) factors implicated in childhood obesity beyond those related to energy balance was conducted. We then conceptualized our perspective that understanding resiliency within an obesogenic environment is warranted. RESULTS Both family resiliency and childhood obesity prevention rely on the assumptions that (1) no one single answer can address the multifactorial nature involved with adopting healthy lifestyle behaviors and (2) the pieces in this complex puzzle will differ between families. Yet, there are limited holistic studies connecting family resiliency measures and childhood obesity prevention. Combining mixed methodology using traditional measures (such as general parenting styles, feeding styles, and parent feeding behaviors) with potential family resiliency measures (such as family routines, family stress, family functioning, and family structure) might serve to broaden understanding of protective strategies. CONCLUSIONS The key to future success in child obesity prevention and treatment may be found in the application of the resiliency framework to the exploration of childhood obesity from a protective perspective focusing on the family context.
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Affiliation(s)
| | - Jenna Hayes
- 1 University of Nevada Cooperative Extension, University of Nevada Reno , Las Vegas, NV
| | - Angela VanBrackle
- 1 University of Nevada Cooperative Extension, University of Nevada Reno , Las Vegas, NV
| | - Barbara Fiese
- 2 Department of Human Development and Family Studies, University of Illinois , Urbana, IL
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Kuhle S, Doucette R, Piccinini-Vallis H, Kirk SFL. Successful childhood obesity management in primary care in Canada: what are the odds? PeerJ 2015; 3:e1327. [PMID: 26623175 PMCID: PMC4662587 DOI: 10.7717/peerj.1327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022] Open
Abstract
Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.
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Affiliation(s)
- Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Rachel Doucette
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University , Halifax, Nova Scotia , Canada ; Department of Family Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | | | - Sara F L Kirk
- School of Health and Human Performance, Dalhousie University and the IWK Health Centre , Halifax, Nova Scotia , Canada
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Stettler N, Wrotniak BH, Hill DL, Kumanyika SK, Xanthopoulos MS, Nihtianova S, Shults J, Leff SS, Pinto A, Berkowitz RI, Faith MS. Prevention of excess weight gain in paediatric primary care: beverages only or multiple lifestyle factors. The Smart Step Study, a cluster-randomized clinical trial. Pediatr Obes 2015; 10:267-74. [PMID: 25251166 PMCID: PMC4372512 DOI: 10.1111/ijpo.260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 06/19/2014] [Accepted: 07/22/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Insufficient evidence exists to support obesity prevention in paediatric primary care. OBJECTIVES To test a theory-based behaviour modification intervention delivered by trained paediatric primary care providers for obesity prevention. METHODS Efficacy trial with cluster randomization (practice level) and a 12-session 12-month sweetened beverages decrease intervention or a comprehensive dietary and physical activity intervention, compared with a control intervention among children ages 8-12 years. RESULTS A low recruitment rate was observed. The increase in body mass index z-score (BMIz) for the 139 subjects (11 practices) randomized to any of the two obesity interventions (combined group) was less than that of the 33 subjects (five practices) randomized to the control intervention (-0.089, 95% confidence interval [CI]: -0.170 to -0.008, P = 0.03) with a -1.44 kg weight difference (95% CI: -2.98 to +0.10 kg, P = 0.095). The incidences of obesity and excess weight gain were lower in the obesity interventions, but the number of subjects was small. Post hoc analyses comparing the beverage only to the control intervention also showed an intervention benefit on BMIz (-0.083, 95% CI: -0.165 to -0.001, P = 0.048). CONCLUSIONS For participating families, an obesity prevention intervention delivered by paediatric primary care clinicians, who are compensated, trained and continuously supported by behavioural specialists, can impact children's BMIz.
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Affiliation(s)
| | - Brian H. Wrotniak
- D’Youville College, Buffalo, NY
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - Justine Shults
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Stephen S. Leff
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Andres Pinto
- Case Western Reserve University School of Dental Medicine, Cleveland, OH
| | - Robert I. Berkowitz
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Myles S. Faith
- Gillings School of Global Public Health University of North Carolina - Chapel Hill, Chapel Hill, NC
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Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions. Curr Obes Rep 2015; 4:157-73. [PMID: 26213643 PMCID: PMC4512668 DOI: 10.1007/s13679-015-0160-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.
