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Fu ES, Berkel C, Merle JL, St George SM, Graham AK, Smith JD. A Scoping Review of Tailoring in Pediatric Obesity Interventions. Child Obes 2024. [PMID: 39008426 DOI: 10.1089/chi.2024.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Background: Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term "tailor" in pediatric obesity interventions and propose a uniform definition. Methods: We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. Results: The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. Conclusions: We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.
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Affiliation(s)
- Emily S Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cady Berkel
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Counts NZ, Feinberg ME, Lee JK, Smith JD. Modeling Long-Term Budgetary Impacts of Prevention: An Overview of Meta-analyses of Relationships Between Key Health Outcomes Across the Life-Course. JOURNAL OF PREVENTION (2022) 2024; 45:177-192. [PMID: 38157132 DOI: 10.1007/s10935-023-00744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 01/03/2024]
Abstract
Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, 500 Montgomery St, Suite 820, Alexandria, VA, 22314, USA.
| | - Mark E Feinberg
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Jin-Kyung Lee
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Hanssen H, Moholdt T, Bahls M, Biffi A, Siegrist M, Lewandowski AJ, Biondi-Zoccai G, Cavarretta E, Kokkvoll A, Løchen ML, Maestrini V, Pinto RS, Palermi S, Thivel D, Wojcik M, Hansen D, Van Craenenbroeck EM, Weghuber D, Kraenkel N, Tiberi M. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group. Eur J Prev Cardiol 2023; 30:1462-1472. [PMID: 37491406 DOI: 10.1093/eurjpc/zwad152] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Martin Bahls
- Department of Internal Medicine B University Medicine Greifswald, University of Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Monika Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Ane Kokkvoll
- Department of Paediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Stefano Palermi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nicolle Kraenkel
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care, Campus Benjamin-Franklin (CBF), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Friede Springer- Cardiovascular Prevention Center @ Charité, Charite- Universitätsmedizin Berlin, Berlin, Germany
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
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Carmo ASD, Mendes LL, Cardoso LDO, Caiaffa WT, Santos LCD. The influence of neighborhood safety and built environment on childhood obesity: isolated and combined effect of contextual factors. CAD SAUDE PUBLICA 2023; 39:e00104822. [PMID: 37585911 PMCID: PMC10511156 DOI: 10.1590/0102-311xen104822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/22/2022] [Accepted: 05/11/2023] [Indexed: 08/18/2023] Open
Abstract
This study aims to analyze the isolated and combined effect of objective measures concerning neighborhood safety, food, and physical activity environments on students' obesity. This is a cross-sectional study conducted with 9- and 10-year-old children enrolled in the municipal education network of a Brazilian metropolis. Environment objective measures comprised neighborhood unsafety (annual criminality and road traffic accident rates), availability of public parks and spaces for physical activity practicing, and index of establishments that predominantly sell ultra-processed food. Euclidean buffers of 1,000m around the children's house were used as eligible geographic units. This study adopted the Principal Component Analysis and Generalized Estimation Equation models. Stratified analyses were conducted based on neighborhood unsafety and on child's family income. In total, 717 students were assessed, 12.2% of them were children with obesity. The latent variable of the obesogenic environment (deduced by environment unsafety rates and the index of establishments that predominantly sell ultra-processed food) was a risk factor for obesity in children with lower socioeconomic levels (OR = 2.37; 95%CI: 1.06-5.19). Public parks and spaces for physical activity practicing were protective factors against childhood obesity only in locations recording the lowest environment unsafety rates (OR = 0.30; 95%CI: 0.09-0.94). Based on our findings, social conditions change the effect of the environment on childhood obesity, reinforcing the relevance of inter-sectoral policies and strategies against this condition.
