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Newson L, Abayomi J. Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors. Proc Nutr Soc 2024:1-12. [PMID: 38205619 DOI: 10.1017/s0029665124000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.
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Affiliation(s)
- Lisa Newson
- School of Psychology, Research Centre for Brain and Behaviour, Faculty of Health, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Julie Abayomi
- Faculty of Health, Social Care and Medicine, Edgehill University, Liverpool, UK
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Riis JL, Dent AL, Silke O, Granger DA. Salivary uric acid across child development and associations with weight, height, and body mass index. Front Pediatr 2023; 11:1235143. [PMID: 38027287 PMCID: PMC10646470 DOI: 10.3389/fped.2023.1235143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Obesity during childhood is a serious and growing chronic disease with consequences for lifelong health. In an effort to advance research into the preclinical indicators of pediatric obesity, we examined longitudinal assessments of uric acid concentrations in saliva among a cohort of healthy children from age 6-months to 12-years (n's per assessment range from 294 to 727). Methods Using data from a subsample of participants from the Family Life Project (an Environmental influences on Child Health Outcomes Program cohort), we: (1) characterized salivary uric acid (sUA) concentrations from infancy to early adolescence by sex and race; (2) assessed changes in sUA levels across development; and (3) evaluated associations between sUA concentrations and measures of child weight, height, and body mass index (BMI). Across four assessments conducted at 6-, 24-, 90-, and 154-months of age, 2,000 saliva samples were assayed for UA from 781 participants (217 participants had sUA data at all assessments). Results There were no significant differences in sUA concentrations by sex at any assessment, and differences in sUA concentrations between White and non-White children varied by age. At the 90- and 154-month assessments, sUA concentrations were positively correlated with measures of child weight, height, and BMI (90-month: weight- ρ(610) = 0.13, p < 0.01; height- ρ(607) = 0.10, p < 0.05; BMI- ρ(604) = 0.13, p < 0.01; 154-month: weight- ρ(723) = 0.18, p < 0.0001; height- ρ(721) = 0.10, p < 0.01; BMI- ρ(721) = 0.17, p < 0.0001). Group based trajectory modeling identified two groups of children in our sample with distinct patterns of sUA developmental change. The majority (72%) of participants showed no significant changes in sUA across time ("Stable" group), while 28% showed increases in sUA across childhood with steep increases from the 90- to 154-month assessments ("Increasing" group). Children in the Increasing group exhibited higher sUA concentrations at all assessments (6-month: t(215) = -5.71, p < 0.001; 24-month: t(215) = -2.89, p < 0.01; 90-month: t(215) = -3.89, p < 0.001; 154-month: t(215) = -19.28, p < 0.001) and higher weight at the 24- and 90-month assessments (24-month: t(214) = -2.37, p < 0.05; 90-month: t(214) = -2.73, p < 0.01). Discussion Our findings support the potential utility of sUA as a novel, minimally-invasive biomarker that may help advance understanding of the mechanisms underlying obesity as well as further surveillance and monitoring efforts for pediatric obesity on a large-scale.
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Affiliation(s)
- J. L. Riis
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, CA, United States
| | - A. L. Dent
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - O. Silke
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - D. A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, CA, United States
- Department of Psychological Science, University of California, Irvine, CA, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Bordeleau M, Purcell M, Provencher V, Panahi S, Jacob R, Alméras N, Drapeau V. Impact of a Web-Based Nutrition Intervention on Eating Behaviors and Body Size Preoccupations among Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1736. [PMID: 38002827 PMCID: PMC10670448 DOI: 10.3390/children10111736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
We aimed to evaluate the impact of a web-based school nutrition intervention on eating behavior traits, body weight concern, body size perception and body size dissatisfaction in adolescents. Ten classes of secondary students in Canada (13.6 ± 0.8 years) were randomized into an intervention (n = 162 students) or control group (n = 75 students). Adolescents in the intervention, conducted between 2011 and 2013, participated in an online nutrition challenge to increase their consumption of vegetables, fruits and dairy products using a web-based platform over six weeks. Measurements were taken at baseline (PRE) and post-intervention (POST). No significant negative changes were observed between the intervention and control groups for eating behavior traits, body weight concern, body size perception and dissatisfaction. However, results suggest a trend for a positive effect of the intervention on susceptibility to hunger in boys (group × time interaction, p = 0.10). Specifically, boys experienced a reduction in their susceptibility to hunger in response to the intervention (PRE: 6.1 ± 3.8, POST: 4.8 ± 3.7, p = 0.009). An intervention aimed at improving the eating habits of adolescents did not negatively influence body size preoccupations. In response to the intervention, boys tended to show a lower susceptibility to hunger, which might help them to prevent overeating and adopt healthy eating habits.
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Affiliation(s)
- Manon Bordeleau
- Département d’Éducation Physique, Université Laval, Québec, QC G1V 0A6, Canada; (M.B.); (M.P.)
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (CRIUCPQ-UL), Québec, QC G1V 4G5, Canada; (S.P.); (N.A.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche Interuniversitaire sur la Formation et Profession Enseignante (CRIFPE), Université de Montréal, Québec, QC H3C 3J7, Canada
| | - Maya Purcell
- Département d’Éducation Physique, Université Laval, Québec, QC G1V 0A6, Canada; (M.B.); (M.P.)
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (CRIUCPQ-UL), Québec, QC G1V 4G5, Canada; (S.P.); (N.A.)
| | - Véronique Provencher
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- École de Nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Shirin Panahi
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (CRIUCPQ-UL), Québec, QC G1V 4G5, Canada; (S.P.); (N.A.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Raphaëlle Jacob
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Natalie Alméras
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (CRIUCPQ-UL), Québec, QC G1V 4G5, Canada; (S.P.); (N.A.)
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Vicky Drapeau
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval (CRIUCPQ-UL), Québec, QC G1V 4G5, Canada; (S.P.); (N.A.)
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche Interuniversitaire sur la Formation et Profession Enseignante (CRIFPE), Université de Montréal, Québec, QC H3C 3J7, Canada
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
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Deslippe AL, González ODJ, Buckler EJ, Ball GDC, Ho J, Bucholz A, Morrison KM, Mâsse LC. Do Individual Characteristics and Social Support Increase Children's Use of an MHealth Intervention? Findings from the Evaluation of a Behavior Change MHealth App, Aim2Be. Child Obes 2023; 19:435-442. [PMID: 36576875 DOI: 10.1089/chi.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Methods: A secondary analysis of two versions of Aim2Be (preteen and teen versions) using covariate-adjusted multivariable regression was conducted. We evaluated associations between social support features (a virtual coach, a social poll, or a social wall), parent co-participation (time spent in the parent app), and app satisfaction on use (time spent in Aim2Be). Models were stratified by age and satisfaction was explored as a moderator. Results: Preteens (n = 83) engagement with the social poll (β = 0.26, p < 0.001), virtual health coach (β = 0.24, p = 0.01), app satisfaction (β = 0.31, p = 0.01), and parent co-participation (β = 0.24, p = 0.01) predicted use. In teens (n = 90), engagement with the virtual coach (β = 0.31, p < 0.001) and full utilization of social wall features (β = 0.41, p < 0.001) predicted use. Furthermore, satisfaction moderated the effects of partial utilization of the social wall among teens (β = 0.32 p = 0.02). Conclusion: Social support in mHealth apps may impact users differently depending on age. Features that include health professionals or peers may be more advantageous across ages. App developers should consider age when designing interventions. Clinical Trial Registration NCT03651284.
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Affiliation(s)
- Alysha L Deslippe
- Human Nutrition, Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
- Healthy Starts, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia De-Jongh González
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation (Behaviour Change Group), BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - E Jean Buckler
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Josephine Ho
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Annick Bucholz
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation (Behaviour Change Group), BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Sela Peremen K, Maor S, Yaniv A, Aloni I, Ziv-Baran T, Dubnov-Raz G. Comparison of a Telehealth-Based Intensive Treatment Program with a Rewarding App vs. On-Site Care for Youth with Obesity: A Historical Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1117. [PMID: 37508614 PMCID: PMC10378604 DOI: 10.3390/children10071117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
The recommended treatment for children with obesity includes numerous consultations by a multidisciplinary team, which is very cumbersome. Telehealth can assist in administering frequent care to children with obesity, yet the exact approaches and modes of delivery are still explored. During the COVID-19 pandemic, we developed an intensive telehealth-based treatment program that included a rewarding app for children with obesity. The aim of this study was to compare 6-month changes in body mass index (BMI) and body fat percent between participants in the program (n = 70) vs. children that underwent historic on-site care (n = 87). After 6 months, more participants in the telehealth group continued treatment compared to the on-site group (79% vs. 60%, p < 0.001). A significant reduction in the median BMI z-score (zBMI) was seen after 6 months in both groups (p < 0.01), with a similar proportion of zBMI reductions (71% in the telehealth group, 75% in the comparison group, p = 0.76). No statistically significant differences were found between the study groups in 6-month changes in BMI, zBMI, body fat percent or fat z-scores. We conclude that our telehealth program, which was executed during the COVID-19 pandemic, resulted in a high proportion of children with zBMI reduction that was comparable with the more personal on-site care.
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Affiliation(s)
| | - Shay Maor
- Pediatric Exercise and Lifestyle Clinic, Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel
| | - Amit Yaniv
- Pediatric Exercise and Lifestyle Clinic, Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel
| | - Ishai Aloni
- Pediatric Exercise and Lifestyle Clinic, Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel
| | - Tomer Ziv-Baran
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Gal Dubnov-Raz
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Pediatric Exercise and Lifestyle Clinic, Safra Children's Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel
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Levaillant L, Levaillant M, Sfeir N, Bouhours-Nouet N, Amsellem-Jager J, Beaumesnil M, Coutant R, Riquin É, Schmitt F. Factors Associated With Weight Loss After Laparoscopic Adjustable Gastric Banding in Adolescents With Severe Obesity. JPGN REPORTS 2023; 4:e296. [PMID: 37200715 PMCID: PMC10187845 DOI: 10.1097/pg9.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 05/20/2023]
Abstract
Childhood obesity is associated with many comorbidities. Bariatric surgery is known to be efficient for reducing weight in adolescents. Objectives The primary outcome was to identify somatic or psychosocial factors associated with success at 24 months after a laparoscopic adjustable gastric banding (LAGB) procedure in our cohort of adolescents with severe obesity. Secondary endpoints were to describe weight loss outcomes, comorbidity resolution, and complications. Methods We have retrospectively reviewed medical records of patients who had LAGB placed between 2007 and 2017. Factors associated with success at 24 months after LAGB were researched, with success being defined as positive percentage of excess weight loss (%EWL) at 24 months. Results Forty-two adolescents underwent a LAGB procedure, the mean %EWL was 34.1% at 24 months, with improvement in most comorbidities and without major complications. Having lost weight before surgery was associated with success, whereas a high body mass index at surgery was associated with a higher risk of failure. No other factor was found to be associated with success. Conclusion Comorbidities mostly improved 24 months after LAGB and no major complication occurred. Having lost weight before surgery was associated with a successful surgery, whereas a high body mass index at surgery increases the risk of failure.