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Affiliation(s)
- Elisabeth M. Seburg
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Barbara A. Olson-Bullis
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Dani M. Bredeson
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Marcia G. Hayes
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Mailstop 23301A, Minneapolis, MN 55440, USA
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Ariza C, Ortega-Rodríguez E, Sánchez-Martínez F, Valmayor S, Juárez O, Pasarín MI. [Childhood obesity prevention from a community view]. Aten Primaria 2015; 47:246-55. [PMID: 25835135 PMCID: PMC6985614 DOI: 10.1016/j.aprim.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/28/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022] Open
Abstract
The percentage of failure and relapse in the treatment of obesity is high. Where possible, the preferred strategy for preventing obesity is to modify eating habits and lifestyles. This article aims to provide a framework for evidence on the most effective interventions for addressing childhood obesity, both from a prevention point of view, as well as reducing it, when it is already established. After a review of the scientific literature, the issues that must be considered both in the universal and selective prevention of childhood obesity are presented. Also, in light of the controversy over the tools for measuring and controlling the problem, some clarification is provided on the criteria. Finally, the approach to the prevention of overweight and obesity with a community perspective is separated, with two short protocols being offered with diagrams of the basic procedure to follow.
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Affiliation(s)
- Carles Ariza
- Agència de Salut Pública de Barcelona, Barcelona, España; Ciber de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, España.
| | - Eduard Ortega-Rodríguez
- Area Básica de Salut Nova Lloreda (Badalona Serveis Assistencials), Badalona, Barcelona, España
| | - Francesca Sánchez-Martínez
- Agència de Salut Pública de Barcelona, Barcelona, España; Ciber de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, España
| | - Sara Valmayor
- Agència de Salut Pública de Barcelona, Barcelona, España
| | - Olga Juárez
- Agència de Salut Pública de Barcelona, Barcelona, España
| | - M Isabel Pasarín
- Agència de Salut Pública de Barcelona, Barcelona, España; Ciber de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, España
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29
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Looney SM, Raynor HA. Examining the effect of three low-intensity pediatric obesity interventions: a pilot randomized controlled trial. Clin Pediatr (Phila) 2014; 53:1367-74. [PMID: 25006118 DOI: 10.1177/0009922814541803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Primary care is an ideal setting to treat pediatric obesity. Effective, low-intensity (≤25 contact hours over 6 months) interventions that reduce standardized body mass index (z-BMI) and can be delivered by primary care providers are needed. OBJECTIVE This pilot randomized controlled trial investigated the effect of 3 low-intensity (≤25 contact hours over 6 months) pediatric obesity treatments on z-BMI. METHODS Twenty-two families (children 8.0 ± 1.8 years, z-BMI of 2.34 ± 0.48) were randomized into 1 of 3, 6-month, low-intensity conditions: newsletter (N), newsletter and growth monitoring (N + GM), or newsletter and growth monitoring plus family-based behavioral counseling (N + GM + BC). Anthropometrics and child eating and leisure-time behaviors were measured. RESULTS Mixed-factor analyses of variance found a significant (P < .05) main effect of time for z-BMI and servings per day of sugar sweetened beverages, with both decreasing over time. CONCLUSION Low-intensity obesity treatments can reduce z-BMI and may be more feasible in primary care.
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Affiliation(s)
- Shannon M Looney
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA University of Tennessee, Knoxville, TN, USA
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30
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Fadzlina AA, Harun F, Nurul Haniza MY, Al Sadat N, Murray L, Cantwell MM, Su TT, Majid HA, Jalaludin MY. Metabolic syndrome among 13 year old adolescents: prevalence and risk factors. BMC Public Health 2014; 14 Suppl 3:S7. [PMID: 25437226 PMCID: PMC4251137 DOI: 10.1186/1471-2458-14-s3-s7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Obesity and metabolic syndrome is prevalent among Malaysian adolescents and has been associated with certain behavioural factors such as duration of sleep, screen time and physical activity. The aim of the study is to report the prevalence of overweight/obesity, metabolic syndrome and its risk factors among adolescents. Methods A multi-staged cluster sampling method was used to select participants from urban and rural schools in Selangor, Perak and Wilayah Persekutuan Kuala Lumpur. Participants underwent anthropometric measurement and physical examination including blood pressure measurement. Blood samples were taken for fasting glucose and lipids and participants answered a self-administered questionnaire. Overweight and obesity was defined using the extrapolated adult body mass index (BMI) cut-offs of >25 kg/m2 and >30 kg/m2, according to the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined based on International Diabetes Federation (IDF) 2007 criteria. Results Data were collected from 1361 participants. After excluding incomplete data and missing values for the variables, we analysed a sample of 1014 participants. Prevalence of overweight and obesity in this population was 25.4% (N = 258). The prevalence of metabolic syndrome was 2.6% in the population and 10% among the overweight and obese adolescents. Participants who slept between 7 and 9 hours a day has a lower risk of developing metabolic syndrome OR 0.38(0.15-0.94). Conclusion Our results provide the prevalence of metabolic syndrome in Malaysian adolescents. Adequate sleep between 7 and 9 hours per day reduces the risk of developing metabolic syndrome.