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Harris A, Jordan N, Carroll AJ, Graham AK, Wilson C, Wilson FA, Berkel C, Smith JD. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun 2023; 4:59. [PMID: 37277878 DOI: 10.1186/s43058-023-00429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation. METHODS We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices. RESULTS The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family). CONCLUSIONS This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up. TRIAL REGISTRATION This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
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Affiliation(s)
- Alexandra Harris
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando A Wilson
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, Spencer Fox Eccles School of Medicine, College of Social and Behavioral Science Department of Economics, Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Cady Berkel
- Population Health & Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Cheng ER, Cengiz AY, Miled ZB. Predicting body mass index in early childhood using data from the first 1000 days. Sci Rep 2023; 13:8781. [PMID: 37258628 PMCID: PMC10232444 DOI: 10.1038/s41598-023-35935-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
Few existing efforts to predict childhood obesity have included risk factors across the prenatal and early infancy periods, despite evidence that the first 1000 days is critical for obesity prevention. In this study, we employed machine learning techniques to understand the influence of factors in the first 1000 days on body mass index (BMI) values during childhood. We used LASSO regression to identify 13 features in addition to historical weight, height, and BMI that were relevant to childhood obesity. We then developed prediction models based on support vector regression with fivefold cross validation, estimating BMI for three time periods: 30-36 (N = 4204), 36-42 (N = 4130), and 42-48 (N = 2880) months. Our models were developed using 80% of the patients from each period. When tested on the remaining 20% of the patients, the models predicted children's BMI with high accuracy (mean average error [standard deviation] = 0.96[0.02] at 30-36 months, 0.98 [0.03] at 36-42 months, and 1.00 [0.02] at 42-48 months) and can be used to support clinical and public health efforts focused on obesity prevention in early life.
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Affiliation(s)
- Erika R Cheng
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46220, USA.
| | - Ahmet Yahya Cengiz
- Department of Computer Science, Purdue School of Science, IUPUI, Indianapolis, IN, USA
| | - Zina Ben Miled
- Department of Electrical and Computer Engineering, School of Engineering and Technology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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Ayre SK, White MJ, Harris HA, Byrne RA. 'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families. MATERNAL & CHILD NUTRITION 2023; 19:e13484. [PMID: 36808876 PMCID: PMC10019066 DOI: 10.1111/mcn.13484] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.
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Affiliation(s)
- Susannah K. Ayre
- Woolworths Centre for Childhood Nutrition Research, Faculty of HealthQueensland University of TechnologySouth BrisbaneQueenslandAustralia
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Melanie J. White
- School of Psychology & Counselling, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Holly A. Harris
- Department of Psychology, Education and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
| | - Rebecca A. Byrne
- Woolworths Centre for Childhood Nutrition Research, Faculty of HealthQueensland University of TechnologySouth BrisbaneQueenslandAustralia
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
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Baseline Targeted Moderation in a Trial of the Family Check-Up 4 Health: Potential Explanations for Finding Few Practical Effects. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:226-236. [PMID: 34159507 DOI: 10.1007/s11121-021-01266-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/25/2022]
Abstract
Not all participants will benefit equally from even well-established, evidence-based prevention programs. For this reason, the field of prevention science is beginning to embrace individual tailoring of interventions. The Family Check-Up was among the first prevention programs to tailor at the family level as opposed to the more prevalent focus on adapting programs for different cultures, genders, and other immutable participant characteristics. Despite tailoring, families with lower levels of stress and parental mental health issues, children with lower baseline conduct problems, and families living in an extremely deprived neighborhood benefitted less from the Family Check-Up. This study examined baseline targeted moderation (BTM) within a trial of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the Family Check-Up for primary care delivery and explicit targeting of obesogenic behaviors. Ethnically diverse, low-income families (N = 240) with children ages 5.5 to 12 years identified in pediatric primary care with elevated body mass index (BMI) were enrolled and randomized to FCU4Health or usual care. Few BTM effects were found using single-variable-as-moderator and latent-class-as-moderator analytic approaches across the primary (child BMI, body composition) and secondary outcomes (family health routines; child eating behaviors, food choices, emotional problems, problem behaviors, quality of life; caregiver BMI and body composition), as well as hypothesized mediators (child self-regulation, parenting skills). The high-risk nature of the sample and the FCU4Health being individually tailored might have mitigated finding BTM effects. This trial was prospectively registered (NCT03013309 ClinicalTrials.gov).
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Karssen LT, Larsen JK, Burk WJ, Kremers SPJ, Hermans RCJ, Ruiter ELM, Vink JM, de Weerth C. Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial. Front Public Health 2022; 10:1012431. [PMID: 36620259 PMCID: PMC9822729 DOI: 10.3389/fpubh.2022.1012431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP). Objective The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices. Methods A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles. Results Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI. Conclusions This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families. Trial registration Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.