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Affiliation(s)
- Lucie Levaillant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Mathieu Levaillant
- Department of Methodology and Biostatistics, University Hospital of Angers, Angers, France
- University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Nathalie Sfeir
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Natacha Bouhours-Nouet
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Jessica Amsellem-Jager
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Marion Beaumesnil
- Department of Paediatric Physical and Rehabilitation Medicine, Centre des Capucins, Angers, France
| | - Régis Coutant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Élise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- Mitovasc Unit, UMR CNRS 6015-INSERM, Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
| | - Françoise Schmitt
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
- Univ Angers, HIFIH, SFR ICAT, Angers, France
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Romanenko E, Homer J, Fismen AS, Rutter H, Lien N. Assessing policies to reduce adolescent overweight and obesity: Insights from a system dynamics model using data from the Health Behavior in School-Aged Children study. Obes Rev 2023; 24 Suppl 1:e13519. [PMID: 36416189 DOI: 10.1111/obr.13519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022]
Abstract
Adolescent overweight and obesity (AdOWOB) in Europe has proven to be a persistent and complex problem, and appropriate systems methods may help in evaluating potential policy options. This paper describes the development of a system dynamics model of AdOWOB as part of the EU-funded CO-CREATE project. The model was developed using literature and data from the Health Behavior in School-Aged Children (HBSC) study across 31 European countries. We identified 10 HBSC variables that were included as direct or indirect drivers of AdOWOB in the dynamic model, seven at the level of the individual, and three related to the social environment. The model was calibrated to 24 separate cases based on four gender and perceived wealth segments for each of the five CO-CREATE countries (The Netherlands, Norway, Poland, Portugal, and the UK) and for Europe overall. Out of 10 possible intervention points tested, exercise, fruit, life dissatisfaction, school pressure, and skipping breakfast were identified as the top five most influential ones across the 24 cases. These model-based priorities can be compared with the policy ideas suggested by the CO-CREATE adolescents.
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Affiliation(s)
- Eduard Romanenko
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jack Homer
- Homer Consulting and MIT Research Affiliate, Barrytown, New York, USA
| | - Anne-Siri Fismen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Center for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Kösling C, Schäfer L, Hübner C, Sebert C, Hilbert A, Schmidt R. Food-Induced Brain Activity in Children with Overweight or Obesity versus Normal Weight: An Electroencephalographic Pilot Study. Brain Sci 2022; 12:brainsci12121653. [PMID: 36552113 PMCID: PMC9775366 DOI: 10.3390/brainsci12121653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although increased food cue reactivity is evidenced to be crucial to the development and maintenance of pediatric obesity, virtually nothing is known about the underlying neurophysiological aspects of food cue reactivity in children with obesity. Therefore, this study aimed at investigating neural characteristics in children with overweight or obesity using electroencephalography (EEG). METHODS Electrophysiological brain activity was measured using EEG frequency band analysis in n = 9 children with overweight or obesity versus n = 16 children with normal weight (8-13 years) during the presentation of high- and low-calorie food pictures and images of appealing non-food stimuli. RESULTS Children with overweight or obesity showed significantly increased relative central beta band activity induced by high-calorie foods and appealing non-food stimuli compared to children with normal weight. Beyond significant effects of the scalp region on EEG activity, non-significant effects of stimulus category or weight status were seen for theta and alpha frequency bands. CONCLUSIONS This study demonstrated elevated beta band activity in children with overweight or obesity when viewing high-calorie food stimuli. Beta band activity may, thus, be a valuable target for neuromodulatory interventions in children with overweight or obesity.
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9
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Ziser K, Junne F, Herschbach A, Martus P, Jacoby J, Stuber F, Rahmani Azad Z, Mack I, Weiland A, Krauß I, Greule C, Sudeck G, Kastner L, Zurstiege G, Hoell A, Bethge W, Sammet T, Schliesing O, Zipfel S, Ehehalt S, Giel KE. Supporting families to achieve a healthy weight development for their child with overweight/obesity using the STARKIDS intervention: study protocol for a cluster-randomized controlled trial. Trials 2022; 23:590. [PMID: 35871013 PMCID: PMC9308115 DOI: 10.1186/s13063-022-06525-0] [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: 12/20/2021] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Childhood and adolescent overweight and obesity are among the most serious health challenges today. Structured weight reduction programs can be helpful to reduce severe health consequences but evidence is partly scarce. The STARKIDS program aims to improve on some of these limitations and is designed to be a structured, stepwise, digitally supported intervention program for the whole family. It is divided into two intervention steps spanning over 1.5 years and aims at promoting a healthy weight development of children/adolescents with overweight/obesity and an increase in quality of life. Methods The STARKIDS intervention is evaluated in a cluster-randomized study design by comparing it with a control group receiving a one-time structured counselling in the pediatric practice. The study aims to include 1000 families with children/adolescents with overweight/obesity from 100 pediatric practices. The main outcomes are reduction in body mass index percentiles and improvements in children’s/adolescent’s quality of life, secondary outcomes refer to the contents of the intervention such as diet, physical activity, stress, and media habits. All outcomes are measured on three measurement time points: (T0) at baseline/inclusion in the study, (T1) baseline + 12 months which is the end of step 1 of the STARKIDS intervention, and (T2) baseline + 18 months which is the end of step 2 of the STARKIDS intervention. Discussion The stepwise, e-health-supported STARKIDS program is a low-threshold intervention program for families with children/adolescents with overweight/obesity. With the proof of concept, STARKIDS provides the potential to be implemented as a standard care tool for the prevention and intervention of childhood/adolescence obesity in the German health system. Trial registration German Clinical Trials Register (DRKS) DRKS00022813 (acknowledged primary register of the World Health Organization). Registered on 27 November 2020 (Universal Trial Number U1111-1254-9536).
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Parvin P, Masihay-Akbar H, Cheraghi L, Razmjouei S, Shab-khaneh AZ, Azizi F, Amiri P. Effectiveness of a practical multi-setting lifestyle intervention on the main BMI trajectories from childhood to young adulthood: A community-based trial. BMC Public Health 2022; 22:1995. [PMCID: PMC9624045 DOI: 10.1186/s12889-022-14306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Preventing overweight in childhood and subsequent stages of life is still a global challenge. Despite numerous relevant lifestyle interventions, data on their impact on different BMI change pathways over time is rare. The present study aimed to investigate the effect of a multi-setting lifestyle intervention on BMI trajectories from childhood to young adulthood. Methods A multi-setting lifestyle intervention at the school, family, and community levels have been conducted in the Tehran Lipid and Glucose Study framework. A total of 2145 children (4–18 years, 49% boys, and 18% intervention) were recruited for the baseline assessment and were followed through five follow-up examinations during a median of 16.1 years. Using a group-based trajectory model, BMI trajectories from childhood to young adulthood were identified, and their association with the implemented intervention was assessed. Results Four trajectory groups of BMI from childhood to young adulthood were identified, including Normal weight (41%), Young adulthood overweight (36%), Early childhood increasing overweight and adulthood obesity (19%), and Early childhood increasing obesity (4%). Only Young adulthood overweight and Early childhood increasing obesity were affected by the intervention and were concomitant with lower BMI levels than the control group, with the highest estimated effect in the latter (β=-0.52 and p = 0.018; β=-1.48 and p < 0.001, respectively). Conclusion The current findings indicate the highest effectiveness of a practical, healthy lifestyle intervention on those whose obesity started in the early years of life or youth. Our results could help policymakers and planners design more targeted lifestyle modification and weight control interventions. Trial registration This study is registered at Iran Registry for Clinical Trials, a WHO primary registry (http://irct.ir). The Iran Registry for Clinical Trials ID and date are IRCTID:IRCT138705301058N1, 29/10/2008. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14306-2.
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Affiliation(s)
- Parnian Parvin
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasti Masihay-Akbar
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soha Razmjouei
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Zareie Shab-khaneh
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- grid.411600.2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Sun G, Li L, Zhang X. A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021). Front Public Health 2022; 10:928720. [PMID: 36339176 PMCID: PMC9632180 DOI: 10.3389/fpubh.2022.928720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Background Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research. Methods Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference. Results 2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends. Conclusion The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.
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Affiliation(s)
- Guotao Sun
- School of Physical Education, Chengdu Sport University, Chengdu, China,College of Education and Sports Science, Yangtze University, Jingzhou, China
| | - Long Li
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China,School of Physical Education, Xichang University, Xichang, China
| | - Xiaolin Zhang
- Sport Research Office, Chengdu Sport University, Chengdu, China,*Correspondence: Xiaolin Zhang
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12
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Tanous DR, Ruedl G, Kirschner W, Drenowatz C, Craddock J, Rosemann T, Wirnitzer K. School health programs of physical education and/or diet among pupils of primary and secondary school levels I and II linked to body mass index: A systematic review protocol within the project From Science 2 School. PLoS One 2022; 17:e0275012. [PMID: 36201567 PMCID: PMC9536596 DOI: 10.1371/journal.pone.0275012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
The most common causes of death in Western countries today are preventable diseases mainly attributed to daily behavior. It has been well documented that genetics are influential but not the deciding factor for developing non-communicable diseases. Ideally, the public should be educated to perform methods of optimal health and wellbeing independently, meaning that individuals should be in control of their health without relying on others. As behavior is known to be consistent over time, good or poor health behavior will track from childhood into adulthood. Physical activity and diet are permanently linked to the individual's state of health, and when properly balanced, the effects on personal health summate, resulting in greater benefits from this dual-approach for public health. The objective is to highlight the different approaches (physical intervention, nutritional intervention, and dual-approach of diet and exercise) and identify effective interventions for sustainable body weight and healthy body mass index in school children. A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The review will assess school-based diet and exercise interventions on children in primary and secondary school levels I and II. Overweight and obesity develop as a result of a prolonged imbalance in the energy balance model, with both physical activity and diet being influential in the fluctuation of body weight. A dual-approach including physical activity and diet could therefore be a very promising method to promote sustainable healthy body weight in school children.
