Obesity prevention interventions for middle school-age children of ethnic minority: a review of the literature

The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to examine the effectiveness of e-health interventions for the treatment of children and adolescents with overweight or obesity. Databases were searched up to November 2020. Studies were randomized controlled trials where interventions were delivered via e-health (e.g., computers, tablets, and smartphones, but not phone calls). Studies should target the treatment of overweight or obesity in children or their agent of changes and report body mass index (BMI) or BMI z-score. A meta-analysis using a random-effects model was conducted. Nineteen studies met the inclusion criteria, and 60% were of high quality. The narrative review revealed variation in behavior change strategies and modes of delivery. The pooled mean reduction in BMI or BMI z-score showed evidence for a nonzero effect (standardized mean difference = -0.31, 95% confidence interval -0.49 to -0.13), with moderately high heterogeneity between studies (I²  = 74%, p < 0.001). Subgroup analysis revealed high heterogeneity in studies with a high or unclear risk of bias. E-health interventions can be effective in treating children and adolescents with overweight and obesity and should be considered by practitioners and policymakers. However, an understanding of the most effective and acceptable intervention components, long-term benefits, and sustainability should be further studied.

Determining Effective Nutrition Intervention Strategies and the Subsequent Impact on Nutrition Knowledge, Dietary Adherence, and Health Outcomes among American Indian/Alaska Native Youth (2-18 Years of Age): a Systematic Review

The PRISMA style literature review was used to determine effective nutrition intervention strategies and their subsequent impact on nutrition knowledge, dietary adherence, and health outcomes among American Indian/Alaskan Native (AI/AN) youth. Peer-reviewed articles published between January 1980 and December 2019 were extracted from PubMed, CINAHL, Cochrane, and PsychInfo databases. A 4-point inclusion criterion was established to include articles with AI/AN youth, nutrition intervention, and presented health outcomes. A quality criteria checklist was used to assess the articles. A total of 12 studies were included in this study. Interventions that incorporated cultural adaptations (e.g., storytelling), theoretical frameworks (e.g., community-based participatory), active learning (e.g., cooking), tribal partnership, and caregiver involvement slightly improved nutrition knowledge, dietary adherence, and health outcomes. Overall, this review revealed that incorporating cultural aspects with input from the community in a nutrition program has a positive impact on AI/AN youths. Steps can be taken at the policy level to direct obesity and non-communicable disease prevention efforts among AI/AN youth.

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

BACKGROUND

Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity.

METHODS

The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography.

DISCUSSION

This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03086161, retrospectively registered.

Ecological Factors Affecting Obesity Among Middle School Students in South Korea

BACKGROUND

Despite the environment being recognized as playing an important role in health, little is known about the influence of school and community factors on student health. This study aimed to identify the ecological factors influencing obesity among middle school students, including intrapersonal, interpersonal, school, and community factors.

METHODS

The study sample consisted of 2069 students from 50 middle schools, with individual-level data. School and community-level data were collected using a school nurse survey and official materials from the National and Civic Statistics. These data were merged and used for a series of multilevel logistic regression analyses.

RESULTS

There were significant variations in the students' overweight/obesity status, by ecological factors. Individual dietary habits, peer social support for physical activity, health education in the regular curriculum, the number of personal computer rooms per 100,000 individuals, and the area of public sports facilities per 100,000 individuals were significantly associated with student obesity.

CONCLUSIONS

To be more effective, overweight/obesity prevention efforts for middle school students should focus not only on individual factors, but also on school and community factors.

Physical Activity in Parents of Young African American Children: The Application of Social Cognitive Theory

Background:

Social cognitive theory (SCT) proposes that personal and environmental factors influence behavior bidirectionally. Research examining the personal and environmental factors of physical activity (PA) among African Americans (AAs) framed by SCT is scarce.

Purpose:

The purpose of this article is to enhance knowledge of SCT as a foundation for health promotion and PA research, in general, and among AAs. Findings from a previous study provide exemplars for key factors and relationships in SCT.

Implications for Research and Practice:

The SCT serves as a good framework for researchers studying health promotion and PA in generalamong AA parents.

Impact of Age and Race on Outcomes of a Program to Prevent Excess Weight Gain and Disordered Eating in Adolescent Girls

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.