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Chen JL, Wilkosz ME. Efficacy of technology-based interventions for obesity prevention in adolescents: a systematic review. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:159-70. [PMID: 25177158 PMCID: PMC4132224 DOI: 10.2147/ahmt.s39969] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
About one third of adolescents in the USA are overweight and/or obese. Obesity during the adolescent years is associated with many adverse health consequences, including type 2 diabetes, hypertension, hyperlipidemia, and psychosocial problems. Because of substantial advances in technologies and wide acceptance by adolescents, it is now possible to use technology for healthy weight management and prevention of obesity. This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and aimed to evaluate the existing literature reported on the effectiveness of technology-based intervention (web-based, e-learning, and active video games) in preventing obesity in adolescents. The primary aim of this review was to explore if components of specific interventions were associated with a reduction in body mass index. Research articles obtained from CINAHL, Embase, PubMed, PsycInfo, and the Cochrane database from1990 to 2014 were reviewed. A total of 131 published articles were identified, and 14 met the inclusion criteria of a randomized or nonrandomized clinical study with body mass index as primary outcome and/or secondary outcomes of diet/physical activity and/or psychosocial function, tested lifestyle interventions to prevent obesity, used technology, and studied adolescents (aged 12-18 years). The results indicated that six of 14 studies found body mass index and/or body fat decreased at short-term (less than 12 months) follow-up. Six of eleven studies that examined physical activity or physical activity-related outcomes found an improved physical activity outcome (time playing active video games and increase in physical activity time), while five of seven studies which assessed dietary outcomes indicated improvement in dietary behaviors. Five of seven studies suggested an improvement in psychosocial function (reduced depression, improved self-esteem and efficacy, improvement on Behavior Assessment Scale) in adolescents involved in the technology-based intervention. All effective interventions utilized dietary and physical activity strategies as part of intervention components. Because of the variation in duration of intervention (range 10 weeks to 2 years), it is not clear what length of intervention is most effective. Future research should assess the long-term impact of technology-based interventions and evaluate mediators and moderators for weight change in adolescents.
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Affiliation(s)
- Jyu-Lin Chen
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA
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Bell AC, Campbell E, Francis JL, Wiggers J. Encouraging general practitioners to complete the four-year-old Healthy Kids Check and provide healthy eating and physical activity messages. Aust N Z J Public Health 2014; 38:253-7. [PMID: 24750555 DOI: 10.1111/1753-6405.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/01/2013] [Accepted: 12/01/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the impact of a training and support intervention to encourage completion of the Healthy Kids Check (HKC) by general practitioners (GP) or practice nurses (PN) and provision of brief advice on diet and physical activity. METHODS The intervention (June 2008 to July 2010) was delivered by Divisions of General Practice (DGP) in the Hunter New England (HNE) region of NSW, Australia, to members in 300 practices. Intervention impact was evaluated using Medicare data on the number of HKCs completed and a post-intervention telephone survey of randomly selected parents in HNE and rest of NSW. RESULTS Training reached 31% of GPs (n∼ 216/700) and 71% of PNs (n∼320/450); 31% of four-year-olds received a HKC in HNE compared to 15% in NSW; 27% of HNE parents (n=162) reported a GP or PN had provided advice during their child's vaccinations visit compared to 15% of parents (n=154) in NSW (p=0.002). There was no significant difference in proportion of children who had weight or height assessed (55.6% in HNE and 54.6% in NSW). CONCLUSIONS Boosting HKC claims and healthy eating and physical activity messages in general practice is feasible. More intensive strategies are required if obesity prevention and management benefits are to be achieved. IMPLICATIONS General practice is an important but under-utilised source of advice for parents and data for policy makers on childhood obesity in Australia.
