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Cuda S. Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS 2024; 11:100113. [PMID: 38953014 PMCID: PMC11216014 DOI: 10.1016/j.obpill.2024.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile. Methods The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child. Conclusions This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Luppino G, Wasniewska M, Casto C, Ferraloro C, Li Pomi A, Pepe G, Morabito LA, Alibrandi A, Corica D, Aversa T. Treating Children and Adolescents with Obesity: Predictors of Early Dropout in Pediatric Weight-Management Programs. CHILDREN (BASEL, SWITZERLAND) 2024; 11:205. [PMID: 38397317 PMCID: PMC10887674 DOI: 10.3390/children11020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Possible therapeutic failure of pediatric obesity is influenced by the high dropout rate. The aim of this study was to evaluate the rate of dropout and the rate of weight loss over the 24 months of follow-up. METHODS The retrospective, single-center study, involved 489 patients followed for obesity in the period 2016-2020. Patients' auxological data and blood samples were collected during the first (V1) and last visit (V2). Dropout was defined as a follow-up of less than 12 months and/or including less than one visit every 6 months. Patients were divided into two groups and compared: Group A of dropout (297 patients) and Group B of non-dropout (192 patients). RESULTS In the follow-up period, which had a mean duration of 24 months, the dropout rate was 60.7%. In Group A, the percentage of patients with BMI ≥ 3 SD at V2 was significantly higher than that in Group B. In Group B, the percentage of patients with pathological HOMA-IR and with fasting glucose >100 mg/dL was higher than group A. The probability of dropout was positively associated with pubertal stage and negatively with impaired fasting glycemia and pathological insulinemia at V1. CONCLUSION The study demonstrated a high dropout rate during follow-up, mainly among adolescents and patients with no glucometabolic alterations.
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Affiliation(s)
- Giovanni Luppino
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Celeste Casto
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Chiara Ferraloro
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Letteria Anna Morabito
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Angela Alibrandi
- Department of Economics, University of Messina, 98125 Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
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Jørgensen RM, Bjørn A, Bjørn V, Bruun JM. The younger the better: importance of age in treatment of childhood obesity. Eur J Pediatr 2023; 182:5417-5425. [PMID: 37752359 PMCID: PMC10746784 DOI: 10.1007/s00431-023-05218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Children living with obesity are prevalent worldwide. It is an established finding that many children who start a lifestyle intervention tend to leave prematurely. The aim of this study was to identify characteristics in children with obesity who prematurely leave a lifestyle intervention. The cohort study includes children living with obesity aged 4-17, treated in a Danish family-centered lifestyle intervention between 2014 and 2017. Data were collected from patient records. BMI-SDS was calculated using an external Danish reference population and multivariable regression analysis was used to answer the research question. Of the 159 children included, 64 children who left the intervention within the first 1.5 years were older compared to those who stayed in the intervention (10.2 years ± 2.9 vs 11.5 years ± 3.1, p = 0.005). Older participants (> 66.6th percentile) had a shorter treatment duration (489 days) compared to the youngest (190 days 95% CI: 60; 320, p = 0.005) and middle third (224 days 95% CI: 89; 358, p = 0.001). Additionally, an inverse association was found between duration of treatment and age at baseline (-31 days, 95% CI (-50; -13), p = 0.001). Conclusion: The risk of leaving a lifestyle intervention prematurely was primarily dependent on the age of the participants, emphasizing the importance of including children early in lifestyle interventions. What is Known: • Lifestyle interventions for childhood obesity that are shorter in duration often lead to short-term weight reductions only. Limited knowledge exists on why some children prematurely leave these interventions. What is New: • This study observes a solid inverse correlation and association between age and time spent in the interventions, when treating childhood obesity. We hereby suggest age as an important determinant for the adherence to lifestyle interventions and emphasize the importance of treatment early in life.
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Affiliation(s)
- Rasmus Møller Jørgensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd 11, 8200, Aarhus, Denmark.
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Palle Juul-Jensens Blvd 11., Denmark.
- Danish National Center for Obesity, Palle Juul-Jensens Blvd. 11, Aarhus, Denmark.
| | - Amanda Bjørn
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd 11, 8200, Aarhus, Denmark
| | - Vitus Bjørn
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd 11, 8200, Aarhus, Denmark
| | - Jens Meldgaard Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Blvd 11, 8200, Aarhus, Denmark
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Palle Juul-Jensens Blvd 11., Denmark
- Danish National Center for Obesity, Palle Juul-Jensens Blvd. 11, Aarhus, Denmark
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Turk T, Hufanga S, Latailakepa S, Fifita L, Tolu OKH, Hola H, Khran J, Osornprasop S. Conducting formative research during a pandemic threat to inform the development of an obesity prevention social and behaviour change communication strategy in Tonga. Health Promot J Austr 2023. [PMID: 37871907 DOI: 10.1002/hpja.821] [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: 07/22/2022] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
ISSUE ADDRESSED The global epidemic of obesity is overtaking many parts of the world with the Pacific Islands at particular risk. Tonga population surveys identify significant increases in overweight and obesity with Social and Behaviour Change Communication (SBCC) offering opportunities for curbing the rise in non-communicable diseases. Formative research was conducted during the Covid-19 pandemic to assess stakeholder and program beneficiary needs and wants toward an obesity prevention SBCC strategy in Tonga. METHODS Semi-structured interviews with 17 key informants and 18 focus group discussions (N = 168) were conducted in Tongatapu. Data analysis was conducted on Nvivo 2020 qualitative software with desk research of secondary data supporting in-field findings. RESULTS Potential barriers to behavioural compliance included social/cultural norms, poor attitudes; low motivation and capability; and vulnerabilities of gender and other social determinants. Opportunities included the Tongan collective mindset and the desire for greater social interaction and fun. Strong political will to affect change was apparent with the need to consider targeting to youth, social mobilisation of communities through empowering messaging, and an integrated range of activities. CONCLUSIONS Co-design in the formative research process was able to be fostered via online communication processes to overcome the challenges of Covid-19 travel restrictions. The innovative approach provided a number of learnings including identification of national and regional priorities and improved efficiencies in SBCC planning, implementation and evaluation. SO WHAT?: Formative research adopting co-design approaches with stakeholders and program beneficiaries can provide optimal engagement and ownership in the SBCC strategy including insights into messaging approaches.
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Affiliation(s)
- Tahir Turk
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
- Communication Partners International, Springfield, New South Wales, Australia
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Maffeis C, Olivieri F, Valerio G, Verduci E, Licenziati MR, Calcaterra V, Pelizzo G, Salerno M, Staiano A, Bernasconi S, Buganza R, Crinò A, Corciulo N, Corica D, Destro F, Di Bonito P, Di Pietro M, Di Sessa A, deSanctis L, Faienza MF, Filannino G, Fintini D, Fornari E, Franceschi R, Franco F, Franzese A, Giusti LF, Grugni G, Iafusco D, Iughetti L, Lera R, Limauro R, Maguolo A, Mancioppi V, Manco M, Del Giudice EM, Morandi A, Moro B, Mozzillo E, Rabbone I, Peverelli P, Predieri B, Purromuto S, Stagi S, Street ME, Tanas R, Tornese G, Umano GR, Wasniewska M. The treatment of obesity in children and adolescents: consensus position statement of the Italian society of pediatric endocrinology and diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery. Ital J Pediatr 2023; 49:69. [PMID: 37291604 DOI: 10.1186/s13052-023-01458-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.
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Affiliation(s)
- Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Francesca Olivieri
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy.
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, Naples, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, Department of Health Science, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Maria Rosaria Licenziati
- Department of Neurosciences, Neuro-Endocrine Diseases and Obesity Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Mariacarolina Salerno
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Annamaria Staiano
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Raffaele Buganza
- Pediatric Endocrinology Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Francesca Destro
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, S. Maria Delle Grazie Hospital, Naples, Pozzuoli, Italy
| | - Mario Di Pietro
- Pediatric and Neonatal Unit, Hospital of Teramo and Atri, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Luisa deSanctis
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionan Area, University of Bari, Bari, Italy
| | | | - Danilo Fintini
- Refernce Center for Prader Willi Syndrome, Endocrinology and Diabetology Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Elena Fornari
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | | | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, Udine, Italy
| | - Adriana Franzese
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Lia Franca Giusti
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Lucca, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Lera
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Alessandria, Italy
| | | | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Valentina Mancioppi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | | | - Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Beatrice Moro
- UOSD Diabetology, Complesso Ai Colli, AULSS 6 Euganea, Padua, Italy
| | - Enza Mozzillo
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Paola Peverelli
- Department of Pediatrics and Gynecology, Hospital of Belluno, Belluno, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano Stagi
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Maria Elisabeth Street
- Department of Medicine and Surgery, Unit of Paediatrics, University of Parma, University Hospital of Parma, Parma, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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A Systematic Review of Behavioral Interventions on Children at Risk for Diabetes. Am J Prev Med 2023; 64:902-909. [PMID: 36805371 DOI: 10.1016/j.amepre.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION In adults, behavioral-based interventions support prevention of Type 2 diabetes; less is known in children. The aim of this systematic review was to examine the impact of behavioral-based interventions on cardiometabolic outcomes among children at risk for diabetes. METHODS PubMed, CINAHL Plus with Full Text, PsycINFO, and Web of Science were searched between September 2011 and September 2021. RCTs in children aged 6-12 years at risk for Type 2 diabetes that implemented a behavioral-based intervention and included ≥1 cardiometabolic outcome were eligible. If reported, dietary quality data were extracted. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. RESULTS Of the 2,386 records identified, 4 met the inclusion criteria. Study length ranged from 10 weeks to 24 months, with sample sizes ranging from 53 to 113 participants. Among the 4 studies, there were 5 behavioral-based arms. All studies included weight status outcomes, with 3 finding significant between-group differences. Four studies assessed fasting glucose, and 3 assessed HbA1c; none found significant changes between groups. Of the 4 studies reporting blood pressure outcomes, 1 found a significant between-group difference for systolic blood pressure. Three studies assessed cholesterol and found no changes. No studies reported measures of dietary quality. All studies had some concerns about risk of bias. DISCUSSION Behavioral-based interventions improved weight status and supported the maintenance of cardiometabolic parameters. Stronger consideration of the most important risk factors in children along with intermediate outcomes (e.g., diet quality) may help to elucidate the relationship between behavioral-based interventions and cardiometabolic outcomes.