A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent-youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Impact of social norms and social support on diet, physical activity and sedentary behaviour of adolescents: a scoping review

The prevalence of non-communicable diseases (NCDs) in adulthood is rapidly increasing, and it is essential that risk factors for NCDs be addressed in adolescence, both for the health of individuals during adolescence and for their health in later life. These risk factors include diet, physical activity and sedentary behaviour. No literature has been published that comprehensively summarizes the impact of social norms and social support on these behaviours among adolescents. Therefore, a scoping review was conducted to determine the extent of recent (since 2000) literature available on this topic. A comprehensive search strategy was used to search PubMed and EMBASE for eligible reviews. Review papers (narrative reviews, systematic and non-systematic reviews) published in English in peer-reviewed journals from 2000 to February 2013 were included in the overview. Two of the authors screened the titles and abstracts of the search results independently. Thirty reviews were included in the scoping review. This scoping review has shown sufficient evidence for parental influences, and especially the positive impact of an authoritative parenting style, on healthy behaviours of adolescents, although the evidence is somewhat more compelling for diet than for physical activity and sedentary behaviour. More research is needed to investigate parental and family influences on physical activity and sedentary behaviour. And the effect of peer influences on diet, physical activity and sedentary behaviour of adolescents requires further investigation. The evidence presented affirms the consideration of social norms and social support in the development of interventions to address these behaviours in adolescents. The evidence regarding parenting style provides some concrete guidance for such interventions.

Perception of Obesity in African-American and Arab-American Minority Groups

BACKGROUND

Effectiveness of health education programs and interventions, designed to improve obesity rates, may vary according to perceptions of health within cultural groups.

METHOD

A qualitative approach was used. Two minority cultural groups (Arab-American and African-American) living in the same county were studied to compare perceptions of health, nutrition, and obesity and subsequent health behaviors.

RESULTS

Control, expectations, bias, acceptance, and access were the five themes identified. Arab-Americans that had lower weights, lower prevalence of chronic diseases, expected healthy weights, reported age and gender bias related to being overweight were not as accepting of being overweight and did not report difficulties in accessing healthy food choices compared to their African-American counterparts.

CONCLUSIONS

Health interventions aimed at reducing obesity rates and related chronic diseases should be culturally specific and aimed at changing expected and accepted cultural norms. Cultural group's void of certain disease states should be studied and used as models to ameliorate the problem in other cultures. Changing health behaviors within a certain cultural group may produce better outcomes when initiated from a member of that same group. The impact of economic and environmental factors on health behaviors must also be considered.

Adapting a Videogame to the Needs of Pediatric Cancer Patients and Survivors

OBJECTIVE

This study assessed whether two serious videogames, "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) (both from Archimage, Inc., Houston, TX) shown to effect change in healthy children's diet and possibly physical activity are acceptable for obesity prevention among pediatric cancer patients and survivors at high risk of obesity.

PATIENTS AND METHODS

Pediatric (9-12-year-old) cancer patients and survivors (n=28) were randomly assigned to one of three groups: Group A, watched film adaptations of both game stories and played the first two episodes of each game; Group B, played all of Diab; or Group C, played all of Nano. Qualitative interviews about what the children liked and didn't like and what should be changed were conducted midway and at the end of each group's participation. Data were analyzed using thematic analysis.

RESULTS

Pediatric cancer patients and survivors enjoyed playing both games. Two themes emerged to guide future modifications of the game: Three patients reported difficulty with the energy balance and meal selection portion of Nano, and four patients stated endings showing a character dying made them sad.

CONCLUSIONS

Two serious videogames designed to promote healthier diet and increased physical activity among healthy children were also found to be acceptable by pediatric cancer patients and survivors. Easier options needed to be programmed into energy balance games in Nano. To avoid possible emotional reactions, such as sadness, Nano's ending will be revised so that a character does not die from his affliction. Minor changes will be made in other gameplay mechanics and storylines to meet target audience needs and preferences.

A systematic review of parent role modeling of healthy eating and physical activity for their young African American children

PURPOSE

We systematically reviewed current literature on parent role modeling of healthy eating and physical activity as a strategy to influence healthy weight of middle school-age African American children.

CONCLUSIONS

The evidence for parent role modeling is low to average. Most studies did not target African American participants or middle school-age children.

PRACTICE IMPLICATIONS

Nurses can begin to remedy deficient knowledge of parent role modeling by assessing parent attitudes, beliefs, and healthy behaviors, as well as the children's. Existing dietary and physical activity guidelines are not specific to African Americans but can be a starting point for educating parents.

Authoritative feeding behaviors to reduce child BMI through online interventions

PURPOSE.: The purpose of the study was to examine the feasibility and initial efficacies of parent- and/or child-focused online interventions and variables correlated with child body mass index percentile change. DESIGN AND METHODS.: A feasibility and cluster randomized controlled pilot study was used. RESULTS.: Recruitment was more effective at parent-teacher conferences compared with when materials were sent home with fifth- to eighth-grade culturally diverse students. Retention was 90% for students and 62-74% for parents. Authoritative parent feeding behaviors were associated with lower child body mass index. A larger study is warranted. PRACTICE IMPLICATIONS.: Online approaches may provide a feasible option for childhood obesity prevention and amelioration.

Correlates of overweight and obesity among American Indian/Alaska Native and Non-Hispanic White children and adolescents: National Survey of Children's Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children's Health, behavioral (child's sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child's bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child's age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10-17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5-2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1-3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3-5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.