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Affiliation(s)
- A Colin Bell
- School of Medicine and Public Health, University of Newcastle, New South Wales
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An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obes (Lond) 2014; 38:887-905. [PMID: 24662696 DOI: 10.1038/ijo.2014.49] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/10/2014] [Indexed: 12/11/2022]
Abstract
The 2013 Pennington Biomedical Research Center's Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.
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Martínez-Andrade GO, Cespedes EM, Rifas-Shiman SL, Romero-Quechol G, González-Unzaga MA, Benítez-Trejo MA, Flores-Huerta S, Horan C, Haines J, Taveras EM, Pérez-Cuevas R, Gillman MW. Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City. BMC Pediatr 2014; 14:77. [PMID: 24649831 PMCID: PMC3999907 DOI: 10.1186/1471-2431-14-77] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/17/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. METHODS We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. RESULTS 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. CONCLUSIONS Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. TRIAL REGISTRATION ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.
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Affiliation(s)
| | - Elizabeth M Cespedes
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 3rd Floor, Boston, MA 02215, USA.
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Bonsergent E, Thilly N, Legrand K, Agrinier N, Tessier S, Lecomte E, Aptel E, Collin JF, Briançon S. Process evaluation of a school-based overweight and obesity screening strategy in adolescents. Glob Health Promot 2014; 20:76-82. [PMID: 23678500 DOI: 10.1177/1757975913483330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) trial highlights the effectiveness of implementing a screening strategy in high schools to prevent overweight/obesity among adolescents. The strategy comprises three steps: i) body measurements to detect overweight/obese adolescents, ii) a medical interview with each adolescent identified to discuss the findings, and iii) an adapted care management consisting of seven group educational sessions. A process evaluation was conducted in the PRALIMAP trial to assess the effective implementation of the screening strategy activities, and the participation of adolescents and school professionals in them, from a qualitative and a quantitative point of view. The present paper describes the process and the implementation of the screening strategy as performed in the PRALIMAP trial, and discusses the feasibility of such an intervention in high school settings. The ability of nurses to explain the screening results improved with the addition of specialist support. The ability of adolescents to take part in the screening strategy improved when the adapted care management was conducted inside schools and could be increased even further if the waiting time between the three steps could be minimised.
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Affiliation(s)
- Emilie Bonsergent
- University of Lorraine, Paris Descartes University, EA4360 Apemac, France.
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36
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Stovitz SD, Berge JM, Wetzsteon RJ, Sherwood NE, Hannan PJ, Himes JH. Stage 1 treatment of pediatric overweight and obesity: a pilot and feasibility randomized controlled trial. Child Obes 2014; 10:50-7. [PMID: 24410433 PMCID: PMC3922232 DOI: 10.1089/chi.2013.0107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Staged clinical treatment of pediatric obesity is recommended, but untested. Understanding the lowest intensity stage's effectiveness is necessary for future research. METHODS This was a randomized controlled trial of children ages 4 to <9 years. Participants were recruited after routine evaluations at a primary care pediatric clinic revealed a BMI ≥85th percentile. The intervention was patterned after the "Prevention plus, Stage 1" treatment recommended by an expert committee. Groups were compared for changes, over a 3-month time period, in BMI z-score and parental reports of behavioral issues related to childhood obesity using intent-to-treat (ITT) analysis. RESULTS Seventy-two (30% of eligible) children were enrolled and 64 were remeasured at 3-month follow-up. ITT analysis revealed that both groups improved mean BMI z-score [adjusted change -0.07, control, and -0.04, intervention; 95% confidence interval (CI) of difference=-0.14-0.20]. Over half of the children in each group improved their BMI z-score (adjusted proportion decreasing=55% in control vs. 72% in intervention; 95% CI of difference=-0.07-0.42). The intervention group improved comparatively to the control group on numerous behavioral indicators. CONCLUSIONS Implementation of the lowest intensity stage of current recommendations is feasible and possibly of benefit toward lifestyle changes. Results of this study can be used by future clinical researchers designing protocols to test the full multi-staged approach for the treatment of pediatric overweight and obesity in primary care clinical settings.