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Affiliation(s)
- Derrick R. Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, Innsbruck, Austria
- * E-mail:
| | - Gerhard Ruedl
- Department of Sport Science, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
| | - Werner Kirschner
- Department of Sport Science, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
| | - Clemens Drenowatz
- Division of Physical Education, University of Education Upper Austria, Linz, Austria
| | - Joel Craddock
- Sydney School of Education and Social Work, The University of Sydney, Sydney, Australia
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, Innsbruck, Austria
- Health and Lifestyle Science Cluster Tirol, Subcluster Health/Medicine/Psychology, Tyrolean University Conference, Verbund West, Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
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13
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Willeboordse M, Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HHCM, Hahnraths MTH, Vonk L, Oosterhoff M, van Schayck CP, Winkens B, Jansen MWJ. Battling the obesity epidemic with a school-based intervention: Long-term effects of a quasi-experimental study. PLoS One 2022; 17:e0272291. [PMID: 36166426 PMCID: PMC9514666 DOI: 10.1371/journal.pone.0272291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background School-based health-promoting interventions are increasingly seen as an effective population strategy to improve health and prevent obesity. Evidence on the long-term effectiveness of school-based interventions is scarce. This study investigates the four-year effectiveness of the school-based Healthy Primary School of the Future (HPSF) intervention on children’s body mass index z-score (BMIz), and on the secondary outcomes waist circumference (WC), dietary and physical activity (PA) behaviours. Methods and findings This study has a quasi-experimental design with four intervention schools, i.e., two full HPSFs (focus: diet and PA), two partial HPSFs (focus: PA), and four control schools. Primary school children (aged 4–12 years) attending the eight participating schools were invited to enrol in the study between 2015 and 2019. Annual measurements consisted of children’s anthropometry (weight, height and waist circumference), dietary behaviours (child- and parent-reported questionnaires) and PA levels (accelerometers). Between 2015 and 2019, 2236 children enrolled. The average exposure to the school condition was 2·66 (SD 1·33) years, and 900 participants were exposed for the full four years (40·3%). After four years of intervention, both full (estimated intervention effect (B = -0·17 (95%CI -0·27 to -0·08) p = 0·000) and partial HPSF (B = -0·16 (95%CI-0·25 to -0·06) p = 0·001) resulted in significant changes in children’s BMIz compared to control schools. Likewise, WC changed in favour of both full and partial HPSFs. In full HPSFs, almost all dietary behaviours changed significantly in the short term. In the long term, only consumption of water and dairy remained significant compared to control schools. In both partial and full HPSFs, changes in PA behaviours were mostly absent. Interpretation This school-based health-promoting intervention is effective in bringing unfavourable changes in body composition to a halt in both the short and long term. It provides policy makers with robust evidence to sustainably implement these interventions in school-based routine.
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Affiliation(s)
- M. Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - N. H. M. Bartelink
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - P. van Assema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - S. P. J. Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - H. H. C. M. Savelberg
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM) and School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - M. T. H. Hahnraths
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - L. Vonk
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Centre for Public Health Limburg, Heerlen, The Netherlands
| | - M. Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M. W. J. Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Centre for Public Health Limburg, Heerlen, The Netherlands
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14
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Romano KA, Heron KE, Everhart RS. Family meals, positive versus negative emotion suppression, and emotional eating: examining adolescent-parent dyadic associations. Eat Weight Disord 2022; 27:1491-1504. [PMID: 34468974 DOI: 10.1007/s40519-021-01292-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The present study aimed to extend existing research by examining adolescent-parent dyadic associations among adaptive and maladaptive family meal characteristics, positive and negative emotion suppression, and emotional eating. METHOD Participants included a community-based sample of adolescents and parents (N = 1646 dyads) who participated in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating Study. Dyad members both completed measures assessing family meal characteristics (family meal importance beliefs, family mealtime television watching), emotion suppression, and emotional eating via online surveys. Actor-partner interdependence models were used to examine dyadic associations among the assessed family meal characteristics, positive and negative emotion suppression, and emotional eating. RESULTS Multiple within-person (e.g., adolescent-adolescent, parent-parent), cross-dyad member (e.g., adolescent-parent, parent-adolescent), and divergent adolescent versus parent dyadic effects were identified that differed based on the extent to which participants suppressed positive versus negative affect. For example, whereas adolescents' stronger beliefs in the importance of frequent family meals were associated with lower levels of their own suppression of positive emotions and, in turn, lower levels of both their own and their parents' emotional eating, these mediational associations were only identified at the within-person (not cross-dyad member) level among parents. CONCLUSIONS Collectively, these findings attest to the complexity of associations among the assessed risk and protective family meal characteristics, the suppression of differentially valenced emotions, and emotional eating that manifest at the adolescent-parent dyadic level. Findings also support the continued use of a family-based perspective to further the understanding of factors that are associated with emotional eating. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA. .,Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA.
| | - Kristin E Heron
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA.,Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA
| | - Robin S Everhart
- Virginia Commonwealth University, 808 West Franklin Street, Richmond, VA, 23284, USA
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15
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Tugault-Lafleur CN, De-Jongh González O, Macdonald J, Bradbury J, Warshawski T, Ball GDC, Morrison K, Ho J, Hamilton J, Buchholz A, Mâsse L. Efficacy of the Aim2Be intervention in changing lifestyle behaviours among adolescents with overweight and obesity: A Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 25:e38545. [PMID: 37097726 PMCID: PMC10170359 DOI: 10.2196/38545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. OBJECTIVE The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. METHODS A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. RESULTS A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. CONCLUSIONS The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. TRIAL REGISTRATION ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-4080-2.
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Affiliation(s)
- Claire N Tugault-Lafleur
- School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Olivia De-Jongh González
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Katherine Morrison
- Department of Pediatrics, Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Louise Mâsse
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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16
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St George SM, Kobayashi MA, Noriega Esquives BS, Ocasio MA, Wagstaff RG, Dorcius DP. Pediatric Obesity Prevention and Treatment Among Hispanics: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 62:438-449. [PMID: 35190103 PMCID: PMC8864167 DOI: 10.1016/j.amepre.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The rates of pediatric obesity in the U.S. are highest among Hispanics. There is no existing meta-analysis of the effects of obesity interventions among Hispanic youth. This systematic review and meta-analysis assesses the effects of obesity prevention and treatment interventions on Hispanic youth's weight status and lifestyle behaviors. METHODS PubMed, PsycINFO, and Scopus were searched between January 1, 2000 and October 30, 2020. Interventions with ≥50% Hispanic youth aged 0-18 years were included. Using a weighted inverse-variance procedure, fixed-effects and random-effects models were run for an overall effect size on the basis of the Qtotal test statistic. Hedges' g was calculated for outcomes of interest between baseline and postintervention separately for studies with multiple versus single conditions. Continuous and categorical moderators were also examined. RESULTS A total of 1,103 articles were screened, of which 117 were included in the narrative synthesis and 105 in the meta-analysis (n=49,276 youth). The overall effects for RCT/quasi-experimental studies on BMI status (g= -0.15, SE=0.03, 95% CI= -0.20, -0.10), waist circumference (g= -0.15, SE=0.10, 95% CI= -0.35, -0.05), physical activity (g=0.12, SE=0.05, 95% CI=0.03, 0.22), fruit and vegetable intake (g=0.08, SE=0.02, 95% CI=0.03, 0.12), and sugar-sweetened beverage intake (g= -0.07, SE= 0.03, 95% CI= -0.13, -0.01) were small. Intervention effects varied by participant developmental stage, SES, study setting, and lifestyle behavior target. DISCUSSION Beyond developing more impactful interventions to address obesity among Hispanic youth, findings highlight the need for targeted policies and more easily disseminable interventions that can spread small effects across a population for maximal public health impact.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
| | - Marissa A Kobayashi
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Blanca S Noriega Esquives
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Manuel A Ocasio
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rachel G Wagstaff
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - David P Dorcius
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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17
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Mandoh M, Redfern J, Mihrshahi S, Cheng HL, Phongsavan P, Partridge SR. Shifting From Tokenism to Meaningful Adolescent Participation in Research for Obesity Prevention: A Systematic Scoping Review. Front Public Health 2022; 9:789535. [PMID: 35004591 PMCID: PMC8734426 DOI: 10.3389/fpubh.2021.789535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Traditionally, adolescent participation in research has been tokenistic. Adolescents are rarely afforded the opportunity to influence decision-making in research designed to prevent obesity. Engaging adolescents in meaningful decision-making may enhance research translation. This review aimed to analyze the current modes and nature of adolescent participation in obesity prevention research decision-making. Methods: A systematic scoping review was conducted using Arksey and O'Malley's six-stage framework. Six major databases were searched for peer-reviewed primary research studies with adolescent participation related to obesity, physical activity, and diet. Modes of adolescent participation were categorized based on the Lansdown-UNICEF conceptual framework for measuring outcomes of adolescent participation. The framework outlines three modes of meaningful participation: (i) consultative, which involves taking opinions and needs into consideration; (ii) collaborative, where adolescents are partners in the decision-making process; and (iii) adolescent-led participation where adolescents have the capacity to influence the process and outcomes. The degree of involvement in research cycles was classified based on the National Health and Medical Research Council consumer engagement framework. Five stages of the research cycle were determined: identify, design and develop, conduct, analyze and disseminate. Results: In total, 126 papers describing 71 unique studies were identified. Of these, 69% (49/71) took place in the USA, and 85% (52/61) were conducted in minority or underserved communities, while males were more likely to be under-represented. In 49% (35/71) of studies, participation was consultative and 9% (6/71) of studies involved an adolescent-led approach. Furthermore, 87% (62/71) of studies incorporated adolescent participation in one or more of the research cycle's formative phases, which involve eliciting views, opinions and idea generation. Only 11% of studies engaged adolescents in all five stages of the research cycle where adolescents could have more influence over the research process. Conclusion: Meaningful adolescent participation in the obesity prevention research cycle is limited. Empowering and mobilizing equal partnership with adolescents should be at the forefront of all adolescent-related obesity prevention research.