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Woo S, Song HJ, Song JK, Kim Y, Lim H, Park KH. Parent and child characteristics associated with treatment non-response to a short- versus long-term lifestyle intervention in pediatric obesity. Eur J Clin Nutr 2023; 77:127-134. [PMID: 36076070 DOI: 10.1038/s41430-022-01207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND/OBJECTIVES This study aimed to identify the factors associated with short- or long-term non-response to an obesity intervention in children and adolescents. SUBJECTS/METHODS In this observational study, a total of 242 children and adolescents (sex- and age-specific body mass index (BMI) ≥ 85th percentile) were divided into three groups according to the BMI z-score change after 6 (n = 163) and 24 months (n = 110) of participating in an obesity intervention: responders, low responders, and non-responders if the BMI z-score decrease was ≥0.25, 0 to 0.25, and if it increased, respectively. RESULTS Short-term non-response was associated with higher maternal psychosocial stress (OR = 2.34, 95% CI [1.07-5.11]) and adolescence (>11 years; OR = 2.40, 95% CI [1.10-5.22]). The odds of long-term non-response were reduced by an increased vegetable consumption of more than five dishes per week (OR = 0.21, 95% CI [0.07-0.69]) and an hour of increased sleep duration during weekends (OR = 0.14, 95% CI [0.04-0.53]). CONCLUSIONS Short-term non-response was associated with child and maternal characteristics, whereas long-term non-response was associated with actual lifestyle changes such as sleep duration and vegetable consumption. Children with obesity may benefit from an hour of weekend catch-up sleep in lowering the risk of long-term treatment non-response. An individualized approach should be considered for children of older age and mothers with a higher level of stress, as they may not benefit from a conventional short-term lifestyle intervention.
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Affiliation(s)
- Sarah Woo
- Department of Medical Sciences, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jung-Kook Song
- Department of Preventive Medicine, College of Medicine, Jeju National University, Jeju-si, Jeju Special Self-Governing Province, Republic of Korea
| | - YoonMyung Kim
- University College, Yonsei University International Campus, Incheon, Republic of Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea.
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Long-term changes in dietary intake and its association with eating-related problems after gastric bypass in adolescents. Surg Obes Relat Dis 2022; 18:1399-1406. [PMID: 36195523 DOI: 10.1016/j.soard.2022.08.008] [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: 06/16/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) surgery is an established, effective treatment for severe adolescent obesity. Long-term dietary intake and the relationship to eating-related problems are scarcely evaluated in this population. OBJECTIVES Assess changes in dietary intake in adolescents after RYGB and explore associations between dietary intake and eating-related problems. SETTING Multicenter study in Swedish university hospitals. METHOD Diet history, binge eating scale (BES), and Three-Factor Eating Questionnaire were assessed preoperatively and 1, 2, and 5 years after RYGB in 85 adolescents (67% female) aged 16.5 ± 1.2 years with a body mass index (BMI) of 45.5 ± 6.0 kg/m2 and compared with control individuals at 5 years. RESULTS Five-year BMI change was -28.6% ± 12.7% versus +9.9% ± 18.9% in RYGB patients versus control individuals (P < .001). Through 5 years, RYGB adolescents reported reduced energy intake, portion size of cooked meals at dinner, and milk/yoghurt consumption (P < .01). The BES scores were 9.3 ± 8.3 versus 13.4 ± 10.5 in RYGB patients versus control individuals (P = .04). Association between BES score and energy intake was stronger in control individuals (r = .27 versus r = .62 in RYGB patients versus control individuals, P < .001). At 5 years, lower energy intake was associated with greater BMI loss in all adolescents (r = .33, P < .001). Higher scores in BES and uncontrolled and emotional eating were associated with higher energy intake, cooked meals, candies/chocolates, cakes/cookies, desserts, and sugary drinks (r > .23, P < .04) and lower intake of fruits/berries (r = -.32, P = .044). A higher score in cognitive restraint was associated with a higher intake of cereals and fruits/berries (r > .22, P < .05) and a lower intake of sugary drinks (r = -.24, P < .03). CONCLUSION To support optimization of long-term outcomes in adolescent RYGB patients, it is important to provide management strategies to reduce energy intake. Monitoring eating-related problems could identify potential individuals at risk of poor weight loss and to initiate treatment interventions.
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The Effect of a Multidisciplinary Lifestyle Intervention on Health Parameters in Children versus Adolescents with Severe Obesity. Nutrients 2022; 14:nu14091795. [PMID: 35565763 PMCID: PMC9102173 DOI: 10.3390/nu14091795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023] Open
Abstract
Lifestyle interventions are the common treatment for children and adolescents with severe obesity. The efficacy of these interventions across age groups remain unknown. Therefore, this study aimed to compare the effectiveness of a lifestyle intervention on health parameters between children and adolescents with severe obesity. A longitudinal design was carried out at the Centre for Overweight Adolescent and Children’s Healthcare (COACH) between December 2010 and June 2020. Children (2–11 years old, n = 83) and adolescents (12–18 years old, n = 77) with severe obesity received a long-term, tailored, multidisciplinary lifestyle intervention. After 1 year, 24 children (28.9%) and 33 adolescents (42.9%) dropped out of the intervention. The primary outcome was the change in body mass index (BMI) z-score after one and two years of intervention. The decrease in BMI z-score over time was significantly higher in children compared to adolescents, the mean decrease was 0.15 (0.08–0.23) versus 0.03 (−0.05–0.11) after one year and 0.25 (0.15–0.35) versus 0.06 (−0.06–0.17) after two years of intervention; p values for the difference between children and adolescents were 0.035 and 0.012. After two years, multiple improvements in cardio metabolic health parameters were observed, especially in children. In conclusion, during our tailored lifestyle intervention, a positive and maintained effect on health parameters was observed in children with severe obesity. Compared to children, the effect on health parameters was less pronounced in adolescents.
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Putri RR, Casswall T, Hagman E. Risk and protective factors of non-alcoholic fatty liver disease in paediatric obesity: A nationwide nested case-control study. Clin Obes 2022; 12:e12502. [PMID: 34873855 DOI: 10.1111/cob.12502] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/09/2021] [Accepted: 11/27/2021] [Indexed: 01/11/2023]
Abstract
Not all children with obesity carry a similar risk of non-alcoholic fatty liver disease (NAFLD). We investigated the effect of obesity severity, metabolic risk parameters, and obesity treatment outcome on later risk of NAFLD in paediatric obesity. We conducted a nested case-control study of children and adolescents enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) (2001-2016). NAFLD was ascertained from the National Patient Register. Five controls per case were matched by sex and age at index date and at the obesity treatment initiation. Seventy-six pairs (n cases = 76, n controls = 241) were included in the analysis (29% females, mean age at obesity treatment initiation was 10.8 ± 3.07 years). Mean age of NAFLD diagnosis was 14.2 ± 3.07 years. The risk for NAFLD increased with severe obesity (odds ratio [OR]: 3.15, 95% confidence interval [CI]: 1.69-5.89), impaired fasting glucose (OR: 5.29, 95% CI: 1.40-20.06), high triglycerides (OR: 2.33, 95% CI: 1.22-4.43) and weight gain (OR: 4.67, 95% CI: 1.51-14.49 per body mass index standard deviation score [BMI SDS] unit). Relative weight loss of at least 0.25 BMI SDS units reduced NAFLD risk independently of other risk factors (OR: 0.09, 95% CI: 0.01-0.56). Severe obesity, impaired fasting glucose and high triglycerides are risk factors for future NAFLD in paediatric obesity. Successful obesity treatment almost eliminates the risk for NAFLD independently of obesity severity, IFG and high triglycerides.
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Affiliation(s)
- Resthie R Putri
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Casswall
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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11
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Martos-Moreno GÁ, Martínez-Villanueva Fernández J, Frías-Herrero A, Martín-Rivada Á, Argente J. Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients. Nutrients 2021; 13:nu13113847. [PMID: 34836102 PMCID: PMC8624087 DOI: 10.3390/nu13113847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Limited therapeutic tools and an overwhelming clinical demand are the major limiting factors in pediatric obesity management. The optimal protocol, environment, body mass index (BMI) change targets and duration of obesity-oriented interventions remain to be elucidated. Aims: We aimed to characterize the singularities of follow-up, anthropometric and metabolic evolution of a large cohort of pediatric patients with obesity in a specialized university hospital outpatient obesity unit. Patients and methods: Follow-up duration (up to seven years), attrition rate and anthropometric and metabolic evolution of 1300 children and adolescents with obesity were studied. An individualized analysis was conducted in patients attaining a high level of weight loss (over 1.5 BMI-SDS (standard deviation score) and/or 10% of initial weight; n = 252; 19.4%) as well as in "metabolically healthy" patients (n = 505; 38.8%). Results: Attrition rate was high during the early stages (11.2% prior to and 32.5% right after their initial metabolic evaluation). Mean follow-up time was 1.59 ± 1.60 years (7% of patients fulfilled 7 years). The highest BMI reduction occurred in the first year (-1.11 ± 0.89 SDS, p < 0.001 in 72.5% of patients). At the end of the follow-up, improvements in glucose and lipid metabolism parameters were observed (both p < 0.05), that were highest in patients with the greatest weight reduction (all p < 0.01), independent of the time spent to achieve weight loss. The pubertal growth spurt negatively correlated with obesity severity (r = -0.38; p < 0.01) but patients attaining adult height exceeded their predicted adult height (n = 308, +1.6 ± 5.4 cm; p < 0.001). "Metabolically healthy" patients, but with insulin resistance, had higher blood pressure, glucose, uric acid and triglyceride levels than those without insulin resistance (all p < 0.05). Preservation of the "metabolically healthy" status was associated with BMI improvement. Conclusions: Behavioral management of children with obesity can be effective and does not impair growth but is highly conditioned by high attrition. The best results regarding BMI reduction and metabolic improvement are achieved in the first year of intervention and can be preserved if follow-up is retained.