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Affiliation(s)
- Steven D. Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Rachel J. Wetzsteon
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN
| | - Peter J. Hannan
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - John H. Himes
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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van Grieken A, Renders CM, Veldhuis L, Looman CWN, Hirasing RA, Raat H. Promotion of a healthy lifestyle among 5-year-old overweight children: health behavior outcomes of the 'Be active, eat right' study. BMC Public Health 2014; 14:59. [PMID: 24447459 PMCID: PMC3911965 DOI: 10.1186/1471-2458-14-59] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 01/16/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study evaluates the effects of an intervention performed by youth health care professionals on child health behaviors. The intervention consisted of offering healthy lifestyle counseling to parents of overweight (not obese) 5-year-old children. Effects of the intervention on the child having breakfast, drinking sweet beverages, watching television and playing outside were evaluated. METHODS Data were collected with the 'Be active, eat right' study, a cluster randomized controlled trial among nine youth health care centers in the Netherlands. Parents of overweight children received lifestyle counseling according to the intervention protocol in the intervention condition (n = 349) and usual care in the control condition (n = 288). Parents completed questionnaires regarding demographic characteristics, health behaviors and the home environment at baseline and at 2-year follow-up. Cluster adjusted regression models were applied; interaction terms were explored. RESULTS The population for analysis consisted of 38.1% boys; mean age 5.8 [sd 0.4] years; mean BMI SDS 1.9 [sd 0.4]. There were no significant differences in the number of minutes of outside play or television viewing a day between children in the intervention and the control condition. Also, the odds ratio for having breakfast daily or drinking two or less glasses of sweet beverages a day showed no significant differences between the two conditions. Additional analyses showed that the odds ratio for drinking less than two glasses of sweet beverages at follow-up compared with baseline was significantly higher for children in both the intervention (p < 0.001) and the control condition (p = 0.029). CONCLUSIONS Comparison of the children in the two conditions showed that the intervention does not contribute to a change in health behaviors. Further studies are needed to investigate opportunities to adjust the intervention protocol, such as integration of elements in the regular well-child visit. The intervention protocol for youth health care may become part of a broader approach to tackle childhood overweight and obesity. TRIAL REGISTRATION Current Controlled Trials ISRCTN04965410.
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Affiliation(s)
- Amy van Grieken
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Lydian Veldhuis
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, the Netherlands
| | - Caspar WN Looman
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, the Netherlands
| | - Remy A Hirasing
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, the Netherlands
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Richardson L, Paulis WD, van Middelkoop M, Koes BW. An overview of national clinical guidelines for the management of childhood obesity in primary care. Prev Med 2013; 57:448-55. [PMID: 23988494 DOI: 10.1016/j.ypmed.2013.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/26/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Review of clinical guidelines. BACKGROUND Most national clinical guidelines for the management of childhood obesity in primary care were published since 2003. It is unknown whether there is international consensus concerning the diagnosis and management of childhood obesity. OBJECTIVE To present an overview of available guidelines for the management of childhood obesity in primary care METHODS Guidelines were included if they met the following criteria: (1) the guideline makes recommendations concerning the management of childhood obesity, (2) the target group consists of primary care health practitioners, (3) the guideline is available in English or Dutch. RESULTS Clinical guidelines from six different countries published from 2003 until 2010 met the selection criteria and were included in this review. The recommendations of the guidelines regarding the management of childhood obesity appeared to be quite similar. A consistent feature was the recommended combined intervention, with diet, physical activity and counselling being the three most important elements. There were discrepancies between the guidelines for recommendations regarding diagnostic classification criteria for childhood obesity. CONCLUSION The present review shows that there is international consensus regarding the recommendations for management of childhood obesity. There is less international consensus regarding the diagnostic classification of childhood obesity.
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Affiliation(s)
- Leroy Richardson
- Dept. of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Mazur A, Matusik P, Revert K, Nyankovskyy S, Socha P, Binkowska-Bury M, Grzegorczyk J, Caroli M, Hassink S, Telega G, Malecka-Tendera E. Childhood obesity: knowledge, attitudes, and practices of European pediatric care providers. Pediatrics 2013; 132:e100-8. [PMID: 23753085 DOI: 10.1542/peds.2012-3239] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.