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Affiliation(s)
- Mariam Mandoh
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, The University of New South Wales, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Hoi Lun Cheng
- Sydney Medical School, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Academic Department of Adolescent Medicine, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephanie R Partridge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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18
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Liu Z, Gao P, Gao AY, Lin Y, Feng XX, Zhang F, Xu LQ, Niu WY, Fang H, Zhou S, Li WH, Yuan JH, Xu CX, Wu N, Li HJ, Wen LM, Patton GC, Wang HJ, Wu YF. Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial. JAMA Pediatr 2022; 176:e214375. [PMID: 34747972 PMCID: PMC8576631 DOI: 10.1001/jamapediatrics.2021.4375] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE A rapid nutritional transition has caused greater childhood obesity prevalence in many countries, but the repertoire of effective preventive interventions remains limited. OBJECTIVE To determine the effectiveness of a novel multifaceted intervention for obesity prevention in primary school children. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial was conducted during a single school year (from September 11, 2018, to June 30, 2019) across 3 socioeconomically distinct regions in China according to a prespecified trial protocol. Twenty-four schools were randomly allocated (1:1) to the intervention or the control group, with 1392 eligible children aged 8 to 10 years participating. Data from the intent-to-treat population were analyzed from October 1 to December 31, 2019. INTERVENTIONS A multifaceted intervention targeted both children (promoting healthy diet and physical activity) and their environment (engaging schools and families to support children's behavioral changes). The intervention was novel in its strengthening of family involvement with the assistance of a smartphone app. The control schools engaged in their usual practices. MAIN OUTCOMES AND MEASURES The primary outcome was the change in body mass index (BMI; calculated as weight in kilograms divided by height in square meters) from baseline to the end of the trial. Secondary outcomes included changes in adiposity outcomes (eg, BMI z score, prevalence of obesity), blood pressure, physical activity and dietary behaviors, obesity-related knowledge, and physical fitness. Generalized linear mixed models were used in the analyses. RESULTS Among the 1392 participants (mean [SD] age, 9.6 [0.4] years; 717 boys [51.5%]; mean [SD] BMI, 18.6 [3.7]), 1362 (97.8%) with follow-up data were included in the analyses. From baseline to the end of the trial, the mean BMI decreased in the intervention group, whereas it increased in the control group; the mean between-group difference in BMI change was -0.46 (95% CI, -0.67 to -0.25; P < .001), which showed no evidence of difference across different regions, sexes, maternal education levels, and primary caregivers (parents vs nonparents). The prevalence of obesity decreased by 27.0% of the baseline figure (a relative decrease) in the intervention group, compared with 5.6% in the control group. The intervention also improved other adiposity outcomes, dietary, sedentary, and physical activity behaviors, and obesity-related knowledge, but it did not change moderate- to vigorous-intensity physical activity, physical fitness, or blood pressure. No adverse events were observed during the intervention. CONCLUSIONS AND RELEVANCE The multifaceted intervention effectively reduced the mean BMI and obesity prevalence in primary school children across socioeconomically distinct regions in China, suggesting its potential for national scaling. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03665857.
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Affiliation(s)
- Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ai-Yu Gao
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Yi Lin
- Urumqi Primary and Secondary School Health Care Center, Xinjiang, China
| | | | - Fang Zhang
- Mentougou Primary and Secondary School Health Care Center, Beijing, China
| | - Li-Qun Xu
- Center of Excellence for mHealth and Smart Healthcare, China Mobile Research Institute, China Mobile Communications Corporation, Beijing, China
| | - Wen-Yi Niu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Wen-Hao Li
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | | | - Chun-Xia Xu
- Urumqi Primary and Secondary School Health Care Center, Xinjiang, China
| | - Na Wu
- Center of Excellence for mHealth and Smart Healthcare, China Mobile Research Institute, China Mobile Communications Corporation, Beijing, China
| | - Hui-Juan Li
- Peking University Clinical Research Institute, Beijing, China
| | - Li-Ming Wen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - George C. Patton
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yang-Feng Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China,Peking University Clinical Research Institute, Beijing, China
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19
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Kobes A, Kretschmer T, Timmerman MC. Prevalence of overweight among Dutch primary school children living in JOGG and non-JOGG areas. PLoS One 2021; 16:e0261406. [PMID: 34919583 PMCID: PMC8682899 DOI: 10.1371/journal.pone.0261406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background One of the most influential integrated approaches towards reducing childhood obesity is EPODE, a program that has been translated to over 20 different countries worldwide. Aim The goal of this study was to explore how JOGG–the Dutch EPODE adaptation–might reduce overweight prevalence among children. Methods To compare whether overweight prevalence was different in JOGG areas vs. non-JOGG areas, in long-term JOGG areas vs. short-term JOGG areas, and in low SES JOGG areas vs. middle/high SES JOGG areas, secondary anthropometric and personal data of 209,565 Dutch children were mapped onto publicly available JOGG data. Results Findings showed that overweight prevalence decreased from 25.17% to 16.08% in JOGG-areas, and from 32.31% to 18.43% in long-term JOGG areas. However, when taking into account SES, the decrease in prevalence was mainly visible in low SES long-term JOGG areas. Conclusion JOGG appeared to be successful in targeting areas where overweight was most prevalent. Low SES areas that had implemented JOGG for a longer period of time, i.e., six years, appeared to be successful in decreasing overweight prevalence.
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Affiliation(s)
- Annita Kobes
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Tina Kretschmer
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Margaretha C. Timmerman
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
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20
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Kristoffersen MJ, Michelsen SI, Rasmussen M, Due P, Thygesen LC, Krølner RF. Study Protocol for Evaluation of an Extended Maintenance Intervention on Life Satisfaction and BMI Among 7-14-Year-Old Children Following a Stay at a Residential Health Camp in Denmark. Front Public Health 2021; 9:733144. [PMID: 34900891 PMCID: PMC8651483 DOI: 10.3389/fpubh.2021.733144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background: It is challenging to maintain effects of public health interventions. For residential health camps benefits often disappear as the child returns home. Furthermore, long-term effects are often not measured or reported. This paper presents the study protocol for an evaluation of an extended maintenance intervention offered to children who have completed a 10-week residential health camp at one of the five Danish Christmas Seal Houses (DCSH). The target group of DSCH is 7–14-year-olds with social, mental, and/or overweight issues and the overall aim of the camp is to increase life satisfaction and a healthy lifestyle. The primary aim of this study is to assess the effectiveness of the maintenance intervention on children's life satisfaction (primary outcome) and BMI Z-score (secondary outcome) 1 year after health camp. Methods: The extended maintenance intervention is developed by DCSH and delivered to each child and family individually by an intervention coordinator to help children maintain positive benefits of the health camp on life satisfaction and health behaviors after returning to their homes. Intervention activities target the child and the family. The effect will be tested in a quasi-experimental design: The intervention is offered to half of the children at one of the five DSCH (intervention group, N~144) while the other half and the children at the other four DSCH receive a standard maintenance intervention (control group, N~894). Children will complete questionnaires on life satisfaction measured by an adapted version of the Cantril ladder and height and weight prior to health camp, at the end of health camp, 3 months and 1 year after the end of health camp. To enable per protocol analysis and nuanced interpretation of effect estimates, we will monitor the implementation of the intervention by a process evaluation study among children, parents, and follow up coordinators using qualitative and quantitative methods. Discussion: We present a systematic approach to evaluating practice-based interventions in a research design. The study will provide new knowledge on the effectiveness of individualized maintenance interventions on long-term effects on life satisfaction and weight loss among children. Trial registration: Prospectively registered at Current Controlled Trials ISRCTN 13011465 https://www.isrctn.com/ISRCTN13011465
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Affiliation(s)
| | - Susan Ishøy Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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21
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Bernstein R, Sanchez N, Clark ELM, Conte I, Gulley LD, Legget KT, Cornier MA, Melby C, Johnson SA, Lucas-Thompson R, Shomaker LB. Mindfulness-based intervention in adolescents at risk for excess weight gain: 1.5-year follow-up of pilot randomized controlled trial. Eat Behav 2021; 43:101580. [PMID: 34775283 PMCID: PMC8691759 DOI: 10.1016/j.eatbeh.2021.101580] [Citation(s) in RCA: 3] [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: 07/20/2020] [Revised: 10/07/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mindfulness-based intervention (MBI) may offer a novel means of preventing excess weight gain in adolescents, theoretically by decreasing stress-eating through altering executive functioning (EF) and food-reward sensitivity. METHODS N = 54 12-17y girls and boys at-risk for excess weight gain (i.e., BMI ≥70th percentile or two biological parents with reported obesity [BMI ≥30 kg/m2]) participated in a 1.5-year follow-up of a pilot randomized controlled trial comparing 6-week/6-session MBI (n = 29) and a health education (HE) control (n = 25). Laboratory stress-eating, food-reward sensitivity, EF, perceived stress, and BMI/adiposity were re-assessed at 1.5-years with validated measures. Changes from baseline to 1.5-year follow-up were explored with ANCOVA, accounting for the respective baseline outcome, age, and sex. RESULTS Compared to MBI (M = -21, SE = 59), HE had greater increases in stress-eating from baseline to 1.5-years (M = 194, SE = 63, Cohen's d = 0.59, p = .01). There were no other between-condition differences. DISCUSSION MBI may prevent worsening stress-eating for adolescents at-risk for excess weight gain. The potential for MBI as an intervention for stress-eating and ultimately, weight stabilization warrants testing in an adequately-powered trial.
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Affiliation(s)
- Ruth Bernstein
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Natalia Sanchez
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Emma L M Clark
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Isabella Conte
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Lauren D Gulley
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Kristina T Legget
- Department of Psychiatry, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17(th) Pl, Aurora, CO 80045, United States; Research Service, Rocky Mountain Regional VA Medical Center, 1700 N. Wheeling St., Aurora, CO 80045, United States
| | - Marc-Andre Cornier
- Division of Endocrinology, Metabolism & Diabetes, Department of Medicine, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17(th) Pl, 80045 Aurora, CO, United States
| | - Christopher Melby
- Food Science & Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO 80523, United States
| | - Sarah A Johnson
- Food Science & Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO 80523, United States
| | - Rachel Lucas-Thompson
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States; Community & Behavioral Health, Colorado School of Public Health, 13001 E. 17(th) Pl, Aurora, CO 80045, United States
| | - Lauren B Shomaker
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States; Community & Behavioral Health, Colorado School of Public Health, 13001 E. 17(th) Pl, Aurora, CO 80045, United States.
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22
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Mingay E, Hart M, Yoong S, Hure A. Why We Eat the Way We Do: A Call to Consider Food Culture in Public Health Initiatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11967. [PMID: 34831723 PMCID: PMC8623951 DOI: 10.3390/ijerph182211967] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
Abstract
The way we eat has changed dramatically in only a few decades. While definitions of food culture have previously existed, a clear description of modern food culture that can be used for health promotion is lacking. In this paper, we propose a concept of food culture for application within public health, what a positive food culture looks like compared to negative elements that have dominated in developed countries and the consequences for physical and mental health and wellbeing. We support calls to action from the international community to reconsider the way we eat. All segments of society have a role to play in building a positive food culture, and it is critical that macro (policy and systems) and meso (community) level environmental factors align and provide supportive environments that promote health-enhancing behaviours. Defining food culture is a necessary step towards articulating the complexities that influence food behaviours and impact health. The ultimate goal is collective action to enable population-wide and sustained improvements to the way we eat, and how we think and feel about food.
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Affiliation(s)
- Edwina Mingay
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia; (S.Y.); (A.H.)
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Melissa Hart
- School of Health Sciences, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Mental Health Service, Waratah, Newcastle, NSW 2298, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia; (S.Y.); (A.H.)
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Hunter New England Population Health, Wallsend, Newcastle, NSW 2287, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Melbourne, VIC 3122, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia; (S.Y.); (A.H.)
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
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23
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School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies. Br J Nutr 2021; 126:1373-1379. [PMID: 33441203 DOI: 10.1017/s0007114521000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.