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Affiliation(s)
- Gabriel Á. Martos-Moreno
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
- La Princesa Research Institute, E-28009 Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28029 Madrid, Spain
| | - Julián Martínez-Villanueva Fernández
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
| | - Alicia Frías-Herrero
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
| | - Álvaro Martín-Rivada
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
| | - Jesús Argente
- Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain; (G.Á.M.-M.); (J.M.-V.F.); (A.F.-H.); (Á.M.-R.)
- La Princesa Research Institute, E-28009 Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28029 Madrid, Spain
- IMDEA Food Institute, CEI UAM & CSIC, E-28049 Madrid, Spain
- Correspondence:
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12
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Somaraki M, Ek A, Eli K, Ljung S, Mildton V, Sandvik P, Nowicka P. Parenting and childhood obesity: Validation of a new questionnaire and evaluation of treatment effects during the preschool years. PLoS One 2021; 16:e0257187. [PMID: 34555050 PMCID: PMC8459975 DOI: 10.1371/journal.pone.0257187] [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: 09/14/2020] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Parenting is an integral component of obesity treatment in early childhood. However, the link between specific parenting practices and treatment effectiveness remains unclear. This paper introduces and validates a new parenting questionnaire and evaluates mothers’ and fathers’ parenting practices in relation to child weight status during a 12-month childhood obesity treatment trial. Methods First, a merged school/clinical sample (n = 558, 82% mothers) was used for the factorial and construct validation of the new parenting questionnaire. Second, changes in parenting were evaluated using clinical data from the More and Less Study, a randomized controlled trial (RCT) with 174 children (mean age = 5 years, mean Body Mass Index Standard Deviation Score (BMI SDS) = 3.0) comparing a parent support program (with and without booster sessions) and standard treatment. Data were collected at four time points over 12 months. We used linear mixed models and mediation models to investigate associations between changes in parenting practices and treatment effects. Findings The validation of the questionnaire (9 items; responses on a 5-point Likert scale) revealed two dimensions of parenting (Cronbach’s alpha ≥0.7): setting limits to the child and regulating one’s own emotions when interacting with the child, both of which correlated with feeding practices and parental self-efficacy. We administered the questionnaire to the RCT participants. Fathers in standard treatment increased their emotional regulation compared to fathers in the parenting program (p = 0.03). Mothers increased their limit-setting regardless of treatment allocation (p = 0.01). No treatment effect was found on child weight status through changes in parenting practices. Conclusion Taken together, the findings demonstrate that the new questionnaire assessing parenting practices proved valid in a 12-month childhood obesity trial. During treatment, paternal and maternal parenting practices followed different trajectories, though they did not mediate treatment effects on child weight status. Future research should address the pathways whereby maternal and paternal parenting practices affect treatment outcomes, such as child eating behaviors and weight status.
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Affiliation(s)
- Maria Somaraki
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Veronica Mildton
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Pernilla Sandvik
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]. Aten Primaria 2021; 53:102122. [PMID: 34144427 PMCID: PMC8220171 DOI: 10.1016/j.aprim.2021.102122] [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: 11/27/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objetivo Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile. Diseño Estudio cualitativo. Lugar Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile. Participantes Veinticuatro madres y un padre de hijos preescolares. Método Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares. Resultados Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño. Conclusiones El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.
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Björk A, Dahlgren J, Gronowitz E, Henriksson Wessely F, Janson A, Engström M, Sjögren L, Olbers T, Järvholm K. High prevalence of neurodevelopmental problems in adolescents eligible for bariatric surgery for severe obesity. Acta Paediatr 2021; 110:1534-1540. [PMID: 33325092 PMCID: PMC8246871 DOI: 10.1111/apa.15702] [Citation(s) in RCA: 6] [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: 10/15/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/27/2022]
Abstract
Aim To assess the prevalence of neurodevelopmental problems in adolescents with severe obesity and their associations with binge eating and depression. Methods Data were collected at inclusion in a randomised study of bariatric surgery in 48 adolescents (73% girls; mean age 15.7 ± 1.0 years; mean body mass index 42.6 ± 5.2 kg/m2). Parents completed questionnaires assessing their adolescents’ symptoms of attention‐deficit/hyperactivity disorder and autism spectrum disorder and reported earlier diagnoses. Patients answered self‐report questionnaires on binge eating and depressive symptoms. Results The parents of 26/48 adolescents (54%) reported scores above cut‐off for symptoms of the targeted disorders in their adolescents, but only 15% reported a diagnosis, 32% of adolescents reported binge eating, and 20% reported symptoms of clinical depression. No significant associations were found between neurodevelopmental problems and binge eating or depressive symptoms. Only a third of the adolescents reported no problems in either area. Conclusion Two thirds of adolescents seeking surgical weight loss presented with substantial mental health problems (reported by themselves or their parents). This illustrates the importance of a multi‐professional approach and the need to screen for and treat mental health disorders in adolescents with obesity.
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Affiliation(s)
- Anna Björk
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Jovanna Dahlgren
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Eva Gronowitz
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Fanny Henriksson Wessely
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Annika Janson
- National Childhood Obesity Centre Karolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
| | - My Engström
- Department of Surgery Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
- Institute of Health and Care Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Lovisa Sjögren
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Metabolic Medicine Linköping University Linköping Sweden
| | - Kajsa Järvholm
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Psychology Lund University Lund Sweden
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15
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Parents accurately perceive problematic eating behaviors but overestimate physical activity levels in preschool children. Eat Weight Disord 2021; 26:931-939. [PMID: 32462361 DOI: 10.1007/s40519-020-00926-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study is to examine the associations between parents' perceptions of their child's physical activity and eating behaviors to actual physical activity, body mass index percentage (BMI%), and body fat percentage (BF%). A secondary aim is to examine additional parental determinants to child's physical activity. METHODS Participants were preschool children (N = 114, 59 females, Mage= 4.06) from three University-sponsored centers and parents (N = 114, 107 mothers). Parents self-reported physical activity, perceptions of child's physical activity, and completed "The Child Eating Behavior Questionnaire". Children physical activity was collected with accelerometers. RESULTS Whereas 97% of the 68 parents with children meeting physical activity guidelines accurately identified their child as active, 93% of the 14 parents with children not meeting physical activity guidelines inaccurately identified their child as active (X2(1, N = 82) = 0.58, p = 0.446)). Regarding eating behaviors, child BMI% was moderately correlated with parent's perceptions of their child's Emotional Overeating (r(74) = 0.416, p < 0.001) and Food Responsiveness (r(74) = 0.543, p < 0.001). Parent's engagement in vigorous physical activity demonstrated a positive relationship to child's physical activity (r(78) = 0.297, p = 0.008). CONCLUSION Parents of inactive children have inaccurate perceptions of their child's physical activity. The association between children's BMI% and eating behaviors indicates parents can accurately perceive problematic eating behaviors. Parents, who accurately perceive their child's behaviors, may be in a better position to identify deficiency and seek early intervention. Additionally, parent's physical activity may have implications to children's physical activity. LEVEL OF EVIDENCE Level V: Descriptive cross-sectional study.
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Reddy P, Dukhi N, Sewpaul R, Ellahebokus MAA, Kambaran NS, Jobe W. Mobile Health Interventions Addressing Childhood and Adolescent Obesity in Sub-Saharan Africa and Europe: Current Landscape and Potential for Future Research. Front Public Health 2021; 9:604439. [PMID: 33777878 PMCID: PMC7991289 DOI: 10.3389/fpubh.2021.604439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
Child and adolescent overweight is a growing public health problem globally. Europe and low and middle-income (LMIC) countries in Sub-Saharan Africa provide sufficiently suitable populations to learn from with respect to the potential for mobile health (mHealth) interventions in this area of research. The aim of this paper is to identify mHealth interventions on prevention and treatment of childhood and adolescent obesity in Sub-Saharan Africa and Sweden and report on their effects, in order to inform future research in this area. A search of peer-reviewed publications was performed using PubMed, ScienceDirect, EBSCOhost, and Scopus. The search included all articles published up to August 2019. The search strings consisted of MeSH terms related to mHealth, overweight or obesity, children, adolescents or youth and individual countries in Europe and Sub-Saharan Africa. Second, a combination of free-text words; mobile phone, physical activity, exercise, diet, weight, BMI, and healthy eating was also used. Seven studies were reported from Europe and no eligible studies from Sub-Saharan Africa. The results of this narrative review indicate a lack of research in the development and testing of mHealth interventions for childhood and adolescent obesity. There is a need for an evidence base of mHealth interventions that are both relevant and appropriate in order to stem the epidemic of overweight and obesity among children and adolescents in these countries. Uptake of such interventions is likely to be high as there is high penetrance of mobile phone technology amongst adolescents, even within poor communities in Africa.
