An individual, community-based treatment for obese children and their families: the solution-focused approach

The effects of group counseling based on the solution-focused approach on anxiety and healthy lifestyle behaviors in individuals with eating disorders

PURPOSE

This study was conducted to determine the effects of group counseling based on the solution-focused approach (SFA) on anxiety and healthy lifestyle behaviors in individuals with eating disorders.

DESIGN AND METHODS

The study was implemented with a pretest-posttest experimental (n:31) randomized controlled (n:45) design. Adults aged 25 and older were included in the study.

FINDINGS

After the intervention, there was a decrease in the trait anxiety inventory scores, while there was an increase in the healthy lifestyle scores and subscale scores. Additionally, the mean weight of the individuals in the experiment group and their body mass indices decreased, and their weekly hours of exercise increased.

PRACTICAL IMPLICATIONS

SFA counseling provided to the individuals with eating disorders decreased the anxiety of the individuals and increased their healthy lifestyle behaviors.

Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment

PURPOSE OF REVIEW

The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity.

RECENT FINDINGS

Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.

The effect of solution-focused interviews (SFI) conducted by nurses on middle school adolescents' healthy lifestyles: a quasi-experimental study

AIM

This study aimed at assessing the effect of solution-focused interviews for the promotion of health locus of control and self-efficacy on adolescents' healthy lifestyles.

METHOD

The present study, which was designed as a quasi-experimental study, included pretest and post-test control groups and was conducted in the period between 5 February 2017 and 30 April 2017. The intervention group comprised 28 (n = 28) adolescents from a school, and the control group comprised 30 (n = 30) adolescents from another school. Solution-focused interviews, which included educational information regarding leading a healthy lifestyle as well as cognitive-behavioural interview, were conducted with the adolescents of the intervention group, 1 day per week (nine sessions in total).

RESULTS

In comparison to the control group, adolescents in the intervention group exhibited differences in all the sub-dimensions health promotion scale (p < 0.001).

CONCLUSIONS

These results established the applicability and effectiveness of the programme, such that the health promotion programme could be included in the literature. Moreover, it is anticipated that this programme would be applied in school settings in the future.

Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach

Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.

Longitudinal changes in BMI z-scores among 45 414 2-4-year olds with severe obesity

BACKGROUND

BMI z-scores (BMIz) based on the Centers for Disease Control and Prevention (CDC) growth charts among children do not accurately characterise BMI levels among children with very high BMIs. These limitations may be particularly relevant in longitudinal and intervention studies, as the large changes in the L (normality) and S (dispersion) parameters with age can influence BMIz.

AIM

To compare longitudinal changes in BMIz with BMI expressed as a percentage of the 95th percentile (%BMIp95) and a modified z-score calculated as log(BMI/M)/S.

SUBJECTS AND METHODS

A total of 45 414 2-4-year-olds with severe obesity (%BMIp95 ≥ 120).

RESULTS

Changes in very high BMIz levels differed from the other metrics. Among severely obese 2-year-old girls, for example, the mean BMIz decreased by 0.6 SD between examinations, but there were only small changes in BMIp95 and modified BMIz. Some 2-year-old girls had BMIz decreases of >1 SD, even though they had large increases in BMI, %BMIp95 and modified BMIz.

CONCLUSIONS

Among children with severe obesity, BMIz changes may be due to differences in the transformations used to estimate levels of BMIz rather than to changes in body size. The BMIs of these children could be expressed relative to the 95th percentile or as modified z-scores.

The Limitations of Transforming Very High Body Mass Indexes into z-Scores among 8.7 Million 2- to 4-Year-Old Children

OBJECTIVE

To examine the associations among several body mass index (BMI) metrics (z-scores, percent of the 95th percentile (%BMIp95) and BMI minus 95th percentile (ΔBMIp95) as calculated in the growth charts from the Centers for Disease Control and Prevention (CDC). It is known that the widely used BMI z-scores (BMIz) and percentiles calculated from the growth charts can differ substantially from those that directly observed in the data for BMIs above the 97th percentile (z = 1.88).

STUDY DESIGN

Cross-sectional analyses of 8.7 million 2- to 4-year-old children who were examined from 2008 through 2011 in the CDC's Pediatric Nutrition Surveillance System.