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24
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Peña S, Carranza M, Cuadrado C, Parra DC, Villalobos Dintrans P, Castillo C, Cortinez-O'Ryan A, Espinoza P, Müller V, Rivera C, Genovesi R, Riesco J, Kontto J, Cerda R, Zitko P. Effectiveness of a Gamification Strategy to Prevent Childhood Obesity in Schools: A Cluster Controlled Trial. Obesity (Silver Spring) 2021; 29:1825-1834. [PMID: 34533295 DOI: 10.1002/oby.23165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity. METHODS Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months. RESULTS: A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found. CONCLUSIONS The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
- Doctoral Programme for Population Health, University of Helsinki, Helsinki, Finland
| | | | - Cristóbal Cuadrado
- Programa de Políticas, Sistemas y Gestión en Salud. Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
- Centre for Health Economics, University of York, York, UK
| | - Diana C Parra
- Program of Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Pablo Villalobos Dintrans
- Facultad de Ciencias Médicas, Programa Centro de Salud Pública, Universidad de Santiago, Santiago, Chile
| | | | - Andrea Cortinez-O'Ryan
- Departamento de Educación Física, Deportes y Recreación, Universidad de la Frontera, Temuco, Chile
| | - Paula Espinoza
- Santiago Sano Program, Municipality of Santiago, Santiago, Chile
| | - Valeska Müller
- Santiago Sano Program, Municipality of Santiago, Santiago, Chile
| | - Cristián Rivera
- Santiago Sano Program, Municipality of Santiago, Santiago, Chile
| | | | | | - Jukka Kontto
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ricardo Cerda
- Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Pedro Zitko
- Health Service & Population Research Department, Institute of Psychiatry, Psychology Neuroscience, King's College, London, UK
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25
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Moorman EL, Koskela-Staples NC, Mathai BB, Fedele DA, Janicke DM. Pediatric Obesity Treatment via Telehealth: Current Evidence and Future Directions. Curr Obes Rep 2021; 10:371-384. [PMID: 34302603 DOI: 10.1007/s13679-021-00446-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Telehealth delivery of pediatric weight management interventions may address time, travel, and cost barriers to in-person interventions, thus improving accessibility. This narrative review highlights findings from the past 5 years of pediatric lifestyle interventions for weight management that utilize telehealth for treatment delivery. We describe impressions and future directions. RECENT FINDINGS We identified and included 20 studies that described unique interventions from the past 5 years. The majority of reviewed studies indicated statistically significant reductions in BMI z-scores, high retention and attendance, and high satisfaction. However, mean decreases in BMI z-scores were marginal (approximately 0.10) in all but two studies. Studies did not often report effect sizes. Pediatric telehealth weight management interventions demonstrate good feasibility and acceptability. Improvement in reporting results and more rigorous research, including use of randomized designs, recruitment of larger samples, and incorporation of extended follow-up is needed to determine clinical impact and magnitude of effects.
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Affiliation(s)
- Erin L Moorman
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Babetta B Mathai
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
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26
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Kieslinger K, Wartha O, Pollatos O, Steinacker JM, Kobel S. Parental Self-Efficacy-A Predictor of Children's Health Behaviors? Its Impact on Children's Physical Activity and Screen Media Use and Potential Interaction Effect Within a Health Promotion Program. Front Psychol 2021; 12:712796. [PMID: 34456826 PMCID: PMC8397494 DOI: 10.3389/fpsyg.2021.712796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Insufficient physical activity (PA) and increased screen media use (SMU) can have detrimental effects on children's health. Parental self-efficacy (PSE) can act as an important predictor for a healthy upbringing. The aim of this study was to investigate the influence of PSE on children's PA and SMU. Additionally, a moderating effect of PSE on the intervention effect of the health promotion program “Join the Healthy Boat” was examined. Using a prospective randomized controlled trial, 558 kindergarten children (3.6 years [SD = 0.6]) were examined. Data was collected using parental self-report. A significant influence of PSE on children's PA (B = 0.33, p = 0.025) and children's SMU (B = 0.42, p = 0.006) was found. The moderating effect of PSE on the intervention effect was neither significantly related to children's PA (p = 0.360) nor to children's SMU (p = 0.531). This confirms the importance of PSE on children's health development. Despite the lack of a moderating effect, interventions should also promote healthy activity behaviors and self-efficacy for parents in order to engage children in a healthy lifestyle.
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Affiliation(s)
- Katrin Kieslinger
- Department Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
| | - Olga Pollatos
- Department Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
| | - Susanne Kobel
- Division of Sports and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
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27
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Kalarchian MA, Hammer J, Kapuścińska A. Fostering Innovation in Prevention and Treatment of Obesity in Youth: Digitally Mediated Physical Play as an Exemplar. Obesity (Silver Spring) 2021; 29:475-477. [PMID: 33538095 DOI: 10.1002/oby.23113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022]
Abstract
Novel approaches to obesity prevention among youth are needed. Accordingly, the Office of Women's Health, Department of Health and Human Services, sponsored a challenge to create an interactive video game for obesity prevention. Our team took a theory-based, evidence-informed approach to increasing physical activity in girls. Our approach-digitally mediated physical play-allowed us to include computing-based strategies that promote activity without keeping players in front of a screen. Our prize-winning prototype app, Frolic, helps girls choose the perfect game to play in any context, engaging parents for support. The app is used to highlight some opportunities and challenges for interdisciplinary collaboration. However, much work remains to be done to deploy innovative digital obesity interventions and fully capture the contributions of these tools. In order to accelerate advances, funding is needed for projects that combine engineering design principles with traditional obesity research paradigms.
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Affiliation(s)
| | - Jessica Hammer
- Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Entertainment Technology Center, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Adela Kapuścińska
- Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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28
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Podnar H, Jurić P, Karuc J, Saez M, Barceló MA, Radman I, Starc G, Jurak G, Đurić S, Potočnik ŽL, Sorić M. Comparative effectiveness of school-based interventions targeting physical activity, physical fitness or sedentary behaviour on obesity prevention in 6- to 12-year-old children: A systematic review and meta-analysis. Obes Rev 2021; 22:e13160. [PMID: 33462934 DOI: 10.1111/obr.13160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022]
Abstract
A systematic search of the literature was performed to compare the effects of interventions that targeted sedentary behaviours or physical activity (PA) or physical fitness on primary prevention of obesity in 6- to 12-year-old children. The search identified 146 reports that provided relevant data for meta-analysis. Point estimates in % body fat were higher for fitness interventions compared with PA interventions (standardized mean difference = -0.11%; 95% CI = -0.26 to 0.04, and -0.04%; 95% CI = -0.15 to 0.06, respectively). Including sedentary behaviour to a PA- or fitness-oriented intervention was not accompanied by an increase in intervention effectiveness, as the point estimates were slightly smaller compared with those for PA- or fitness-only interventions. Overall, the effects tended to be larger in girls than in boys, especially for PA + sedentary behaviour interventions. There was some evidence for inequality, as the effects on body mass index were seen when interventions were delivered in the general population (standardized mean difference = -0.05, 95% CI = -0.07 to -0.02), but not in groups of disadvantaged children (standardized mean difference = -0.01, 95% CI = -0.29 to 0.19). In conclusion, school-based PA interventions appear to be an effective strategy in the primary prevention of childhood obesity among 6- to 12-year-old children, but targeting sedentary behaviour in addition to PA or fitness does not increase the effectiveness of the intervention.
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Affiliation(s)
- Hrvoje Podnar
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Petra Jurić
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Josip Karuc
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Maria A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Ivan Radman
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor Jurak
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Đurić
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | | | - Maroje Sorić
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia.,Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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29
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Fernández-Ruiz VE, Solé-Agustí M, Armero-Barranco D, Cauli O. Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I 2AO 2 Family Program: A Randomized Controlled Clinical Trial. Biol Res Nurs 2021; 23:488-503. [PMID: 33517762 DOI: 10.1177/1099800420987303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.
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Affiliation(s)
- Virginia E Fernández-Ruiz
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Clinic Hospital Murcia, Spain.,Nursing Department, Faculty of Nursing, Calle Campus Universitario, 16751University of Murcia, Spain
| | | | - David Armero-Barranco
- Nursing Department, Faculty of Nursing, Calle Campus Universitario, 16751University of Murcia, Spain
| | - Omar Cauli
- Nursing Department, Faculty of Nursing and Podiatrics, 16781University of Valencia, Spain
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Jacob CM, Hardy-Johnson PL, Inskip HM, Morris T, Parsons CM, Barrett M, Hanson M, Woods-Townsend K, Baird J. A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. Int J Behav Nutr Phys Act 2021; 18:1. [PMID: 33397403 PMCID: PMC7784329 DOI: 10.1186/s12966-020-01065-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. METHODS A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. RESULTS Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. CONCLUSIONS Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.
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Affiliation(s)
- Chandni Maria Jacob
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.
- Institute of Developmental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Mail point 887, Tremona Road, Southampton, SO16 6YD, UK.
| | - Polly Louise Hardy-Johnson
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK.
| | - Hazel M Inskip
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Taylor Morris
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Camille M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Millie Barrett
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Mark Hanson
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- Institute of Developmental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Mail point 887, Tremona Road, Southampton, SO16 6YD, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Janis Baird
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
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Vazquez CE, Cubbin C. Socioeconomic Status and Childhood Obesity: a Review of Literature from the Past Decade to Inform Intervention Research. Curr Obes Rep 2020; 9:562-570. [PMID: 32785878 DOI: 10.1007/s13679-020-00400-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This is a review of the patterns, conceptualization, and suggested mechanisms underlying the relationship of socioeconomic status (SES) to obesity in childhood and the implications of these data for interventions going forward. RECENT FINDINGS Adiposity and SES are negatively associated in high-income countries and positively associated in medium to low-income countries. Several mechanisms, such as early introduction of solid food and parental behaviors, which may explain the association of SES and adiposity, have been identified. Parental education and adiposity and early pediatric nutrition appear to be particularly salient SES-related effectors on adiposity. There is a clear association of SES and adiposity which is affected by population affluence. Evaluation of the relationship of SES and obesity in children are complicated by the complexity of SES and lack of common definition. A number of SES-related interventional targets have been identified. Intervention research should ensure they are addressing SES-associated issues in the study population.