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Affiliation(s)
- Priscilla Reddy
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa.,Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Natisha Dukhi
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Ronel Sewpaul
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | | | - Nilen Sunder Kambaran
- Analytics, Retirement, Compensation and Health Actuarial Consulting, Westlake, Cape Town, South Africa
| | - William Jobe
- Department of Informatics, University West, Trollhättan, Sweden
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Sustainable weight loss over three years in children with obesity: a pragmatic family-centered lifestyle intervention. Eat Weight Disord 2021; 26:537-545. [PMID: 32170662 DOI: 10.1007/s40519-020-00887-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Childhood obesity has psychological consequences and increases the risk of continuous obesity into adulthood, associated with development of non-communicable disease (e.g. type 2 diabetes). Short-term weight loss intervention studies show good results but long-term studies are limited. METHODS One hundred ninety-nine obese children (4-18 years of age), with a BMI-SDS (standard deviation score) above + 2 SDS were enrolled into a multifactorial family-centered lifestyle intervention study. The children had yearly visits in the outpatient clinic for anthropometrics, blood samples and DXA-scans, and 6-8 meeting with community health workers between these visits. The children followed the intervention up to 3 years. RESULTS After a follow-up of 26.7 ± 17.5 months a reduction in BMI-SDS of - 0.25 SDS (p < 0.001) was observed. The 57 children who were adherent to the intervention for ≥ 2 years had significantly reduced BMI-SDS compared to the 142 children with shorter intervention (BMI-SDS: - 0.38 ± 0.67 vs. - 0.20 ± 0.50, p = 0.036). All weight loss was accompanied by decrease in fat mass and increase in muscle mass (p < 0.001). CONCLUSION The intervention was found to induce long-term reduction in BMI-SDS in obese children, with beneficial change in body composition. Children who followed the intervention the longest had the greatest reduction in BMI-SDS. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Raynor HA, Barroso C, Propst S, Berlin K, Robson S, Khatri P. Reach of a low-intensity, multicomponent childhood overweight and obesity intervention delivered in an integrated primary care setting. Transl Behav Med 2020; 10:760-769. [PMID: 31220326 PMCID: PMC7413189 DOI: 10.1093/tbm/ibz055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Reach (i.e., proportion and representativeness of participants) of low-intensity, multicomponent childhood overweight/obesity interventions delivered in primary care settings with low-income and/or minority families is unknown. The purpose of this research is to describe the reach of a low-intensity, multicomponent childhood overweight/obesity intervention delivered in an integrated primary care setting in a federally qualified health center (FQHC). Eligibility criteria included children aged 4-10 years with a body mass index (BMI) ≥85th percentile, with a female caregiver. Using the electronic health record (EHR) and release forms, families were broadly categorized into groupings from recruitment flow, with differing proportions calculated from these groupings. Representativeness was determined using EHR data from families who were informed about the program (n = 963). Three calculated reach rates ranged from 54.9% to 3.9%. Lower reach rates were calculated using the number of families randomized (n = 73) as the numerator and the children from families who were informed about the program (n = 963) or all eligible children in the FQHC attending appointments (n = 1,864) as denominators. The first two steps in recruitment, informing families about the program and families initiating participation, were where the largest decreases in reach occurred. Children who were randomized were older, had a higher BMI, had a greater number of medical diagnoses indicating overweight or obesity, and were Hispanic. Reach of the intervention was low. Strategies that assist with reducing time for informing families of treatment and increasing families' awareness of their child's weight status should assist with enhancing reach.
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Affiliation(s)
- Hollie A Raynor
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Cristina Barroso
- Department of Public Health, University of Tennessee Knoxville, Knoxville, TN, USA
| | | | | | - Shannon Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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Duchen K, Jones M, Faresjö ÅO, Faresjö T, Ludvigsson J. Predicting the development of overweight and obesity in children between 2.5 and 8 years of age: The prospective ABIS study. Obes Sci Pract 2020; 6:401-408. [PMID: 32874675 PMCID: PMC7448170 DOI: 10.1002/osp4.418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A relationship between overweight and obesity early in life and adolescence has been reported. The aim of this study was to track changes in overweight/obesity in children and to assess risk factors related to the persistence of overweight/obesity between 2.5 and 8 years. STUDY DESIGN Children who participated in all three follow-ups at 2.5, 5 and 8 years in the prospective cohort All Children in Southeast Sweden (ABIS) (N = 2245, 52.1% boys and 47.9% girls) were classified as underweight, normal, overweight or with obesity, and changes within categories with age were related to risk factors for development of obesity in a multivariate analysis. RESULTS The prevalence of overweight and obesity between 2.5 and 8 years was 11%-12% and 2%-3%, respectively. Children with normal weight remained in the same category over the years, 86% between 2.5 to 5 years and 87% between 5 and 8 years. Overweight and obesity at 5 and 8 years were positively related to each other (p < 0.0001 for both). High level of TV watching at 8 years and high maternal body mass index (BMI) when the child was 5 years were related to lower probability to a normalized ISO-BMI between 5 and 8 years of age (p < 0.05 for both). CONCLUSION Children with ISO-BMI 18.5 to 24.9 remain in that range during the first 8 years of life. Children with overweight early in life gain weight and develop obesity, and children with obesity tend to remain with obesity up to 8 years of age. TV watching and high maternal BMI were related to lower probability to weight normalization between 5 and 8 years of age. A multidisciplinary approach to promote dietary and physical activity changes in the entire family should be used for the treatment and prevention of overweight and obesity in early childhood.
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Affiliation(s)
- Karel Duchen
- Division of Children's and Women's Health, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Mike Jones
- Department of Psychology, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyAustralia
| | - Åshild Olsen Faresjö
- Division of Society and Health, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Tomas Faresjö
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Johnny Ludvigsson
- Division of Children's and Women's Health, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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Hagman E, Bohlin A, Klaesson S, Ejderhamn J, Danielsson P. Promising results from an implemented treatment model for paediatric obesity. Acta Paediatr 2020; 109:1656-1664. [PMID: 31899803 DOI: 10.1111/apa.15158] [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] [Received: 07/08/2019] [Revised: 11/29/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To investigate the implementation of a plan of action for treatment of childhood obesity, and the effect after 2 years of treatment. METHODS Children aged 6-12.9 years who started obesity treatment between 2008 and 2015 in a paediatric clinic in Stockholm County were included. The treatment model included staff education and support and group activities for parents and children separately followed by individual sessions to a multidisciplinary team. The main outcome was change in body mass index standard deviation score (BMI SDS), in comparison to a matched control group. RESULTS In the intervention group, 1334 children (52% boys) with an average age of 9.3 years and BMI SDS of 2.7 and 3012 children in the control group were included. The intervention group decreased their BMI SDS more after two years compared with the control group, (-0.31 vs -0.23, P < .001). Younger age and higher BMI SDS at treatment initiation and families that completed the group sessions (all P < .001) had greater decreases in BMI SDS after 2 years. Sex did not affect the outcome. CONCLUSION Even though the treatment in the control group was effective, the implementation of the action plan yielded a better treatment response compared with the control group.
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Affiliation(s)
- Emilia Hagman
- Division of Paediatrics Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Anna Bohlin
- Department of Women's and Children's Health Södertälje Hospital Sodertalje Sweden
| | - Sven Klaesson
- Department of Women's and Children's Health Södertälje Hospital Sodertalje Sweden
| | - Jan Ejderhamn
- Astrid Lindgren Children's HospitalKarolinska University Hospital Stockholm Sweden
| | - Pernilla Danielsson
- Division of Paediatrics Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
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21
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Hagman E, Danielsson P, Lindberg L, Marcus C. Paediatric obesity treatment during 14 years in Sweden: Lessons from the Swedish Childhood Obesity Treatment Register-BORIS. Pediatr Obes 2020; 15:e12626. [PMID: 32074662 DOI: 10.1111/ijpo.12626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment of paediatric obesity has been offered customarily and free of charge for more than 15 years in Sweden. The Swedish Childhood Obesity Treatment Register (BORIS) is a prospective register of children and adolescents undergoing obesity treatment. OBJECTIVES To investigate how patient characteristics and treatment efficacy has changed over 14 years on a national scale. METHODS All subjects in BORIS with data from 2004 until 2017 were included, n = 21 499. Outcomes were age and BMI SDS at treatment initiation, dropout rates and treatment outcome up to 3 years after treatment initiation. RESULTS Age and BMI SDS at treatment initiation have decreased during the years (both P < .0001). Of the patients who started treatment before 2009, more than 80% had at least 1-year follow-up. This number has decreased to about 60% in 2017. Since 2004, no trend in improvement of treatment results was observed when evaluating change in either BMI SDS or proportion of obesity remission. There was no difference between the sexes. CONCLUSION Although children in Sweden receive treatment at an earlier age, which is a major determinant of treatment success, and at a lower degree of obesity at treatment initiation, the effect of childhood obesity treatment on standard anthropometric measures has not improved over the investigated years.
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Affiliation(s)
- Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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22
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Duchen K, Faresjö ÅO, Klingberg S, Faresjö T, Ludvigsson J. Fatty fish intake in mothers during pregnancy and in their children in relation to the development of obesity and overweight in childhood: The prospective ABIS study. Obes Sci Pract 2020; 6:57-69. [PMID: 32128243 PMCID: PMC7042022 DOI: 10.1002/osp4.377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/17/2019] [Accepted: 10/07/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although controversial, lower maternal intake of n-3 polyunsaturated fatty acid (PUFA) during pregnancy and lower levels of omega-3 PUFA in serum phospholipids during childhood have been related to obesity. The main source of omega-3 PUFA is fatty fish in the diet. OBJECTIVES To assess the relationship between overweight/obesity and the intake of fatty fish in maternal diet during pregnancy and in children up to 8 years of age. METHODS The prospective cohort All Children in South-East Sweden (ABIS) followed babies from birth to 8 years of age. A total of 6749 children at 5 years of age (boys 52.6%) and 3017 children at 8 years (boys 52.3%) participated. A "fatty-fish index" was constructed on the basis of self-reports of nutritional habits. RESULTS The prevalence of overweight and obesity in children at 5 years were 12.9% and 4.2%, respectively. At 8 years, 12.2% of the children presented overweight and 2.3% obesity. Girls were more affected than boys by overweight/obesity. A higher fish index during pregnancy was not related to overweight/obesity in the children, whereas a higher fish index in the children during the first years of life was related to obesity at 5 and 8 years of age. This relationship disappeared in a multivariable analysis. Maternal body mass index (BMI), maternal education, maternal smoking during pregnancy, birth weight, and physical activity all remained related to overweight/obesity at both 5 and 8 years of age. CONCLUSION No relationships were found between a lower intake of fatty fish in the diet, neither in mothers during pregnancy nor in early childhood, and increased risk of overweight/obesity.