RESULTS

Because of the transformation used to calculate z-scores, the theoretical maximum BMIz varied by >3-fold across ages. This results in the conversion of very high BMIs into a narrow range of z-scores that varied by sex and age. Among children with severe obesity, levels of BMIz were only moderately correlated (r ~ 0.5) with %BMIp95 and ΔBMIp95. Among these children with severe obesity, BMIz levels could differ by more than 1 SD among children who had very similar levels of BMI, %BMIp95 and ΔBMIp95 due to differences in age or sex.

CONCLUSIONS

The effective upper limit of BMIz values calculated from the CDC growth charts, which varies by sex and age, strongly influences the calculation of z-scores for children with severe obesity. Expressing these very high BMIs relative to the CDC 95th percentile, either as a difference or percentage, would be preferable to using BMI-for-age, particularly when assessing the effectiveness of interventions.

Tracking of BMI z Scores for Severe Obesity

BACKGROUND

Although the Centers for Disease Control (CDC) growth charts are widely used in studies of childhood obesity, BMI z scores are known to be inaccurate at values greater than the 97th percentile.

METHODS

We used longitudinal data from 6994 children in the Bogalusa Heart Study who were examined multiple times to compare tracking of 3 BMI metrics: BMI-for-sex/age z score (BMIz), BMI expressed as a percentage of the 95th percentile (%BMIp95), and levels of BMI z score that adjust for the compression of very high z scores (adjusted z score [BMIaz]). The later 2 metrics, unlike BMIz, do not have an upper limit. The mean interval between examinations was 2.8 years. We were particularly interested in these metrics among children with obesity or severe obesity (%BMIp95 ≥120%).

RESULTS

Although there was little difference in the tracking of the 3 metrics in the overall sample, among 247 children with severe obesity, the correlation of BMIz levels between examinations (r = 0.46) was substantially weaker than those for BMIaz and %BMIp95 (r = 0.65 and 0.61). Age-stratified analyses indicated that the weak tracking of BMIz was particularly evident before the age of 10 years (r = 0.36 vs 0.57 and 0.60). Several children with severe obesity showed BMIz decreases between examinations despite having BMI increases of over 5.

CONCLUSIONS

Among children with severe obesity, the tracking of BMIz is weak. This is because of the constraints in converting very high BMIs into z scores based on the CDC growth charts. Rather than using BMIz, it would be preferable to express very high BMIs relative to the CDC 95th percentile or to use BMIaz.

BMI z-Scores are a poor indicator of adiposity among 2- to 19-year-olds with very high BMIs, NHANES 1999-2000 to 2013-2014

OBJECTIVE

Although the Centers for Disease Control and Prevention (CDC) growth charts are widely used, BMI-for-age z-Scores (BMIz) are known to be uninformative above the 97th percentile. This study compared the relations of BMIz and other BMI metrics (%BMI_p95 , percent of 95th percentile, and ΔBMI_p95 , BMI minus 95th percentile) to circumferences, skinfolds, and fat mass. We were particularly interested in the differences among children with severe obesity (%BMI_p95  ≥ 120).

METHODS

Data was used from 30,003 2- to 19-year-olds who were examined from 1999-2000 through 2013-2014 in the National Health and Nutrition Examination Survey (NHANES).

RESULTS

The theoretical maximum BMIz based on the growth charts varied by more than threefold across ages. The BMI metrics were strongly intercorrelated, but BMIz was less strongly related to the adiposity measures than were ΔBMI_p95 and %BMI_p95 . Among children with severe obesity, circumferences and triceps skinfold showed almost no association with BMIz (r ≤ 0.10), whereas associations with %BMI_p95 and ΔBMI_p95 ranged from r = 0.32 to 0.79. Corresponding associations with fat mass ÷ height² ranged from r = 0.40 (BMIz) to r =0.82 (%BMI_p95 ) among 8- to 19-year-olds.

CONCLUSIONS

Among children with severe obesity, BMIz is only weakly associated with other measures of body fatness. Very high BMIs should be expressed relative to the CDC 95th percentile, particularly in studies that evaluate obesity interventions.