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Affiliation(s)
- Levie T. Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands,*Correspondence: Levie T. Karssen ✉
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Stef P. J. Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Roel C. J. Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L. M. Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Ruiter ELM, Molleman GRM, Kleinjan M, Kraiss JT, ten Klooster PM, van der Velden K, Engels RCME, Fransen GAJ. The effectiveness of a web-based Dutch parenting program to prevent overweight in children 9-13 years of age: Results of a two-armed cluster randomized controlled trial. PLoS One 2022; 17:e0276168. [PMID: 36269738 PMCID: PMC9586369 DOI: 10.1371/journal.pone.0276168] [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: 09/29/2021] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Although parental support is an important component in programs designed to prevent overweight in children, current programs pay remarkably little attention to the role of parenting. We therefore developed a web-based parenting program entitled "Making a healthy deal with your child". This e-learning program can be incorporated into existing overweight prevention programs. The aim of this study was to determine the effectiveness of this e-learning program. MATERIALS AND METHODS The effectiveness was examined in a two-armed cluster randomized controlled trial. The participants were 475 parent-child dyads of children 9-13 years of age in the Netherlands who participated in an existing schoolclass-based overweight prevention program. At the school grade level, parents were randomly assigned to either the intervention or the control condition. Measurements were taken from both parents and children at baseline, and 5 and 12 months after baseline. Primary outcomes included the child's dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices, and parental self-efficacy. Linear mixed effects models and generalized linear mixed effects models were conducted in R. RESULTS Intention-to-treat analyses and completers only revealed no significant effects between the intervention and control condition on energy balance-related behaviors of the child and parenting skills after correction for multiple testing. The parents' mean satisfaction with the e-learning program (on a 10-point scale) was 7.0±1.1. CONCLUSIONS Although parents were generally satisfied with the parenting program, following this program had no significant beneficial effects regarding the children's energy balance-related behaviors or the parenting skills compared to the control condition. This program may be more beneficial if used by high-risk groups (e.g. parents of children with unhealthy energy balance-related behaviors and/or with overweight) compared to the general population, warranting further study.
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Affiliation(s)
- Emilie L. M. Ruiter
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
- * E-mail:
| | - Gerard R. M. Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | | | - Jannis T. Kraiss
- Department of Psychology, Health and Technology, University of Twente, AE Enschede, The Netherlands
| | - Peter M. ten Klooster
- Department of Psychology, Health and Technology, University of Twente, AE Enschede, The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | | | - Gerdine A. J. Fransen
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
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Gomahr J, Julian V, Thivel D, Maruszczak K, Schneider AM, Weghuber D. Childhood obesity prevention: what can be achieved? Curr Opin Clin Nutr Metab Care 2022; 25:223-231. [PMID: 35256565 DOI: 10.1097/mco.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Childhood obesity is a pandemic generating an enormous individual and socioeconomic burden worldwide. This narrative review summarizes recent evidence on successful and recommended prevention strategies according to age groups and different levels of interventions. RECENT FINDINGS Effective prevention of childhood obesity is feasible and most successful early in life up to preschool age, and it should include a multicomponent approach, integrating individuals, family and society. Trials that improve nutrition and/or enhance physical activity are the cornerstones of childhood obesity prevention on an individual level. However, their efficacy is determined by the combination of interventions for the target age group. Further, improving family support and sleep, as well as reducing screen time, lead to favourable results. Many research gaps remain, including a lack of effective interventions for high-risk groups. SUMMARY As a multifactorial condition, childhood obesity requires a multicomponent approach. Interventions should be developmental stage-specific and adjusted to the setting. Current research gaps need to be targeted by future trials, with a special focus on the benefit of the most vulnerable groups. From a systems response perspective, a paradigm shift from interventions focusing on the individual to approaches that target society as a whole is warranted.