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Affiliation(s)
- Artur Mazur
- Medical Faculty, University of Rzeszow, Rzeszow, Poland.
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40
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Martin J, Chater A, Lorencatto F. Effective behaviour change techniques in the prevention and management of childhood obesity. Int J Obes (Lond) 2013; 37:1287-94. [PMID: 23756676 DOI: 10.1038/ijo.2013.107] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/29/2013] [Accepted: 06/02/2013] [Indexed: 11/09/2022]
Abstract
Rates of childhood obesity are increasing, and it is essential to identify the active components of interventions aiming to prevent and manage obesity in children. A systematic review of behaviour change interventions was conducted to find evidence of behaviour change techniques (BCTs) that are most effective in changing physical activity and/or eating behaviour for the prevention or management of childhood obesity. An electronic search was conducted for randomised controlled trials published between January 1990 and December 2009. Of 4309 titles and abstracts screened, full texts of 135 articles were assessed, of which 17 published articles were included in this review. Intervention descriptions were coded according to the behaviour-specific CALO-RE taxonomy of BCTs. BCTs were identified and compared across obesity management (n=9) vs prevention (n=8) trials. To assess the effectiveness of individual BCTs, trials were further divided into those that were effective (defined as either a group reduction of at least 0.13 body mass index (BMI) units or a significant difference in BMI between intervention and control groups at follow-up) vs non-effective (reported no significant differences between groups). We reliably identified BCTs utilised in effective and non-effective prevention and management trials. To illustrate the relative effectiveness of each BCT, effectiveness ratios were calculated as the ratio of the number of times each BCT was a component of an intervention in an effective trial divided by the number of times they were a component of all trials. Results indicated six BCTs that may be effective components of future management interventions (provide information on the consequences of behaviour to the individual, environmental restructuring, prompt practice, prompt identification as role model/position advocate, stress management/emotional control training and general communication skills training), and one that may be effective in prevention interventions (prompting generalisation of a target behaviour). We identified that for management trials, providing information on the consequences of behaviour in general was a feature of non-effective interventions and for prevention trials, providing information on the consequences of behaviour in general, providing rewards contingent on successful behaviour and facilitating social comparison were non-effective. To design effective behaviour change programmes for the prevention and management of childhood obesity, we would recommend utilising the BCTs identified as effective in this review. The impact on intervention effectiveness of combining BCTs should be the topic of further research.
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Affiliation(s)
- J Martin
- Department of Psychology, University of Sheffield, Sheffield, UK
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41
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Wake M, Lycett K, Clifford SA, Sabin MA, Gunn J, Gibbons K, Hutton C, McCallum Z, Arnup SJ, Wittert G. Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial. BMJ 2013; 346:f3092. [PMID: 23751902 PMCID: PMC3677741 DOI: 10.1136/bmj.f3092] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years. DESIGN Randomised controlled trial. SETTING 22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia. PARTICIPANTS Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010. INTERVENTION Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or "usual care" (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment. MAIN OUTCOME MEASURES Children's body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents' body mass index (all 15 months post-enrolment). RESULTS 118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference -0.1 (95% confidence interval -0.7 to 0.5; P=0.7)) and body mass index z score (-0.05 (-0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score -0.20 (SD 0.25, range -0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight. CONCLUSIONS Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12608000055303.
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Affiliation(s)
- Melissa Wake
- Royal Children's Hospital, Parkville VIC 3052, Australia.