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Affiliation(s)
- Karel Duchen
- Crown Princess Victoria Children's Hospital, Region ÖstergötlandLinköpingSweden
- Division of Pediatrics, Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Åshild Olsen Faresjö
- Department of Medicine and Health, Division of Community MedicineLinköping UniversityLinköpingSweden
| | - Sofia Klingberg
- Department of Public Health and Community Medicine, Section of Epidemiology and Social MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Tomas Faresjö
- Department of Medicine and Health, Division of Community MedicineLinköping UniversityLinköpingSweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Region ÖstergötlandLinköpingSweden
- Division of Pediatrics, Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
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23
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Ek A, Nordin K, Nyström CD, Sandvik P, Eli K, Nowicka P. Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity. Appetite 2019; 145:104488. [PMID: 31626835 DOI: 10.1016/j.appet.2019.104488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 10/10/2019] [Indexed: 12/31/2022]
Abstract
This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Christine Delisle Nyström
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Pernilla Sandvik
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
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24
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Ek A, Chamberlain KL, Sorjonen K, Hammar U, Malek ME, Sandvik P, Somaraki M, Nyman J, Lindberg L, Nordin K, Ejderhamn J, Fisher PA, Chamberlain P, Marcus C, Nowicka P. A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial. Pediatrics 2019; 144:peds.2018-3457. [PMID: 31300528 PMCID: PMC8853645 DOI: 10.1542/peds.2018-3457] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST). METHODS Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (-0.5) was assessed with risk ratios. RESULTS A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: -0.45 to -0.15) compared with ST (0.07; 95% CI: -0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (-0.54; 95% CI: -0.77 to -0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST. CONCLUSION A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology,
| | | | - Kimmo Sorjonen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Ulf Hammar
- Department of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden,Section of Molecular Epidemiology, Departments of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mahnoush Etminan Malek
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden,Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Sandvik
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden,Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Maria Somaraki
- Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Jonna Nyman
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Ejderhamn
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Philip A. Fisher
- Oregon Social Learning Center, Eugene, Oregon,Department of Psychology, University of Oregon, Eugene, Oregon
| | | | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Stockholm, Sweden,Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
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25
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Henfridsson P, Laurenius A, Wallengren O, Beamish AJ, Dahlgren J, Flodmark CE, Marcus C, Olbers T, Gronowitz E, Ellegard L. Micronutrient intake and biochemistry in adolescents adherent or nonadherent to supplements 5 years after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2019; 15:1494-1502. [PMID: 31371184 DOI: 10.1016/j.soard.2019.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective obesity treatment in adults and has become established in adolescents. Lower adherence to supplementation in adolescents confers a risk for long-term nutritional deficiencies. OBJECTIVES To assess adherence to supplementation, micronutrient intake, and biochemistry in adolescents through 5 years after RYGB. SETTING University hospitals, multicenter study, Sweden. METHODS Micronutrient intake and adherence to supplementation were assessed by diet history interviews and biochemistry preoperatively, 1, 2, and 5 years after RYGB in 85 adolescents (67% females), aged 16.5 years (± 1.2) with a body mass index of 45.5 kg/m2 (± 6.0). Adherence was defined as taking prescribed supplements ≥3 times a week. Micronutrient intake and biochemistry were compared with matched controls at 5 years. RESULTS Over 75% completed the dietary assessments across 5 years after RYGB. Adherence ranged between 44-61% through 5 years. At 5 years, ferritin and hemoglobin decreased (P < .04) and 61% had iron deficiency (P ≤ .001). Among females with iron deficiency, most did not adhere to supplementation (P = .005), and 59% of these had anemia (P < .001). Vitamin D insufficiency continued after surgery and 80% of participants who did not adhere to supplementation had insufficiency (P = .002). Adolescents not adhering had lower levels of vitamin D, B12, and ferritin (females) compared with both adhering adolescents and the control group (all P < .04). CONCLUSIONS Half of adolescents after RYGB reported sufficient long-term adherence to supplementation. Adhering to supplements and reporting a higher micronutrient intake were associated with more favorable biochemistry. Results support the recommendations for monitoring micronutrient intake and biochemistry in all patients who have undergone RYGB surgery, and the recommendation of higher preventive supplementation of vitamin D and iron in both sexes. As hypothesized, adolescents not adhering had a higher prevalence of long-term micronutrient deficiencies.
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Affiliation(s)
- Pia Henfridsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Anna Laurenius
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Beamish
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Norrköping, Linköping University, Linköping, Sweden
| | - Eva Gronowitz
- Department of Pediatrics and Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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26
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Quah PL, Fries LR, Chan MJ, Fogel A, McCrickerd K, Goh AT, Aris IM, Lee YS, Pang WW, Basnyat I, Wee HL, Yap F, Godfrey KM, Chong YS, Shek LPC, Tan KH, Forde CG, Chong MFF. Validation of the Children's Eating Behavior Questionnaire in 5 and 6 Year-Old Children: The GUSTO Cohort Study. Front Psychol 2019; 10:824. [PMID: 31031683 PMCID: PMC6470280 DOI: 10.3389/fpsyg.2019.00824] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/27/2019] [Indexed: 01/30/2023] Open
Abstract
Revised subscales of the Children’s Eating Behavior Questionnaire (CEBQ) have been proposed to be more appropriate for assessing appetitive traits in Singaporean 3 year-olds, but the CEBQ has not yet been validated in older children in this population. The current study aimed to validate the CEBQ at ages 5 (n = 653) and 6 (n = 449) in the ethnically diverse GUSTO cohort. Confirmatory factor analysis (CFA) examined whether the established eight-factor model of the CEBQ was supported in this sample. Overall, the CFA showed a poor model fit at both ages 5 and 6. At both ages 5 and 6, an exploratory factor analysis revealed a six-factor structure: food fussiness, enjoyment of food, slowness in eating, emotional undereating, emotional overeating and desire to drink. Cronbach’s alpha estimates ranged from 0.70 to 0.85 for all subscales. Criterion validity was tested by correlating subscales with the weight status of 6 years of age. At age 5 and 6, lower scores of slowness of eating while higher scores of enjoyment of food was associated with child overweight. At age 6, higher scores of desire to drink was also associated child overweight. In conclusion, a revised six factor-structure of the CEBQ at ages 5 and 6 were more appropriate for examining appetitive traits in this sample.
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Affiliation(s)
- Phaik Ling Quah
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | | | - Mei Jun Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Anna Fogel
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Keri McCrickerd
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Ai Ting Goh
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Singapore.,Divisions of Pediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore - National University Health System, Singapore, Singapore
| | - Iccha Basnyat
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Fabian Yap
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, National Institute for Health Research Southampton Biomedical Research Centre, The University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore - National University Health System, Singapore, Singapore
| | - Lynette P C Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ciaran G Forde
- Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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27
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Forsell C, Gronowitz E, Larsson Y, Kjellberg BM, Friberg P, Mårild S. Four-year outcome of randomly assigned lifestyle treatments in primary care of children with obesity. Acta Paediatr 2019; 108:718-724. [PMID: 30230026 DOI: 10.1111/apa.14583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
AIM To assess the four-year outcome in children with obesity randomised to one of two 12-month lifestyle treatment programmes in primary care. METHODS At baseline, 64 children with obesity aged 8.0-13.0 years were randomised to a treatment programme managed either by a nurse, dietician and physiotherapist (n = 32) or by a nurse and dietician (n = 32). RESULTS From baseline to follow-up, the mean body mass standard deviation score (BMISDS) had decreased by -0.50 [standard deviation (SD) 0.73], p = 0.002, in the nurse, dietician and physiotherapist group (n = 27), by -0.26 (SD 0.73), p = 0.057 in the other group (n = 29); adjusted mean difference was -0.22, 95% confidence interval -0.59; 0.16, p = 0.25. Changes in weight categories did not differ between the groups: both had a change from obesity to normal weight in 1 and to overweight in 6; in the physiotherapist group 1 case of severe obesity changed to obesity. The combined treatment groups (n = 56) had a mean reduction in BMISDS of -0.37 (SD 0.73) and an improved distribution in weight categories, p = 0.015. CONCLUSION After four years, there was no difference in outcome between the treatment options. In the treatment groups combined the number of children with obesity and their adiposity measures were significantly lower.
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Affiliation(s)
- Christer Forsell
- Paediatric Department; Alingsås Hospital; Västra Götaland Region Sweden
| | - Eva Gronowitz
- Department of Paediatrics; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Yvonne Larsson
- Paediatric Department; Alingsås Hospital; Västra Götaland Region Sweden
| | | | - Peter Friberg
- Department of Physiology; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Staffan Mårild
- Department of Paediatrics; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
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28
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Hagman E, Hecht L, Marko L, Azmanov H, Groop L, Santoro N, Caprio S, Weiss R. Predictors of responses to clinic-based childhood obesity care. Pediatr Diabetes 2018; 19:1351-1356. [PMID: 30225917 DOI: 10.1111/pedi.12774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/03/2018] [Accepted: 09/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Lifestyle modification is the therapy of choice for childhood obesity, yet the response rate is variable and may be affected by genetic factors. We aimed to investigate predictors of poor response to lifestyle modification obesity treatment in children. METHODS A prospective cohort study of 434 youths (64.5% females) between 4 and 20 years of age undergoing a standard care of lifestyle modification obesity management for 35.9 ± 20.8 months at Yale Childhood Obesity Clinic, USA. The primary outcome was a "poor response," defined as the quintile with the largest increase in BMI Z-score over time. The secondary outcome was the endpoint BMI Z-score. Covariates investigated were sex, baseline pubertal status and degree of obesity, race, biochemical profile, and family history of overweight. A subsample (n = 214) had FTO genotyping (SNP rs8050136) tested. RESULTS Males (hazard ratio [HR] = 5.35, 95% confidence interval [CI] [3.32-8.61], P < 0.0001) and pubertal adolescents (HR = 2.78, [1.40-5.50], P = 0.003) compared to prepubertal children were more prone to respond poorly. Baseline degree of obesity was associated with relative protection from responding poorly (HR per BMI Z-score unit = 0.32, [0.17-0.61], P = 0.0006). Carriers of the FTO obesity-predisposing allele (AA genotype) were protected from responding poorly compared to non-carriers (CC genotype) (HR = 0.33, [0.12-0.88], P = 0.028). CONCLUSIONS Boys and pubertal adolescents are more prone to respond poorly to standard obesity care while those with greater baseline degree of obesity and carriers of the FTO obesity-predisposing allele are not.