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Affiliation(s)
- Julian Gomahr
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand
| | - David Thivel
- Laboratory AME2P, University of Clermont Auvergne, Aubiere, Franoe
| | - Katharina Maruszczak
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Anna-Maria Schneider
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Weghuber
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
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12
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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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13
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Ayala GX, Monge-Rojas R, King AC, Hunter R, Berge JM. [Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]. Obes Rev 2021; 22 Suppl 5:e13350. [PMID: 34708540 PMCID: PMC9138052 DOI: 10.1111/obr.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/02/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X Ayala
- School of Public Health, San Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK Center, San Diego, California, EE. UU
| | - Rafael Monge-Rojas
- Unidad de Salud y Nutrición, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica
| | - Abby C King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, Stanford, California, EE. UU
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, Irlanda del Norte, Belfast, Reino Unido
| | - Jerica M Berge
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Mineápolis, Minesota, EE. UU
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14
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Smith JD, Berkel C, Carroll AJ, Fu E, Grimm KJ, Mauricio AM, Rudo-Stern J, Winslow E, Dishion TJ, Jordan N, Atkins DC, Narayanan SS, Gallo C, Bruening MM, Wilson C, Lokey F, Samaddar K. Health behaviour outcomes of a family based intervention for paediatric obesity in primary care: A randomized type II hybrid effectiveness-implementation trial. Pediatr Obes 2021; 16:e12780. [PMID: 33783104 DOI: 10.1111/ijpo.12780] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paediatric obesity is a multifaceted public health problem. Family based behavioural interventions are the recommended approach for the prevention of excess weight gain in children and adolescents, yet few have been tested under "real-world" conditions. OBJECTIVES To evaluate the effectiveness of a family based intervention, delivered in coordination with paediatric primary care, on child and family health outcomes. METHODS A sample of 240 families with racially and ethnically diverse (86% non-White) and predominantly low-income children (49% female) ages 6 to 12 years (M = 9.5 years) with body mass index (BMI) ≥85th percentile for age and gender were identified in paediatric primary care. Participants were randomized to either the Family Check-Up 4 Health (FCU4Health) program (N = 141) or usual care plus information (N = 99). FCU4Health, an assessment-driven individually tailored intervention designed to preempt excess weight gain by improving parenting skills was delivered for 6 months in clinic, at home and in the community. Child BMI and body fat were assessed using a bioelectrical impedance scale and caregiver-reported health behaviours (eg, diet, physical activity and family health routines) were obtained at baseline, 3, 6 and 12 months. RESULTS Change in child BMI and percent body fat did not differ by group assignment. Path analysis indicated significant group differences in child health behaviours at 12 months, mediated by improved family health routines at 6 months. CONCLUSION The FCU4Health, delivered in coordination with paediatric primary care, significantly impacted child and family health behaviours that are associated with the development and maintenance of paediatric obesity. BMI did not significantly differ.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Psychiatry and Behavioral Sciences and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cady Berkel
- Integrated Behavioral Health Program, College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin J Grimm
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Anne M Mauricio
- Prevention Science Institute, University of Oregon, Eugene, Oregon, USA
| | | | - Emily Winslow
- REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Thomas J Dishion
- REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shrikanth S Narayanan
- Department of Electrical Engineering and Computer Science, University of Southern California, Los Angeles, California, USA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meg M Bruening
- Department of Nutrition, College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | | | - Farah Lokey
- Palo Verde Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona, USA
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15
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Ayala GX, Monge‐Rojas R, King AC, Hunter R, Berge JM. The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America. Obes Rev 2021; 22 Suppl 3:e13246. [PMID: 33951272 PMCID: PMC8365653 DOI: 10.1111/obr.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X. Ayala
- School of Public HealthSan Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK CenterSan DiegoCaliforniaUSA
| | - Rafael Monge‐Rojas
- Health and Nutrition UnitCosta Rican Institute for Research and Education on Nutrition and Health (INCIENSA)CartagoCosta Rica
| | - Abby C. King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center)Stanford University School of MedicineStanfordCaliforniaUSA
| | - Ruth Hunter
- Centre for Public HealthQueen's University Belfast, North IrelandBelfastUK
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, Medical SchoolUniversity of MinnesotaMinneapolisMinnesotaUSA
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16
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Karssen LT, Vink JM, de Weerth C, Hermans RCJ, de Kort CPM, Kremers SP, Ruiter ELM, Larsen JK. An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework. JMIR Form Res 2021; 5:e24802. [PMID: 33988510 PMCID: PMC8164123 DOI: 10.2196/24802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. OBJECTIVE This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP. METHODS The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. RESULTS In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). CONCLUSIONS The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. TRIAL REGISTRATION Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.