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Affiliation(s)
- Christian E Vazquez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
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Effect of omega-3 fatty acids supplementation on anthropometric indices in children and adolescents: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2020; 53:102487. [PMID: 33066870 DOI: 10.1016/j.ctim.2020.102487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/02/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
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Fröberg A, Lindroos A, Ekblom Ö, Nyberg G. Organised physical activity during leisure time is associated with more objectively measured physical activity among Swedish adolescents. Acta Paediatr 2020; 109:1815-1824. [PMID: 31977109 DOI: 10.1111/apa.15187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/09/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Abstract
AIM The aim of this study was to investigate associations between participation in organised physical activity (PA), such as sport and exercise during leisure time, and objectively measured PA and sedentary time in a large representative sample of Swedish adolescents. METHODS This study was part of the school-based cross-sectional Swedish national dietary survey Riksmaten Adolescents 2016-17. Data from 3477 adolescents aged 11-12, 14-15 and 17-18 years were used in the analyses. Participation in organised PA and parental education were reported in questionnaires. PA and sedentary time were objectively measured through accelerometry during seven consecutive days. RESULTS Adolescents who participated in organised PA had significantly higher total PA (14%, P < .001), more time spent on moderate-to-vigorous PA (MVPA) (8 minutes, P < .001) and had less sedentary time (15 minutes, P < .001). Those who participated in organised PA were more likely to reach recommended PA levels. Total PA and MVPA did not differ by parental education among those who participated in organised PA. CONCLUSION Adolescents who participated in organised PA were more physically active, less sedentary and more likely to reach PA recommendations than those who did not.
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Affiliation(s)
- Andreas Fröberg
- Department of Food and Nutrition and Sport Science University of Gothenburg Gothenburg Sweden
| | - Anna‐Karin Lindroos
- Swedish Food Agency Uppsala Sweden
- Department of Internal Medicine and Clinical Nutrition Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Örjan Ekblom
- The Swedish School of Sport and Health Sciences Stockholm Sweden
| | - Gisela Nyberg
- The Swedish School of Sport and Health Sciences Stockholm Sweden
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
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Salam RA, Padhani ZA, Das JK, Shaikh AY, Hoodbhoy Z, Jeelani SM, Lassi ZS, Bhutta ZA. Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E2208. [PMID: 32722112 PMCID: PMC7468898 DOI: 10.3390/nu12082208] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: -0.12; 95% CI: -0.18 to -0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: -0.41 kg/m2; 95% CI: -0.60 to -0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: -1.59; 95% CI: -2.95 to -0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: -0.07; 95% CI: -0.14 to -0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: -0.08; 95% CI: -0.16 to -0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: -0.13; 95% CI: -0.25 to -0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: -0.13; 95% CI: -0.20 to -0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: -0.88; 95% CI: -1.265 to -0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: -3.01; 95% CI: -5.56 to -0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: -0.08; 95% CI: -0.16 to -0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: -0.16; 95% CI: -0.26 to -0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: -0.09; 95% CI: -0.14 to -0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.
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Affiliation(s)
- Rehana A. Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Zahra A. Padhani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Jai K. Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Amina Y. Shaikh
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Zahra Hoodbhoy
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Sarah Masroor Jeelani
- Department of Trauma & Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust Victoria Rd, Macclesfield SK10 3BL, UK;
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Gray JC, Schvey NA, Tanofsky-Kraff M. Demographic, psychological, behavioral, and cognitive correlates of BMI in youth: Findings from the Adolescent Brain Cognitive Development (ABCD) study. Psychol Med 2020; 50:1539-1547. [PMID: 31288867 DOI: 10.1017/s0033291719001545] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous research has implicated demographic, psychological, behavioral, and cognitive variables in the onset and maintenance of pediatric overweight/obesity. No adequately-powered study has simultaneously modeled these variables to assess their relative associations with body mass index (BMI; kg/m2) in a nationally representative sample of youth. METHODS Multiple machine learning regression approaches were employed to estimate the relative importance of 43 demographic, psychological, behavioral, and cognitive variables previously associated with BMI in youth to elucidate the associations of both fixed (e.g. demographics) and potentially modifiable (e.g. psychological/behavioral) variables with BMI in a diverse representative sample of youth. The primary analyses consisted of 9-10 year olds divided into a training (n = 2724) and test (n = 1123) sets. Secondary analyses were conducted by sex, ethnicity, and race. RESULTS The full sample model captured 12% of the variance in both the training and test sets, suggesting good generalizability. Stimulant medications and demographic factors were most strongly associated with BMI. Lower attention problems and matrix reasoning (i.e. nonverbal abstract problem solving and inductive reasoning) and higher social problems and screen time were robust positive correlates in the primary analyses and in analyses separated by sex. CONCLUSIONS Beyond demographics and stimulant use, this study highlights abstract reasoning as an important cognitive variable and reaffirms social problems and screen time as significant correlates of BMI and as modifiable therapeutic targets. Prospective data are needed to understand the predictive power of these variables for BMI gain.
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Affiliation(s)
- Joshua C Gray
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD20814, USA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD20814, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD20814, USA
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Lima RA, Andersen LB, Soares FC, Kriemler S. The causal pathway effects of a physical activity intervention on adiposity in children: The KISS Study cluster randomized clinical trial. Scand J Med Sci Sports 2020; 30:1685-1691. [PMID: 32501613 PMCID: PMC7496602 DOI: 10.1111/sms.13741] [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: 03/13/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022]
Abstract
Background Very little information on the potential mechanisms of the physical activity interventions effects on adiposity is available. We evaluated the possible mediating factors of a physical activity school‐based intervention on the sum of skinfolds in children. Methods This is a cluster randomized trial, secondary analysis of the KISS study. Children (n = 499) from the first and fifth grades were randomly assigned to intervention or control group. Adiposity was estimated by four skinfolds, aerobic fitness assessed by the shuttle run test, and insulin, triglycerides, total cholesterol, high‐density lipoprotein (HDL), and glucose collected via fasting blood samples. Results The intervention affected aerobic fitness (0.140 SD, 95% CI 0.011 to 0.270), triglycerides (0.217 SD, 95% CI −0.409 to −0.025), cholesterol/HDL ratio (−0.191 SD, 95% CI −0.334 to −0.047), glucose (−0.330 SD, 95% CI −0.538 to −0.121), and skinfolds (−0.122 SD, 95% CI −0.189 to −0.056). No intervention effect on insulin was found. We observed that changes in aerobic fitness impacted children's triglycerides and cholesterol/HDL ratio and consecutively the glucose levels mediating 30% of the intervention effect on skinfolds. Conclusions Our findings provided evidence of the positive metabolic distress caused by a physical activity intervention on adiposity levels in children.
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Affiliation(s)
- Rodrigo Antunes Lima
- Institute of Sports Science, University of Graz, Graz, Austria.,Research Group on Lifestyles and Health, University of Pernambuco, Recife, Brazil
| | - Lars Bo Andersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Faculty of Education, Arts and Sport, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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Dickens CE, Safer DL, Runfola CD, Gibbs EL, Welch H, Sadeh-Sharvit S. The offspring of parents undergoing a weight loss surgery: a systematic review. Surg Obes Relat Dis 2020; 16:806-815. [PMID: 32334972 DOI: 10.1016/j.soard.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
The offspring of parents with obesity are at an increased risk of developing this condition themselves because of genetic and environmental factors. One subgroup that may be at particularly high risk of developing obesity is the offspring of parents who have undergone weight loss surgery (PWLS). To date, little research has focused on these offspring or their parents. This systematic review addresses this gap by integrating available literature and assessing the quality of the evidence. To be included, studies were required to have researched characteristics of the offspring of PWLS or parental feeding practices within this population. After review, 12 studies met inclusion criteria. Findings include evidence for heightened risk of obesity among children of PWLS. However, research suggests these children may experience positive, although time-limited, health outcomes after their parents' surgeries. Quality of the evidence was rated as low, primarily because of the lack of randomized controlled studies and information regarding available interventions specifically targeting this vulnerable population. This review underscores the need for research to improve understanding of PWLS families to better support them and capitalize on postbariatric surgery benefits.
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Affiliation(s)
- Caroline E Dickens
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Elise L Gibbs
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Hannah Welch
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.
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Mâsse LC, Vlaar J, Macdonald J, Bradbury J, Warshawski T, Buckler EJ, Hamilton J, Ho J, Buchholz A, Morrison KM, Ball GDC. Aim2Be mHealth intervention for children with overweight and obesity: study protocol for a randomized controlled trial. Trials 2020; 21:132. [PMID: 32014057 PMCID: PMC6998843 DOI: 10.1186/s13063-020-4080-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens. Purpose The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10- to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention. Methods We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019–2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy. Discussion Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management. Trial registration ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.
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Affiliation(s)
- Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, F508 - 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Janae Vlaar
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, F508 - 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Janice Macdonald
- Childhood Obesity Foundation, Robert HN Ho Research Centre, 771A - 2635 Laurel Street, VGH Hospital Campus, Vancouver, BC, V5 1M9, Canada
| | - Jennifer Bradbury
- Childhood Obesity Foundation, Robert HN Ho Research Centre, 771A - 2635 Laurel Street, VGH Hospital Campus, Vancouver, BC, V5 1M9, Canada
| | - Tom Warshawski
- Childhood Obesity Foundation, Robert HN Ho Research Centre, 771A - 2635 Laurel Street, VGH Hospital Campus, Vancouver, BC, V5 1M9, Canada
| | - E Jean Buckler
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, F508 - 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Jill Hamilton
- Division of Endocrinology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON,, M5G 1X8, Canada
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, 1280 Main Street W., HSC-3A, Hamilton, ON, L8S 4K1,, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 1C9, Canada
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Kaiser KA, Carson TL, Dhurandhar EJ, Neumeier WH, Cardel MI. Biobehavioural approaches to prevention and treatment: A call for implementation science in obesity research. Obes Sci Pract 2020; 6:3-9. [PMID: 32128237 PMCID: PMC7042105 DOI: 10.1002/osp4.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022] Open
Abstract
Much progress has been made in the last 30 years in understanding the causes and mechanisms that contribute to obesity, yet widely available and successful strategies for prevention and treatment remain elusive at population levels. This paper discusses the biobehavioural framework and provides suggestions for applying it to enable greater progress in the science of obesity prevention and treatment, including an increased focus on implementation of science strategies. The objective is to promote a re-evaluation of current views about preventing and treating obesity within a unified biobehavioural framework. Further integration of research exploring how both behavioural and biological components interact is a critical step forward.