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Affiliation(s)
- Emilia Hagman
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel.,Department of Clinical Science, Intervention and Technology, Karolinska Insitutet, Stockholm, Sweden
| | - Lior Hecht
- Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Limor Marko
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Henny Azmanov
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Malmö, Sweden
| | - Nicola Santoro
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Sonia Caprio
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Ram Weiss
- Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel.,Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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29
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Henfridsson P, Laurenius A, Wallengren O, Gronowitz E, Dahlgren J, Flodmark CE, Marcus C, Olbers T, Ellegård L. Five-year changes in dietary intake and body composition in adolescents with severe obesity undergoing laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2018; 15:51-58. [PMID: 30497848 DOI: 10.1016/j.soard.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/07/2018] [Accepted: 10/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). OBJECTIVES To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB. SETTING University hospitals, multicenter study, Sweden. METHODS Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m2) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years. RESULTS Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P = .03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P = .003). CONCLUSIONS In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass.
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Affiliation(s)
- Pia Henfridsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Laurenius
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Norrköping, Linköping University, Linköping, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Predicting weight status in Chinese pre-school children: independent and interactive effects of caregiver types and feeding styles. Public Health Nutr 2017; 21:1123-1130. [DOI: 10.1017/s1368980017003603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractObjectiveTo investigate caregiver type as a potential moderating effect in the relationship between feeding style and weight status among Chinese pre-school children.DesignCross-sectional data collected with the Caregiver’s Feeding Style Questionnaire (CFSQ), anthropometric data, childcare and sociodemographic information.SettingShenyang, China.SubjectsCaregiver–child dyads (n 857).ResultsAfter controlling for confounders, authoritarian feeding style was associated with a 0·30 lower BMI Z-score. Fathers as primary caregivers were related to lower BMI Z-score (β=−0·66), while grandparents as main caregivers were associated with higher BMI Z-score (β=0·66) after adjusting for covariates. Mothers buffered the relationship between authoritarian (β=0·50, 95 % CI 0·04, 0·95) or indulgent (β=−0·60, 95 % CI −1·06, −0·14) feeding styles and BMI Z-score. Grandparents strengthened the trend that indulgent feeding style was related to higher BMI Z-score (β=0·54, 95 % CI 0·01, 1·08).ConclusionsThe results of independent and interactive effects of specific feeding styles and caregiver types had different influences on child BMI Z-scores. Longitudinal investigations are needed to evaluate the effect of fathers’ and grandparents’ feeding on their children’s nutrition and weight status.
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Hagman E, Danielsson P, Brandt L, Svensson V, Ekbom A, Marcus C. Childhood Obesity, Obesity Treatment Outcome, and Achieved Education: A Prospective Cohort Study. J Adolesc Health 2017; 61:508-513. [PMID: 28693958 DOI: 10.1016/j.jadohealth.2017.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/28/2017] [Accepted: 04/19/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Childhood obesity represents a social burden. This study aims to investigate whether achieved educational level differs in young adults who have suffered obesity in childhood compared with the general population and to determine how obesity treatment influences achieved educational level. METHODS This prospective cohort study includes subjects from the Swedish Childhood Obesity Treatment Registry (BORIS, n = 1,465) who were followed up after 20 years of age. They were compared with a randomly selected matched population-based group (n = 6,979). Achieved educational level was defined as ≥12 years in school (completers). Covariates include sex, migration background, and attention deficit disorders for both groups. Furthermore, age and degree of obesity at start of obesity treatment, treatment duration, and efficacy were analyzed in the obese cohort. RESULTS In the obese cohort, 55.4% were school completers, compared with 76.2% in the comparison group (adjusted odds ratio [OR] = .42, p < .0001). Subjects with moderate obesity had a completion rate of 64.4%, compared with 50.9% among subjects with morbid obesity (adjusted OR = .57, p < .0001). Successful obesity treatment was associated with increased future educational level, compared with those experiencing no treatment effect (61.9% vs. 51.3% completers; adjusted OR = 1.4, p < .05). In children with attention deficit disorder, obesity was not an extra risk for not completing 12 or more years of schooling, p = .11. CONCLUSIONS Obesity in childhood was associated with low educational level in early adulthood. Children and adolescents with obesity may require special support at school in addition to health care treatment to lose weight.
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Affiliation(s)
- Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lena Brandt
- Unit of Clinical Epidemiology, Department of Medicine/Solna, Karolinska Institutet, Stockholm, Sweden
| | - Viktoria Svensson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ekbom
- Unit of Clinical Epidemiology, Department of Medicine/Solna, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Ligthart KA, Buitendijk L, Koes BW, van Middelkoop M. The association between ethnicity, socioeconomic status and compliance to pediatric weight-management interventions – A systematic review. Obes Res Clin Pract 2017; 11:1-51. [DOI: 10.1016/j.orcp.2016.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 11/26/2022]
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Williams SL, Van Lippevelde W, Magarey A, Moores CJ, Croyden D, Esdaile E, Daniels L. Parent engagement and attendance in PEACH™ QLD - an up-scaled parent-led childhood obesity program. BMC Public Health 2017; 17:559. [PMID: 28599644 PMCID: PMC5466714 DOI: 10.1186/s12889-017-4466-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/25/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parenting, Eating and Activity for Child Health (PEACH™) is a multicomponent treatment program delivered over ten group sessions to parents of overweight/obese primary school-aged children. It has been shown to be efficacious in an RCT and was recently translated to a large-scale community intervention funded by the Queensland (Australia) Government. Engagement (enrolment and attendance) was critical to achieving program outcomes and was challenging. The purpose of the present study was to examine sample characteristics and mediating factors that potentially influenced program attendance. METHODS Data collected from parents who attended at least one PEACH™ Queensland session delivered between October 2013 and October 2015 (47 programs implemented in 29 discrete sites), was used in preliminary descriptive analyses of sample characteristics and multilevel single linear regression analyses. Mediation analysis examined associations between socio-demographic and parent characteristics and attendance at group sessions and potential mediation by child and parent factors. RESULTS 365/467 (78%) enrolled families (92% mothers) including 411/519 (79%) children (55% girls, mean age 9 ± 2 years) attended at least one session (mean 5.6 ± 3.2). A majority of families (69%) self-referred to the program. Program attendance was greater in: advantaged (5.9 ± 3.1 sessions) vs disadvantaged families (5.4 ± 3.4 sessions) (p < 0.05); partnered (6.1 ± 3.1 sessions) vs un-partnered parents (5.0 ± 3.1 sessions) (p < 0.01); higher educated (6.1 ± 3.0 sessions) vs lower educated parents (5.1 ± 3.3 sessions) (p = 0.02); and self-referral (6.1 ± 3.1) vs professional referral (4.7 ± 3.3) (p < 0.001). Child (age, gender, pre-program healthy eating) and parent (perceptions of child weight, self-efficacy) factors did not mediate these relationships. CONCLUSIONS To promote reach and effectiveness of up-scaled programs, it is important to identify ways to engage less advantaged families who carry higher child obesity risk. Understanding differences in referral source and parent readiness for change may assist in tailoring program content. The influence of program-level factors (e.g. facilitator and setting characteristics) should be investigated as possible alternative mediators to program engagement.
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Affiliation(s)
- Susan L. Williams
- Central Queensland University, School of Health, Medical and Applied Sciences, Building 6, Bruce Highway, Rockhampton, QLD 4702 Australia
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, De Pintelaan 185 – 4K3 room 036, 9000 Ghent, Belgium
| | - Anthea Magarey
- Flinders University, Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Carly J. Moores
- Flinders University, Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Debbie Croyden
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
| | - Emma Esdaile
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
| | - Lynne Daniels
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
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Danielsson P, Bohlin A, Bendito A, Svensson A, Klaesson S. Five-year outpatient programme that provided children with continuous behavioural obesity treatment enjoyed high success rate. Acta Paediatr 2016; 105:1181-90. [PMID: 26859578 DOI: 10.1111/apa.13360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/03/2015] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
AIM Results from long-time follow-up of obesity treatment in early childhood are lacking. We investigate long-term continuous behavioural childhood obesity treatment and factors of importance for treatment effect. METHOD A five-year longitudinal retrospective controlled study of children aged five to 13 years in obesity treatment, divided into three groups depending on age at start of treatment. Outcome is presented as change in degree of obesity, body mass index standard deviation score (BMI SDS), change in weight status and decrease of ≥0.5 BMI SDS units, in relation to a age-matched obese comparison group. RESULTS In total, 220 children (46% females) were included. After five years of treatment, the decrease in BMI SDS was significant in all age groups with the largest effect in age group 4-6 years. Compared to the comparison group (n = 369), the decline in BMI SDS was greater (p = 0.001). After five years of treatment, 48% of the patients were cured from their obesity and 72% reached a decline of 0.5 BMI SDS units. Age at start of treatment was the only factor affecting treatment efficacy. CONCLUSION The ability to reach a significant weight loss in a paediatric outpatient clinic is promising through a long-term behavioural obesity treatment.
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Affiliation(s)
- Pernilla Danielsson
- Department of Clinical Science; Division of Pediatrics; Karolinska Institutet; Intervention and Technology (CLINTEC); Stockholm Sweden
| | - Anna Bohlin
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
| | - Ana Bendito
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
| | - Annie Svensson
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
| | - Sven Klaesson
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
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Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality. Curr Atheroscler Rep 2016. [PMID: 26208618 DOI: 10.1007/s11883-015-0532-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is a major health problem across all age groups and has escalated to pandemic proportions. The proportion of children with overweight or obesity has risen rapidly over recent decades, and it is recognized that most obese children become obese adults. Furthermore, BMI is the strongest CV risk factor to track from childhood into adulthood. As well as BMI, multiple CV risk factors begin in childhood and strong associations between these factors and BMI are evident. Clear evidence exists for the CV benefits of reversing obesity in adults, much of which examines the effects of bariatric surgery. The capacity of bariatric surgery to reliably achieve safe and lasting improvement in BMI is unparalleled, and the emerging evidence base in adolescent bariatric surgery has so far concurred. In the absence of effective alternatives, it appears that the increase in use of bariatric surgery in adolescents will continue.