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Affiliation(s)
- Levie T Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roel C J Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
- Netherlands Nutrition Centre, The Hague, Netherlands
| | - Carina P M de Kort
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Stef Pj Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L M Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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17
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Larsen JK, Bode L. Obesogenic Programming Effects during Lactation: A Narrative Review and Conceptual Model Focusing on Underlying Mechanisms and Promising Future Research Avenues. Nutrients 2021; 13:nu13020299. [PMID: 33494303 PMCID: PMC7911998 DOI: 10.3390/nu13020299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 12/18/2022] Open
Abstract
Animal studies have consistently demonstrated that maternal obesity and a high-fat diet during lactation enhances obesity risk in the offspring. However, less is known about these potential obesogenic programming effects in obese humans. We propose three important pathways that may explain obesogenic programming effects of human breastmilk. First, human milk components and hormones may directly affect child eating and satiety characteristics. Second, human milk constituents can affect child microbiota that, in turn, may influence child eating and weight outcomes. Third, human milk composition may affect child eating and weight outcomes through flavor exposure. We reviewed a few very recent findings from well-powered longitudinal or experimental human research with regard to these three pathways. Moreover, we provide a research agenda for future intervention research with the overarching aim to prevent excessive pediatric weight gain during lactation and beyond. The ideas presented in this paper may represent important “black box” constructs that explain obesogenic programming effects during lactation. It should be noted, however, that given the scarcity of studies, findings should be seen as working hypotheses to further test in future research.
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Affiliation(s)
- Junilla K. Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- Correspondence:
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist-Foundation Mother-Milk-Infant Center of Research Excellence, University of California, San Diego, CA 92101, USA;
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18
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Raab R, Michel S, Günther J, Hoffmann J, Stecher L, Hauner H. Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:8. [PMID: 33413486 PMCID: PMC7792105 DOI: 10.1186/s12966-020-01075-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal health and lifestyle during pregnancy may be critical for the onset and progression of childhood obesity. Prenatal lifestyle interventions have been shown to positively affect maternal behaviors, gestational weight gain, and anthropometric outcomes in infants at birth. The influence of such interventions on child weight or growth beyond birth is unknown. We therefore examined the association between lifestyle interventions during pregnancy and anthropometric outcomes during childhood. METHODS A systematic literature search was conducted in three electronic databases, two clinical trial registers and further sources, without language or publication status restrictions. Additionally, 110 study authors were contacted to obtain unpublished data. Randomized controlled trials comparing any antenatal lifestyle or behavioral intervention to standard prenatal care, in women of any body mass index (BMI), with offspring anthropometric data at 1 month of age or older, were considered. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration's updated tool. Data on weight, length, and BMI, and corresponding z-scores, were stratified into six age ranges and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated in univariate and multivariate random-effects meta-analytical models. RESULTS Twenty trials comprising 11,385 women were included in this systematic review, of which 19 were combined in meta-analyses. Overall, lifestyle interventions during pregnancy were not associated with differences in weight, length, BMI, or corresponding z-scores, in children aged 1 month to 7 years (e.g. weight in 5 to 6 month old children, WMD: 0.02 kg; 95% CI: - 0.05 to 0.10 kg, I2 = 38%; 13 studies, 6667 participants). Findings remained consistent when studies were stratified by maternal baseline BMI or other risk factors, and intervention content and duration. Based on the GRADE criteria, the strength of the body of evidence was considered moderate. CONCLUSION Prenatal lifestyle interventions were not shown to influence childhood weight or growth. Nevertheless, women should be encouraged to pursue a healthy lifestyle during pregnancy. Further efforts to establish early prevention strategies for childhood obesity are urgently needed. Thus, large, high-quality studies with pre-planned, long-term follow-ups are warranted. TRIAL REGISTRATION PROSPERO CRD42018118678 .
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Sophie Michel
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Julia Günther
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Julia Hoffmann
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Lynne Stecher
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
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19
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Smith JD, Fu E, Kobayashi MA. Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annu Rev Clin Psychol 2020; 16:351-378. [PMID: 32097572 PMCID: PMC7259820 DOI: 10.1146/annurev-clinpsy-100219-060201] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.
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Affiliation(s)
- Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136, USA;
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