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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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Carter CJ. Toxoplasmosis and Polygenic Disease Susceptibility Genes: Extensive Toxoplasma gondii Host/Pathogen Interactome Enrichment in Nine Psychiatric or Neurological Disorders. J Pathog 2013; 2013:965046. [PMID: 23533776 PMCID: PMC3603208 DOI: 10.1155/2013/965046] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/18/2012] [Accepted: 09/10/2012] [Indexed: 01/04/2023] Open
Abstract
Toxoplasma gondii is not only implicated in schizophrenia and related disorders, but also in Alzheimer's or Parkinson's disease, cancer, cardiac myopathies, and autoimmune disorders. During its life cycle, the pathogen interacts with ~3000 host genes or proteins. Susceptibility genes for multiple sclerosis, Alzheimer's disease, schizophrenia, bipolar disorder, depression, childhood obesity, Parkinson's disease, attention deficit hyperactivity disorder (P from 8.01E - 05 (ADHD) to 1.22E - 71) (multiple sclerosis), and autism (P = 0.013), but not anorexia or chronic fatigue are highly enriched in the human arm of this interactome and 18 (ADHD) to 33% (MS) of the susceptibility genes relate to it. The signalling pathways involved in the susceptibility gene/interactome overlaps are relatively specific and relevant to each disease suggesting a means whereby susceptibility genes could orient the attentions of a single pathogen towards disruption of the specific pathways that together contribute (positively or negatively) to the endophenotypes of different diseases. Conditional protein knockdown, orchestrated by T. gondii proteins or antibodies binding to those of the host (pathogen derived autoimmunity) and metabolite exchange, may contribute to this disruption. Susceptibility genes may thus be related to the causes and influencers of disease, rather than (and as well as) to the disease itself.
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Affiliation(s)
- C. J. Carter
- Polygenic Pathways, Flat 2, 40 Baldslow Road, Hastings, East Sussex TN34 2EY, UK
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Niederer I, Bürgi F, Ebenegger V, Marques-Vidal P, Schindler C, Nydegger A, Kriemler S, Puder JJ. Effects of a lifestyle intervention on adiposity and fitness in overweight or low fit preschoolers (Ballabeina). Obesity (Silver Spring) 2013; 21:E287-93. [PMID: 23592683 DOI: 10.1002/oby.20119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 09/07/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Overweight (OW) and low fit children represent cardiovascular high-risk groups. A multidimensional school-based lifestyle intervention performed in 652 preschoolers reduced skinfold thickness and waist circumference, and improved fitness, but did not affect BMI. The objective of this study is to examine whether the intervention was equally effective in OW (≥90th national percentile) and/or low fit (lowest sex- and age-adjusted quartile of aerobic fitness) children compared to their normal weight and normal fit counterparts. DESIGN AND METHODS Cluster randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschool classes in Switzerland. The intervention included a playful physical activity program and lessons on nutrition, media use and sleeps. Primary outcomes were BMI and aerobic fitness; secondary outcomes included sum of four skinfolds, waist circumference and motor agility. Modification of intervention effects by BMI-group and fitness-group was tested by interaction terms. RESULTS Compared to their counterparts, OW children (n = 130) had more beneficial effects on waist circumference (p for interaction = 0.001) and low fit children (n = 154) more beneficial effects on all adiposity outcomes (p for interaction ≤0.03). The intervention effects on both fitness outcomes were not modified by BMI- or fitness-group (all p for interaction ≥0.2). Average intervention effect sizes for BMI were -0.12, -0.05, -0.26 and -0.02 kg/m(2) and for aerobic fitness were 0.40, 0.30, 0.12 and 0.36 stages for OW, normal weight, low fit and normal fit children, respectively. CONCLUSIONS This multidimensional intervention was equally and for some adiposity measures even more effective in high-risk preschoolers and represents a promising option for these children.
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Affiliation(s)
- I Niederer
- Institute of Exercise and Health Sciences, University of Basel, 4052 Basel, Switzerland
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O'Connor TM, Hilmers A, Watson K, Baranowski T, Giardino AP. Feasibility of an obesity intervention for paediatric primary care targeting parenting and children: Helping HAND. Child Care Health Dev 2013; 39:141-9. [PMID: 22066521 DOI: 10.1111/j.1365-2214.2011.01344.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours, and improve weight status among children. OBJECTIVE Test the feasibility of Helping HAND (Healthy Activity and Nutrition Directions), an obesity intervention for 5- to 8-year-old children in primary care clinics. METHODS A randomized controlled pilot study of Helping HAND, a 6-month intervention, targeted children with body mass index 85-99%tile and their parents. Intervention group attended monthly sessions and self-selected child behaviours and parenting practices to change. Control group received regular paediatric care and was wait-listed for Helping HAND. Session completion, participant satisfaction, child anthropometrics, dietary intake, physical activity, TV viewing and behaviour-specific parenting practices were measured pre and post intervention. RESULTS Forty parent-child dyads enrolled: 82.5% were Hispanic, 80% had a girl and 65% reported income ≤ $30, 000/year. There was 20% attrition from Helping HAND (attended <4/6 sessions). Families self-selected 4.35 (SD 1.75) behaviours to target during the 6-month programme and each of the seven behaviours was selected by 45-80% of the families. There were no between group differences in the child's body mass index z-score, dietary intake or physical activity post intervention. Intervention group viewed 14.9 (SE 2.3) h/week of TV post intervention versus control group 23.3 (SE 2.4) h/week (P < 0.05). CONCLUSION Helping HAND is feasible, due to low attrition, good programme attendance, and clinically relevant improvements in some child and parenting behaviours.