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Affiliation(s)
- Kathryn A. Kaiser
- Department of Health Behavior, School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabama
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
| | - Tiffany L. Carson
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
- Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Emily J. Dhurandhar
- Department of Kinesiology and Sport ManagementTexas Tech UniversityLubbockTexas
| | - William H. Neumeier
- United States Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Michelle I. Cardel
- Department of Health Outcomes & Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFlorida
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Morgan EH, Schoonees A, Sriram U, Faure M, Seguin‐Fowler RA. Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors. Cochrane Database Syst Rev 2020; 1:CD012547. [PMID: 31902132 PMCID: PMC6956675 DOI: 10.1002/14651858.cd012547.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Poor diet and insufficient physical activity are major risk factors for non-communicable diseases. Developing healthy diet and physical activity behaviors early in life is important as these behaviors track between childhood and adulthood. Parents and other adult caregivers have important influences on children's health behaviors, but whether their involvement in children's nutrition and physical activity interventions contributes to intervention effectiveness is not known. OBJECTIVES • To assess effects of caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors, including those intended to prevent overweight and obesity • To describe intervention content and behavior change techniques employed, drawing from a behavior change technique taxonomy developed and advanced by Abraham, Michie, and colleagues (Abraham 2008; Michie 2011; Michie 2013; Michie 2015) • To identify content and techniques related to reported outcomes when such information was reported in included studies SEARCH METHODS: In January 2019, we searched CENTRAL, MEDLINE, Embase, 11 other databases, and three trials registers. We also searched the references lists of relevant reports and systematic reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of interventions to improve children's dietary intake or physical activity behavior, or both, with children aged 2 to 18 years as active participants and at least one component involving caregivers versus the same interventions but without the caregiver component(s). We excluded interventions meant as treatment or targeting children with pre-existing conditions, as well as caregiver-child units residing in orphanages and school hostel environments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures outlined by Cochrane. MAIN RESULTS We included 23 trials with approximately 12,192 children in eligible intervention arms. With the exception of two studies, all were conducted in high-income countries, with more than half performed in North America. Most studies were school-based and involved the addition of healthy eating or physical education classes, or both, sometimes in tandem with other changes to the school environment. The specific intervention strategies used were not always reported completely. However, based on available reports, the behavior change techniques used most commonly in the child-only arm were "shaping knowledge," "comparison of behavior," "feedback and monitoring," and "repetition and substitution." In the child + caregiver arm, the strategies used most commonly included additional "shaping knowledge" or "feedback and monitoring" techniques, as well as "social support" and "natural consequences." We considered all trials to be at high risk of bias for at least one design factor. Seven trials did not contribute any data to analyses. The quality of reporting of intervention content varied between studies, and there was limited scope for meta-analysis. Both validated and non-validated instruments were used to measure outcomes of interest. Outcomes measured and reported differed between studies, with 16 studies contributing data to the meta-analyses. About three-quarters of studies reported their funding sources; no studies reported industry funding. We assessed the quality of evidence to be low or very low. Dietary behavior change interventions with a caregiver component versus interventions without a caregiver component Seven studies compared dietary behavior change interventions with and without a caregiver component. At the end of the intervention, we did not detect a difference between intervention arms in children's percentage of total energy intake from saturated fat (mean difference [MD] -0.42%, 95% confidence interval [CI] -1.25 to 0.41, 1 study, n = 207; low-quality evidence) or from sodium intake (MD -0.12 g/d, 95% CI -0.36 to 0.12, 1 study, n = 207; low-quality evidence). No trial in this comparison reported data for children's combined fruit and vegetable intake, sugar-sweetened beverage (SSB) intake, or physical activity levels, nor for adverse effects of interventions. Physical activity interventions with a caregiver component versus interventions without a caregiver component Six studies compared physical activity interventions with and without a caregiver component. At the end of the intervention, we did not detect a difference between intervention arms in children's total physical activity (MD 0.20 min/h, 95% CI -1.19 to 1.59, 1 study, n = 54; low-quality evidence) or moderate to vigorous physical activity (MVPA) (standard mean difference [SMD] 0.04, 95% CI -0.41 to 0.49, 2 studies, n = 80; moderate-quality evidence). No trial in this comparison reported data for percentage of children's total energy intake from saturated fat, sodium intake, fruit and vegetable intake, or SSB intake, nor for adverse effects of interventions. Combined dietary and physical activity interventions with a caregiver component versus interventions without a caregiver component Ten studies compared dietary and physical activity interventions with and without a caregiver component. At the end of the intervention, we detected a small positive impact of a caregiver component on children's SSB intake (SMD -0.28, 95% CI -0.44 to -0.12, 3 studies, n = 651; moderate-quality evidence). We did not detect a difference between intervention arms in children's percentage of total energy intake from saturated fat (MD 0.06%, 95% CI -0.67 to 0.80, 2 studies, n = 216; very low-quality evidence), sodium intake (MD 35.94 mg/d, 95% CI -322.60 to 394.47, 2 studies, n = 315; very low-quality evidence), fruit and vegetable intake (MD 0.38 servings/d, 95% CI -0.51 to 1.27, 1 study, n = 134; very low-quality evidence), total physical activity (MD 1.81 min/d, 95% CI -15.18 to 18.80, 2 studies, n = 573; low-quality evidence), or MVPA (MD -0.05 min/d, 95% CI -18.57 to 18.47, 1 study, n = 622; very low-quality evidence). One trial indicated that no adverse events were reported by study participants but did not provide data. AUTHORS' CONCLUSIONS Current evidence is insufficient to support the inclusion of caregiver involvement in interventions to improve children's dietary intake or physical activity behavior, or both. For most outcomes, the quality of the evidence is adversely impacted by the small number of studies with available data, limited effective sample sizes, risk of bias, and imprecision. To establish the value of caregiver involvement, additional studies measuring clinically important outcomes using valid and reliable measures, employing appropriate design and power, and following established reporting guidelines are needed, as is evidence on how such interventions might contribute to health equity.
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Affiliation(s)
- Emily H Morgan
- University of VermontDepartment of Nutrition and Food Sciences225B Marsh Life Science109 Carrigan DriveBurlingtonVTUSA05405
| | - Anel Schoonees
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownWestern CapeSouth Africa7505
| | - Urshila Sriram
- Cornell UniversityDivision of Nutritional Sciences2250 N Triphammer Rd, Apt E8IthacaNew YorkUSA14850
- Texas A&M AgriLife ResearchCollege StationTXUSA
| | - Marlyn Faure
- Stellenbosch UniversityDean's Division, Faculty of Medicine and Health SciencesFrancie van Zijl Drive, ParowCape TownWestern CapeSouth Africa14853
| | - Rebecca A Seguin‐Fowler
- Texas A&M AgriLife ResearchCollege StationTXUSA
- Texas A&M UniversityDepartment of Nutrition and Food Science, College of Agriculture and Life SciencesAgriculture and Life Sciences Building600 John Kimbrough Boulevard, Suite 512College StationTXUSA77843‐2142
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Associations between obesity, asthma and physical activity in children and adolescents. APUNTS SPORTS MEDICINE 2020. [DOI: 10.1016/j.apunsm.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Influence of parenting styles in the context of adolescents' energy balance-related behaviors: Findings from the FLASHE study. Appetite 2019; 142:104364. [DOI: 10.1016/j.appet.2019.104364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/20/2023]
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The CHIRPY DRAGON intervention in preventing obesity in Chinese primary-school--aged children: A cluster-randomised controlled trial. PLoS Med 2019; 16:e1002971. [PMID: 31770371 PMCID: PMC6879117 DOI: 10.1371/journal.pmed.1002971] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In countries undergoing rapid economic transition such as China, rates of increase in childhood obesity exceed that in the West. However, prevention trials in these countries are inadequate in both quantity and methodological quality. In high-income countries, recent reviews have demonstrated that school-based prevention interventions are moderately effective but have some methodological limitations. To address these issues, this study evaluated clinical- and cost- effectiveness of the Chinese Primary School Children Physical Activity and Dietary Behaviour Changes Intervention (CHIRPY DRAGON) developed using the United Kingdom Medical Research Council complex intervention framework to prevent obesity in Chinese primary-school-aged children. METHODS AND FINDINGS In this cluster-randomised controlled trial, we recruited 40 state-funded primary schools from urban districts of Guangzhou, China. A total of 1,641 year-one children with parent/guardian consent took part in baseline assessments prior to stratified randomisation of schools (intervention arm, 20 schools, n = 832, mean age = 6.15 years, 55.6% boys; control arm n = 809, mean age = 6.14 years, 53.3% boys). The 12-month intervention programme included 4 school- and family-based components delivered by 5 dedicated project staff. We promoted physical activity and healthy eating behaviours through educational and practical workshops, family activities, and supporting the school to improve physical activity and food provision. The primary outcome, assessed blind to allocation, was between-arm difference in body mass index (BMI) z score at completion of the intervention. A range of prespecified, secondary anthropometric, behavioural, and psychosocial outcomes were also measured. We estimated cost effectiveness based on quality-adjusted life years (QALYs), taking a public sector perspective. Attrition was low with 55 children lost to follow up (3.4%) and no school dropout. Implementation adherence was high. Using intention to treat analysis, the mean difference (MD) in BMI z scores (intervention - control) was -0.13 (-0.26 to 0.00, p = 0.048), with the effect being greater in girls (MD = -0.18, -0.32 to -0.05, p = 0.007, p for interaction = 0.015) and in children with overweight or obesity at baseline (MD = -0.49, -0.73 to -0.25, p < 0.001, p for interaction < 0.001). Significant beneficial intervention effects were also observed on consumption of fruit and vegetables, sugar-sweetened beverages and unhealthy snacks, screen-based sedentary behaviour, and physical activity in the intervention group. Cost effectiveness was estimated at £1,760 per QALY, with the probability of the intervention being cost effective compared with usual care being at least 95% at a willingness to pay threshold of £20,000 to 30,000 per QALY. There was no evidence of adverse effects or harms. The main limitations of this study were the use of dietary assessment tools not yet validated for Chinese children and the use of the UK value set to estimate QALYS. CONCLUSIONS This school- and family-based obesity prevention programme was effective and highly cost effective in reducing BMI z scores in primary-school-aged children in China. Future research should identify strategies to enhance beneficial effects among boys and investigate the transferability of the intervention to other provinces in China and countries that share the same language and cultures. TRIAL REGISTRATION ISRCTN Identifier ISRCTN11867516.