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Lerea JS, Ring LE, Hassouna R, Chong ACN, Szigeti-Buck K, Horvath TL, Zeltser LM. Reducing Adiposity in a Critical Developmental Window Has Lasting Benefits in Mice. Endocrinology 2016; 157:666-78. [PMID: 26587784 PMCID: PMC4733128 DOI: 10.1210/en.2015-1753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although most adults can lose weight by dieting, a well-characterized compensatory decrease in energy expenditure promotes weight regain more than 90% of the time. Using mice with impaired hypothalamic leptin signaling as a model of early-onset hyperphagia and obesity, we explored whether this unfavorable response to weight loss could be circumvented by early intervention. Early-onset obesity was associated with impairments in the structure and function of brown adipose tissue mitochondria, which were ameliorated by weight loss at any age. Although decreased sympathetic tone in weight-reduced adults resulted in net reductions in brown adipose tissue thermogenesis and energy expenditure that promoted rapid weight regain, this was not the case when dietary interventions were initiated at weaning. Enhanced energy expenditure persisted even after mice were allowed to resume overeating, leading to lasting reductions in adiposity. These findings reveal a time window when dietary interventions can produce metabolic improvements that are stably maintained.
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Affiliation(s)
- Jaclyn S Lerea
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Laurence E Ring
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Rim Hassouna
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Angie C N Chong
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Klara Szigeti-Buck
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Tamas L Horvath
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
| | - Lori M Zeltser
- Institute of Human Nutrition (J.S.L., A.C.N.N.), Columbia University, New York, New York 10032; Department of Anesthesiology (L.E.R.), Columbia University, New York, New York 10032; Naomi Berrie Diabetes Center (R.H., L.M.Z.), Columbia University, New York, New York 10032; Department of Obstetrics, Gynecology, and Reproductive Sciences (K.S.-B., T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; Department of Neurobiology (T.L.H.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Pathology and Cell Biology (L.M.Z.), Columbia University, New York, New York 10032
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Ek A, Sorjonen K, Eli K, Lindberg L, Nyman J, Marcus C, Nowicka P. Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist. PLoS One 2016; 11:e0147257. [PMID: 26799397 PMCID: PMC4723125 DOI: 10.1371/journal.pone.0147257] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/02/2016] [Indexed: 01/29/2023] Open
Abstract
Introduction Insight into parents’ perceptions of their children’s eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children’s eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers’ eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ). Materials and Methods Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators. Results 478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71). Discussion The CEBQ is a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental pressure to eat was strongly associated with children’s food avoidance. Parental restriction, however, was more strongly associated with parents’ concerns about their children’s weights than with children’s food approach. This suggests that childhood obesity interventions should address parents’ perceptions of healthy weight alongside perceptions of healthy eating.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Sorjonen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, United Kingdom
| | - Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jonna Nyman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- * E-mail:
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Järvholm K, Karlsson J, Olbers T, Peltonen M, Marcus C, Dahlgren J, Gronowitz E, Johnsson P, Flodmark CE. Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity. Obesity (Silver Spring) 2015; 23:1966-72. [PMID: 26227556 DOI: 10.1002/oby.21188] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate changes in mental health over 2 years in adolescents undergoing gastric bypass. METHODS Eighty-eight adolescents (65% girls) aged 13 to 18 years were assessed at baseline and 1 and 2 years after surgery. Generic and obesity-specific questionnaires were used to evaluate outcomes in mental health, also in relation to age- and gender-specific norms. RESULTS Symptoms of anxiety (P = 0.001), depression (P = 0.001), anger (P = 0.001), and disruptive behavior (P = 0.022) were significantly reduced at 2 years after surgery, as were obesity-related problems (P < 0.001). Self-esteem (P < 0.001), self-concept (P < 0.001), and overall mood (P = 0.025) improved significantly. Improvements were mainly observed during the first year after surgery. The second year was characterized by stabilization. Symptoms of anxiety, depression, anger, disruptive behavior, and self-concept were at normative levels after surgery. However, 19% of the adolescents had depressive symptoms in the clinical range. CONCLUSIONS A substantial improvement in mental health in adolescents over the first 2 years after gastric bypass was found. Most adolescents had a level of mental health and self-concept similar to norms, but a marked subgroup showed substantial depressive symptoms 2 years after surgery.
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Affiliation(s)
- Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Jan Karlsson
- Centre for Health Care Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Johnsson
- Department of Psychology, Lund University, Lund, Sweden
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Ek A, Chamberlain KL, Ejderhamn J, Fisher PA, Marcus C, Chamberlain P, Nowicka P. The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers. BMC Public Health 2015; 15:735. [PMID: 26231850 PMCID: PMC4522072 DOI: 10.1186/s12889-015-1912-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023] Open
Abstract
Background While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status. Methods/design This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II). Discussion This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life. Trial registration ClinicalTrials.gov NCT01792531 Registered February 14, 2013.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
| | | | - Jan Ejderhamn
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Philip A Fisher
- Oregon Social Learning Center, Eugene, OR, USA. philf@uoregon.\edu.,University of Oregon, Eugene, OR, USA. philf@uoregon.\edu
| | - Claude Marcus
- Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
| | | | - Paulina Nowicka
- Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
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Chaufan C, Yeh J, Sigal B. Advancing family health through the Garden of Eatin': on-site food gardens in early childhood education. Am J Public Health 2015; 105:625-8. [PMID: 25713934 DOI: 10.2105/ajph.2014.302422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Nutritional practices develop over the life course. Developing healthy habits at an early age can contribute to combating increasing child obesity rates. Through a range of activities that rely on the presence of an on-site food garden, North Bay Children's Center (NBCC), an early childhood education program, has enacted a "culture of health" into all aspects of the curriculum to promote healthy eating practices among children, families, teachers and staff. NBCC's garden program serves as a model in early childhood education and as a community-based intervention to improve family health and prevent child obesity.
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Affiliation(s)
- Claudia Chaufan
- Claudia Chaufan and Jarmin Yeh are with the Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California, San Francisco. Byron Sigal is the former associate director of North Bay Children's Center, San Francisco
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Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes 2015; 10:7-14. [PMID: 24347523 DOI: 10.1111/j.2047-6310.2013.00212.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/15/2013] [Accepted: 10/20/2013] [Indexed: 01/28/2023]
Abstract
UNLABELLED What is already known about this subject Lifestyle intervention is regarded as therapy of choice in obese children and adolescents. It is unclear whether extremely obese children and adolescents respond to lifestyle intervention. What this study adds Extremely obese children respond better than obese children to a lifestyle intervention. In contrast, most extremely obese adolescents achieved no weight loss in lifestyle intervention suggesting that other treatment approaches are needed for them. BACKGROUND There are conflicting results of treating extreme obesity in childhood by lifestyle interventions in the literature. METHODS We analysed the outcome of a 1-year lifestyle intervention in an intention-to-treat approach in 1291 children (mean age 11.0 ± 2.5 years, mean body mass index [BMI] 27.5 ± 4.7 kg m(-2), 55.8% female, 62.4% obese, 37.6% extremely obese (defined by BMI-SDS >2.3) at end of intervention and 1 year later. RESULTS The mean BMI-SDS reduction was -0.20 ± 0.32 at end of intervention and -0.14 ± 0.37 1 year after end of intervention compared to baseline (comparing intervention vs. 1 year later P = 0.010). Extremely obese children ≤10 years demonstrated a significantly greater BMI-SDS reduction than obese children ≤10 years (-0.24 ± 0.38 vs. -0.16 ± 0.38, P = 0.021). Extremely obese adolescents >10 years demonstrated a significantly lower BMI-SDS reduction compared to obese adolescents >10 years (-0.05 ± 0.30 vs. -0.15 ± 0.39, P < 0.001). Comparing the BMI-SDS reduction between obese children <10 years and >10 years revealed no significant difference (P = 0.195) in contrast to the comparison between extremely obese children <10 years and >10 years (P < 0.001). The same findings were observed in the follow-up period after the end of intervention. CONCLUSIONS Our study demonstrated an encouraging effect of lifestyle intervention in extremely obese children ≤10 years at the end of intervention and 1 year later, but only a limited effect in extremely obese adolescents >10 years.
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Affiliation(s)
- C Knop
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten, Herdecke, Germany
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Eli K, Howell K, Fisher PA, Nowicka P. "A little on the heavy side": a qualitative analysis of parents' and grandparents' perceptions of preschoolers' body weights. BMJ Open 2014; 4:e006609. [PMID: 25500371 PMCID: PMC4265138 DOI: 10.1136/bmjopen-2014-006609] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Parents' difficulties in perceiving children's weight status accurately pose a barrier for family-based obesity interventions; however, the factors underlying weight misinterpretation still need to be identified. This study's objective was to examine parents and grandparents' perceptions of preschoolers' body sizes. Interview questions also explored perceptions of parental responsibility for childhood obesity and appropriate contexts in which to discuss preschoolers' weights. DESIGN Semistructured interviews, which were videotaped, transcribed and analysed qualitatively. SETTING Eugene and the Springfield metropolitan area, Oregon, USA PARTICIPANTS: Families of children aged 3-5 years were recruited in February-May 2011 through advertisements about the study, published in the job seekers' sections of a classified website (Craigslist) and in a local newspaper. 49 participants (22 parents and 27 grandparents, 70% women, 60% with overweight/obesity) from 16 low-income families of children aged 3-5 years (50% girls, 56% with overweight/obesity) were interviewed. RESULTS There are important gaps between clinical definitions and lay perceptions of childhood obesity. While parents and grandparents were aware of their preschoolers' growth chart percentiles, these measures did not translate into recognition of children's overweight or obesity. The participants spoke of obesity as a problem that may affect the children in the future, but not at present. Participants identified childhood obesity as being transmitted from one generation to the next, and stigmatised it as resulting from 'lazy' parenting. Parents and grandparents avoided discussing the children's weights with each other and with the children themselves. CONCLUSIONS The results suggest that clinicians should clearly communicate with parents and grandparents about the meaning and appearance of obesity in early childhood, as well as counteract the social stigma attached to obesity, in order to improve the effectiveness of family-based interventions to manage obesity in early childhood.