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Affiliation(s)
- T M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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46
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Bonsergent E, Agrinier N, Thilly N, Tessier S, Legrand K, Lecomte E, Aptel E, Hercberg S, Collin JF, Briançon S. Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting. Am J Prev Med 2013; 44:30-9. [PMID: 23253647 DOI: 10.1016/j.amepre.2012.09.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/10/2012] [Accepted: 09/07/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority. PURPOSE To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting. DESIGN PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011. SETTING/PARTICIPANTS A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial. INTERVENTIONS The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management). MAIN OUTCOMES MEASURES The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes. RESULTS Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention. CONCLUSIONS Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small. TRIAL REGISTRATION This study is registered at www.clinicaltrials.govNCT00814554.
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Sargent GM, Forrest LE, Parker RM. Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. Obes Rev 2012; 13:1148-71. [PMID: 22973970 PMCID: PMC3533768 DOI: 10.1111/j.1467-789x.2012.01029.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/30/2012] [Indexed: 11/29/2022]
Abstract
Nurses in primary health care (PHC) provide an increasing proportion of chronic disease management and preventive lifestyle advice. The databases MEDLINE, CINAHL, EMBASE and PsychINFO were searched and the articles were systematically reviewed for articles describing controlled adult lifestyle intervention studies delivered by a PHC nurse, in a PHC setting. Thirty-one articles describing 28 studies were analysed by comparison group which revealed: (i) no difference of effect when the same intervention was delivered by a PHC nurse compared to other health professionals in PHC (n = 2); (ii) the provision of counselling delivered by a PHC nurse was more effective than health screening (n = 10); (iii) counselling based on behaviour change theory was more effective than the same dose of non-behavioural counselling when at least three counselling sessions were delivered (n = 3). The evidence supports the effectiveness of lifestyle interventions delivered by nurses in PHC to affect positive changes on outcomes associated with the prevention of chronic disease including: weight, blood pressure, cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for change and quality of life. The strength of recommendations is limited by the small number of studies within each comparison group and the high risk of bias of the majority of studies.
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Affiliation(s)
- G M Sargent
- The Australian Primary Health Care Research Institute (APHCRI), The Australian National University (ANU), Australian Capital Territory, Canberra, Australia.
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48
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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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Dolinsky DH, Armstrong SC, Walter EB, Kemper AR. The effectiveness of a primary care-based pediatric obesity program. Clin Pediatr (Phila) 2012; 51:345-53. [PMID: 22013148 DOI: 10.1177/0009922811425232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this retrospective cohort study was to evaluate the effectiveness of the Duke University Healthy Lifestyles Program (HLP), a primary care-based childhood obesity treatment program. The study population included obese 2- through 19-year-old patients who entered the HLP between October 2006 through December 2008 and who had a visit to the HLP between the sixth and eighth month after entry. Most of the 282 patients were female (57%) and non-Hispanic/non-White (61%). The median age was 11 years. At baseline, the mean body mass index standard deviation score (BMI SDS) was 2.51, and patients achieved a mean reduction in BMI SDS of 0.10 (standard deviation = 0.20). For patients with baseline and follow-up measures of comorbidities, there were improvements in blood pressure, triglycerides, total cholesterol, and insulin resistance (P < .05). The patients in our obesity program demonstrated a small reduction in the severity of obesity. Improvements occurred in some obesity-associated comorbidities.
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Current world literature. Curr Opin Psychiatry 2012; 25:155-62. [PMID: 22297717 DOI: 10.1097/yco.0b013e3283514a53] [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: 11/26/2022]
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