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Shomaker LB, Berman Z, Burke M, Annameier SK, Pivarunas B, Sanchez N, Smith AD, Hendrich S, Riggs NR, Legget KT, Cornier MA, Melby C, Johnson SA, Lucas-Thompson R. Mindfulness-based group intervention in adolescents at-risk for excess weight gain: A randomized controlled pilot study. Appetite 2019; 140:213-222. [PMID: 31112737 PMCID: PMC6585452 DOI: 10.1016/j.appet.2019.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess feasibility/acceptability of a mindfulness-based approach to excess weight prevention in adolescents at-risk for excess weight gain. To pilot test efficacy of a mindfulness-based intervention for improving food reward sensitivity, stress-eating, executive function (EF), and BMI/adiposity. METHODS A pilot randomized controlled trial was conducted with 12-17y adolescents at-risk for excess weight gain based on above-average weight (body mass index [BMI]≥70%ile) or parental history of obesity (BMI≥30 kg/m2). Adolescents were randomized to a mindfulness-based (n = 29) or health education control group (n = 25) that met for six weekly one-hour sessions. Feasibility/acceptability were determined from attendance and acceptability survey ratings. At baseline, six-week and six-month follow-up, adolescents' perceived stress was measured with the Perceived Stress Scale, food reward sensitivity with a behavioral task, stress-eating during a laboratory test meal, and EF with the parent-reported Behavior Rating Inventory of Executive Function and NIH Toolbox. At the same intervals, BMI indices and body fat by air displacement plethysmography were assessed in a fasted state. RESULTS Median session attendance was 6:6 sessions in both conditions; program acceptability ratings were above-average. Compared to health education, adolescents in mindfulness had lower food reward sensitivity at six-months (Cohen's d = 0.64, p = .01). There were no between-condition differences in BMI (mindfulness vs. health educationΔsix-months 95%CI 0.20, 1.52 kg/m2 vs. 0.21, 1.62 kg/m2) or adiposity (-3.64, -0.61% vs. -4.31, -1.04%) changes. CONCLUSIONS A mindfulness-based group intervention is feasible/acceptable among adolescents at-risk for excess weight. In this pilot sample, mindfulness and health education were equivocal for BMI/adiposity outcomes. Future trials with a larger, adequately-powered sample and longer-term follow-up are necessary to test efficacy of a mindfulness-based intervention for food reward sensitivity, stress-eating, EF, and stabilizing growth trajectories in youth at-risk for adult obesity.
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Affiliation(s)
- Lauren B Shomaker
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States; Community & Behavioral Health, Colorado School of Public Health, 13001 E. 17th Pl, Aurora, CO, 80045, United States.
| | - Zoe Berman
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Morgan Burke
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Shelly K Annameier
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Bernadette Pivarunas
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Natalia Sanchez
- Community & Behavioral Health, Colorado School of Public Health, 13001 E. 17th Pl, Aurora, CO, 80045, United States
| | - Amy D Smith
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Silas Hendrich
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Nathaniel R Riggs
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Kristina T Legget
- Psychiatry, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl, Aurora, CO, 80045, United States
| | - Marc-Andre Cornier
- Division of Endocrinology, Metabolism & Diabetes, Department of Medicine, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl, Aurora, CO, 80045, Aurora, CO, United States
| | - Christopher Melby
- Food Science & Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Sarah A Johnson
- Food Science & Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO, 80523, United States
| | - Rachel Lucas-Thompson
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523, United States
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Lu C, Huang G, Corpeleijn E. Environmental correlates of sedentary time and physical activity in preschool children living in a relatively rural setting in the Netherlands: a cross-sectional analysis of the GECKO Drenthe cohort. BMJ Open 2019; 9:e027468. [PMID: 31092663 PMCID: PMC6530350 DOI: 10.1136/bmjopen-2018-027468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study examined the relationship between environmental correlates and children's sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) in preschool children. DESIGN Cross-sectional study SETTING: A birth cohort in Drenthe, a northern province and relatively rural area of the Netherlands. PARTICIPANTS Valid data both for the ActiGraph and the questionnaire were obtained from 505 child-parent pairs. PRIMARY AND SECONDARY OUTCOME MEASURES ST, LPA and MVPA of children were objectively measured by ActiGraph accelerometry (minimum three wearing days, more than 10 hours/day). Environmental correlates were collected using a questionnaire reported by parents that included household characteristics, parental and children's PA behaviours and neighbourhood environment (eg, traffic safety, road network and presence of PA facilities). Potential correlates were identified using linear regression analysis, adjusted by age, gender, siblings, and maternal age and education level. Ordinary least square regression-based path analysis was used to estimate direct and indirect effects on activity outcomes in mediation models. RESULTS Linear regression analysis showed that 'parents taking children to play sports' was related to less ST, more LPA and MVPA; more outdoor play was also related to less ST and more LPA, but not MVPA. Parents who perceived more PA facilities in their neighbourhood showed more support for 'taking children to play sports', and this was associated with less ST or more MVPA compared with children living with less PA facilities in their neighbourhood. No evidence was found for a relation between traffic safety or road network with ST, LPA and MVPA. CONCLUSIONS This study indicated that parental support and child outdoor play may influence children's daily PA patterns. Convenient neighbourhood PA facilities, such as parks and playgrounds, had an indirect effect through parental support associated with lower children's ST and higher MVPA, even in relatively rural areas.
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Affiliation(s)
- Congchao Lu
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Centre for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Guowei Huang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Centre for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Russell CG, Russell A. A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research. Obes Rev 2019; 20:725-749. [PMID: 30768750 DOI: 10.1111/obr.12838] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.
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Affiliation(s)
- Catherine G Russell
- Faculty of Health, School of Exercise and Nutrition Sciences, Centre for Advanced Sensory Science, Deakin University, Burwood, Australia
| | - Alan Russell
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia
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A values-alignment intervention protects adolescents from the effects of food marketing. Nat Hum Behav 2019; 3:596-603. [PMID: 30988478 DOI: 10.1038/s41562-019-0586-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/07/2019] [Indexed: 01/24/2023]
Abstract
Adolescents are exposed to extensive marketing for junk food, which drives overconsumption by creating positive emotional associations with junk food1-6. Here we counter this influence with an intervention that frames manipulative food marketing as incompatible with important adolescent values, including social justice and autonomy from adult control. In a preregistered, longitudinal, randomized, controlled field experiment, we show that this framing intervention reduces boys' and girls' implicit positive associations with junk food marketing and substantially improves boys' daily dietary choices in the school cafeteria. Both of these effects were sustained for at least three months. These findings suggest that reframing unhealthy dietary choices as incompatible with important values could be a low-cost, scalable solution to producing lasting, internalized change in adolescents' dietary attitudes and choices.
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Salam RA, Das JK, Hoodbhoy Z, Nathani KR, Bhutta ZA. PROTOCOL: Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-33. [PMID: 37131387 PMCID: PMC8428039 DOI: 10.1002/cl2.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Chung SJ, Ersig AL, McCarthy AM. Parent, school, and peer factors related to U.S. adolescents' diet and exercise. J SPEC PEDIATR NURS 2018; 23:e12227. [PMID: 30431705 DOI: 10.1111/jspn.12227] [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] [Received: 01/12/2018] [Revised: 09/17/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Adolescent obesity is a significant public health problem in the United States. Developing interventions to prevent or improve adolescent obesity may positively affect physical and mental health across the lifespan. However, to ensure that interventions are effective, influential factors must first be identified. The purpose of this study was to examine associations among parent-, school-, and peer-related factors and diet and physical activity of the adolescents in the United States. DESIGN AND METHODS Using logistic regression analyses, cross-sectional data of 5,248 adolescents in grades 5-10 from 184 schools from the World Health Organization's 2009/2010 survey of Health Behavior in School-Aged Children (HBSC) for the United States were analyzed, including variables for parent, peer, and school factors. RESULTS Parent- and peer-related factors were associated with adolescents' diet and physical activity (PA). Peer factors were associated with time spent on PA, but not a parent or school factors. The type of school lunch program was the only school factor associated with diet; no school factors were associated with exercise. PRACTICE IMPLICATIONS Results of this secondary analysis extend prior work, which identified associations between parent- and peer factors and adolescents' diet and exercise. Findings will help identify targets for improving adolescents' diet and exercise behaviors.
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Affiliation(s)
- Sophia Jihey Chung
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Anne L Ersig
- School of Nursing, The University of Wisconsin-Madison, Madison, Wisconsin
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Rausch LK, Hofer M, Pramsohler S, Kaser S, Ebenbichler C, Haacke S, Gatterer H, Netzer NC. Adiponectin, Leptin and Visfatin in Hypoxia and its Effect for Weight Loss in Obesity. Front Endocrinol (Lausanne) 2018; 9:615. [PMID: 30405530 PMCID: PMC6200908 DOI: 10.3389/fendo.2018.00615] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
Rationale: Hypoxia induces leptin gene expression in human adipocytes via hypoxia-inducible factors (HIF-α/β). Under ambient moderate hypoxia, leptin in adipocytes is elevated for at least 14 days. Leptin is supposedly involved in the reduced food intake, increased utilization of fatty acids for energy production and possible weight loss observed at high altitudes. Literature on adiponectin and visfatin in high altitude is inconsistent with reports of elevated levels and non-elevated levels. Exercise in hypoxia studies in obese subjects have shown a significant weight loss after up to 3 weeks, but it is unclear if this effect holds up for longer time periods. Therefore, we aimed to investigate 32 obese subjects completing 52 exercise and rest sessions within 8 months at either moderate or sham hypoxia and to analyze leptin, adiponectin, and visfatin mRNA-expression at different time points of exposure. Methods: Abdominal subcutaneous fat biopsies were taken from 32 obese subjects before, after 3 months and after 8 months of intervention. Subjects were randomly divided into two groups and exercised at moderate intensity at two different study sites twice a week. The IG was exposed to normobaric hypoxia (FiO2: 14.0 ± 0.2%,) at exercise and at rest (FiO2: 12.0 ± 0.2%) and the CG to sham hypoxia. Quantitative real-time polymerase chain reaction (qPCR) was used in order to determine mRNA-levels of leptin, adiponectin, and visfatin. Results: No differences in leptin levels after 3 and 8 months compared to baseline and between groups were found. There was no significant difference regarding adiponectin or visfatin at any time point compared to baseline in the hypoxia group, but an increase after 3 months was seen in the control group at normoxia compared to the hypoxia group (adiponectin: p = 0.029 and visfatin: p = 0.014). Conclusion: In this first several months' duration randomized sham controlled hypoxia exercise and rest study with obese subjects, we found no time extended leptin mRNA-expression in subjects under hypoxia after 3 and 8 months compared to baseline levels. Moderate exercise in normoxia not in hypoxia leads to elevated adiponectin and visfatin levels after 3 months.
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Affiliation(s)
- Linda K Rausch
- Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Bad Aibling, Germany
- Department Sports Science, University Innsbruck, Tirol, Austria
| | - Maximilian Hofer
- Department of Internal Medicine 1, Medical University of Innsbruck, Tirol, Austria
- CD Laboratory for Metabolic Crosstalk, Department of Internal Medicine 1, Medical University of Innsbruck, Tirol, Austria
| | - Stephan Pramsohler
- Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Bad Aibling, Germany
| | - Susanne Kaser
- Department of Internal Medicine 1, Medical University of Innsbruck, Tirol, Austria
- CD Laboratory for Metabolic Crosstalk, Department of Internal Medicine 1, Medical University of Innsbruck, Tirol, Austria
| | | | | | - Hannes Gatterer
- Institute for Mountain Emergency Medicine, Eurac Research, Bozen, Italy
| | - Nikolaus C Netzer
- Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Bad Aibling, Germany
- Department Sports Science, University Innsbruck, Tirol, Austria
- Institute for Mountain Emergency Medicine, Eurac Research, Bozen, Italy
- Division of Sports Medicine and Rehabilitation, Department of Medicine, University Ulm, Ulm, Germany
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