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Affiliation(s)
- Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK
| | - Kyndal Howell
- Department of Psychology, University of Oregon, Eugene, USA
| | | | - Paulina Nowicka
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK
- Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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van Hoek E, Feskens EJM, Bouwman LI, Janse AJ. Effective interventions in overweight or obese young children: systematic review and meta-analysis. Child Obes 2014; 10:448-60. [PMID: 25333421 DOI: 10.1089/chi.2013.0149] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment programs for overweight and obese young children are of variable effectiveness, and the characteristics of effective programs are unknown. In this systematic review with meta-analysis, the effectiveness of treatment programs for these children is summarized. METHODS PubMed, Embase, Web of Science, and PsycINFO databases were searched up to April 2012. Articles reporting the effect of treatment on the body weight of overweight or obese children with a mean age in the range of 3-<8 years are included. Studies reporting the change in BMI z-score with standard error were included in a meta-analysis. For this purpose, a random-effects model was used. RESULTS The search identified 11,250 articles, of which 27 were included in this review. Eleven studies, including 20 treatment programs with 1015 participants, were eligible for the meta-analysis. The pooled intervention effect showed high heterogeneity; therefore, subgroup analysis was performed. Subgroup analysis showed that program intensity and used components partly explained the heterogeneity. The subgroup with two studies using multicomponent treatment programs (combining dietary and physical activity education and behavioral therapy) of moderate or high intensity showed the largest pooled change in BMI z-score (-0.46; I2, 0%). CONCLUSION Although the subgroup multicomponent treatment programs of moderate to high intensity contained only two studies, these treatment programs appeared to be most effective in treating overweight young children.
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Affiliation(s)
- Esther van Hoek
- 1 Department of Pediatrics, Gelderse Vallei Hospital , Ede, The Netherlands
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Beamish AJ, Johansson SE, Olbers T. Bariatric surgery in adolescents: what do we know so far? Scand J Surg 2014; 104:24-32. [DOI: 10.1177/1457496914553150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Obesity represents a vast and rapidly increasing global burden. Bariatric surgery is the only intervention achieving sustained weight loss, among its wide-ranging benefits. Methods: In this article, we describe the growing challenges presented by adolescents with severe obesity and review the literature on surgical and other treatment options. Results: Outcomes in terms of weight loss, metabolic and quality of life improvement, reversal of obstructive sleep apnea, insulin resistance, type II diabetes mellitus, hypertension, and dyslipidemia appear comparable to those seen in adults. However, long-term data on safety and sustainability are lacking. There is a growing acceptance of the need for surgery as a treatment for the morbidly obese adolescent population, and the number of studies reporting outcomes after adolescent bariatric surgery is increasing. Conclusion: Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. Thus, adolescent bariatric surgery appears to be safe and effective in achieving benefits desired in terms of weight control and improvements in metabolic health and quality of life. However, particular care must be taken when treating a young population, and long-term outcomes are awaited to properly define indications and limitations.
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Affiliation(s)
- A. J. Beamish
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S. E. Johansson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T. Olbers
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hedvall Kallerman P, Hagman E, Edstedt Bonamy AK, Zemack H, Marcus C, Norman M, Westerståhl M. Obese children without comorbidities have impaired microvascular endothelial function. Acta Paediatr 2014; 103:411-7. [PMID: 24372596 DOI: 10.1111/apa.12549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/04/2013] [Accepted: 12/18/2013] [Indexed: 01/18/2023]
Abstract
AIM The aim was to test acetylcholine-induced endothelium-dependent vasodilatation in obese children without comorbidities, compared with normal weight controls, and to analyse associations between vasodilatation and other potential risk factors. METHODS Endothelium-dependent vasodilatation was induced by transdermal iontophoresis of acetylcholine in 54 obese children (8.3-18.2 years old, 41% girls) and 44 normal weight controls (7.5-20.2 years old, 82% girls), and the subsequent change in perfusion was measured with laser Doppler flowmetry. In a subgroup of the obese children, associations between acetylcholine-induced vasodilatation and blood lipids, glucose/insulin metabolism, inflammation, 24-h ambulatory blood pressure (ABP), cardiovascular fitness and duration of obesity were evaluated. RESULTS We found a lower endothelium-dependent vasodilatory response to acetylcholine in the obese children than the controls (p < 0.001). The peak perfusion response was 33% lower in obese children (p = 0.001). There was a trend towards lower vasodilatation in obese children with higher levels of triglycerides (p = 0.07). Children with the shortest duration of obesity exhibited the lowest vasodilatation (p = 0.03). No associations were found between 24-h ABP, cardiovascular fitness, inflammation and glucose/insulin metabolism. CONCLUSION Obese children without comorbidities have significantly impaired microvascular endothelial function. The children who had been obese for a longer time seemed less affected.
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Affiliation(s)
- P Hedvall Kallerman
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - E Hagman
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - A-K Edstedt Bonamy
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - H Zemack
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - C Marcus
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- National Childhood Obesity Center; Karolinska University Hospital Huddinge; Stockholm Sweden
| | - M Norman
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - M Westerståhl
- Divisions of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Division of Clinical Physiology; Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
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Göthberg G, Gronowitz E, Flodmark CE, Dahlgren J, Ekbom K, Mårild S, Marcus C, Olbers T. Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid obesity--surgical aspects and clinical outcome. Semin Pediatr Surg 2014; 23:11-6. [PMID: 24491362 DOI: 10.1053/j.sempedsurg.2013.10.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this paper, we address surgical aspects on bariatric surgery in adolescents from a nationwide Swedish study. Laparoscopic gastric bypass surgery was performed for 81 adolescents with morbid obesity (13-18 years), while 81 adolescents with obesity-matched by age, sex, and BMI received conventional care. Another comparison group was adults undergoing gastric bypass at the same institution during the same time period. This report addresses the 2-year clinical outcome and five-year surgical adverse event rate. Body weight decreased from 133 kg (SD = 22) at inclusion to 92 kg (SD = 17) after 1 year and was 89 (SD = 18) after 2 years (p < 0·001) representing a 32% (-35 to -30) weight loss after 2 years, corresponding to 76% (-81 to -71) excess weight loss. Weight loss was similar in the adult gastric bypass patients (-31%) while weight gain (+3%) was seen in the conventionally treated obese adolescents. Significant improvement in cardiovascular and metabolic risk factors and inflammation was seen after surgery. The treatment was generally well tolerated and quality of life improved significantly. The surgical adverse events included cholecystectomies (10%) and operations for internal hernia (9%) but no postoperative mortality. Adolescents undergoing laparoscopic gastric bypass surgery achieve similar weight loss to adults. Improvements in risk factors and quality of life were substantial. There were surgical complications similar to the adult group, which may be preventable.
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Affiliation(s)
- Gunnar Göthberg
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | | | - Jovanna Dahlgren
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Kerstin Ekbom
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Division of Paediatrics, and National Childhood Obesity Centre, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Mårild
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Division of Paediatrics, and National Childhood Obesity Centre, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Olbers
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden.
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Davis AM, Daldalian MC, Mayfield CA, Dean K, Black WR, Sampilo ML, Gonzalez-Mijares M, Suminski R. Outcomes from an urban pediatric obesity program targeting minority youth: the Healthy Hawks program. Child Obes 2013; 9:492-500. [PMID: 24175630 DOI: 10.1089/chi.2013.0053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study was to describe the outcomes of a family-based behavioral group treatment program with a group of urban, minority, low-income families. METHODS Two hundred and ten families enrolled in a 12-week family-based behavioral group treatment program for pediatric obesity. The program was offered in English and in Spanish and targeted the enrollment of low-income highly diverse youth and families. Primary outcome measures included child BMI z-score (zBMI), maternal BMI, 3-day diet record, and accelerometer. RESULTS Seventy-one percent of enrolled families completed the 12-week program. Significant 12-week outcomes were achieved for child zBMI (p<0.001) and for maternal BMI (p<0.001), as well as for child kcals (p<0.001), sugar-sweetened beverages (p=0.017), and red foods (p<0.001). Only change in child zBMI remained significant at 1 year (p<0.05). Physical activity outcomes were not significant and not in the expected direction. There were no differences in outcome by race/ethnicity, but by age, younger children had higher zBMI at baseline and were also more likely to decrease zBMI during the intervention. CONCLUSIONS It is possible to enroll and maintain urban, minority, low-income families in a family-based behavioral group treatment program for pediatric obesity. Outcome data indicate that these families achieve significant outcomes on zBMI, and that children who remain available for assessment maintain this at 1 year, which is an improvement over previous research using other intervention methodologies with this population.
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Affiliation(s)
- Ann M Davis
- 1 Department of Pediatrics, Center for Children's Healthy Lifestyles & Nutrition, University of Kansas Medical Center , Kansas City, KS
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Van Ryzin MJ, Nowicka P. Direct and indirect effects of a family-based intervention in early adolescence on parent-youth relationship quality, late adolescent health, and early adult obesity. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2013; 27:106-16. [PMID: 23421838 PMCID: PMC3634561 DOI: 10.1037/a0031428] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We explored family processes in adolescence that may influence the likelihood of obesity in early adulthood using a randomized trial of a family-based intervention (the Family Check-Up, or FCU). The FCU has been shown to reduce escalations in antisocial behavior and depression in adolescence by supporting positive family management practices, but no research has examined the mechanisms by which the FCU could influence health-related attitudes and behaviors linked to obesity. Participants were 998 adolescents (n = 526 male; n = 423 European American; M age 12.21 years) and their families, recruited in 6th grade from 3 middle schools in the Pacific Northwest. We used structural equation modeling (SEM) and an Intent-To-Treat (ITT) design to evaluate the direct and indirect effects of the FCU on parent-youth relationship quality (ages 12-15), healthy lifestyle behaviors, eating attitudes, depressive symptoms (all measured at age 17), and obesity (age 22). We found that the FCU led to greater parent-youth relationship quality, which predicted enhanced health-related behaviors, reduced maladaptive eating attitudes, and reduced depression. In turn, reduced maladaptive eating attitudes predicted reduced odds of obesity. The indirect effect of the FCU on obesity by way of parent-youth relationship quality and eating attitudes was significant. Our findings illustrate how family processes may influence adolescent health and suggest that family functioning may be an additional factor to consider when developing intervention programs for obesity.
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Affiliation(s)
- Mark J Van Ryzin
- Child and Family Center, University of Oregon, Eugene, OR 97403-6217, USA.
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