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Wills-Ibarra N, Chemtob K, Hart H, Frati F, Pratt KJ, Ball GD, Van Hulst A. Family systems approaches in pediatric obesity management: a scoping review. BMC Pediatr 2024; 24:235. [PMID: 38566046 PMCID: PMC10985863 DOI: 10.1186/s12887-024-04646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) (n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) (n = 18), mental health (n = 12), FST-related outcomes (n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) (n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research.
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Affiliation(s)
- Natasha Wills-Ibarra
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keryn Chemtob
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Heather Hart
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Francesca Frati
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Centre, Columbus, OH, USA
| | - Geoff Dc Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andraea Van Hulst
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada.
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Briatico D, Reilly KC, Tucker P, Irwin JD, Johnson AM, Pearson ES, Bock DE, Burke SM. Using the RE-AIM framework to evaluate the feasibility of a parent-focused intervention targeting childhood obesity. Pilot Feasibility Stud 2023; 9:38. [PMID: 36915150 PMCID: PMC10009980 DOI: 10.1186/s40814-023-01248-8] [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: 04/20/2022] [Accepted: 01/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Childhood obesity remains a serious public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviors and outcomes among children, but require thorough evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a community-based, parent-focused childhood obesity intervention ("C.H.A.M.P. Families") using the RE-AIM framework, an evaluation tool for health interventions. METHODS A single-group, non-randomized, repeated measures feasibility study was conducted. Participants (n = 16 parents/caregivers of 11 children with obesity) completed a 13-week parent-focused education intervention. The intervention consisted of three main components: (a) eight group-based (parent-only) education sessions; (b) eight home-based (family-centered) activities; and (c) two group-based follow-up support sessions for parents and children. The five dimensions of RE-AIM-reach, effectiveness, adoption, implementation, and maintenance-were assessed using various measures and data sources (e.g., child, parent/caregiver, costing, census) obtained throughout the study period. Outcome variables were measured at baseline, mid-intervention, post-intervention, and at a 6-month follow-up. RESULTS Overall, the C.H.A.M.P. Families intervention reached approximately 0.09% of eligible families in London, Ontario. Despite the small number, participants were generally representative of the population from which they were drawn, and program participation rates were high (reach). Findings also suggest that involvement in the program was associated with improved health-related quality of life among children (effectiveness/individual-level maintenance). In addition, the intervention had high fidelity to protocol, attendance rates, and cost-effectiveness (implementation). Lastly, important community partnerships were established and maintained (adoption/setting-level maintenance). CONCLUSIONS Based on a detailed and comprehensive RE-AIM evaluation, the C.H.A.M.P. Families intervention appears to be a promising parent-focused approach to the treatment of childhood obesity. TRIAL REGISTRATION ISRCTN Registry, Study ID ISRCTN 10752416 . Registered 24 April 2018.
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Affiliation(s)
- Daniel Briatico
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kristen C Reilly
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Patricia Tucker
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Canada
| | - Jennifer D Irwin
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Andrew M Johnson
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Erin S Pearson
- Faculty of Health and Behavioural Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Dirk E Bock
- Children's Health Research Institute, Lawson Health Research Institute, London, Canada.,Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Office for Child and Adolescent Medicine, Windisch, Aargau, Switzerland
| | - Shauna M Burke
- Faculty of Health Sciences, Western University, London, Ontario, Canada. .,Children's Health Research Institute, Lawson Health Research Institute, London, Canada.
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Spence ND, Newton AS, Keaschuk RA, Ambler KA, Holt NL, Jetha MM, Mushquash AR, Rosychuk RJ, Sharma AM, Spence JC, Ball GDC. Parents as Agents of Change in Managing Pediatric Obesity: A Randomized Controlled Trial Comparing Cognitive Behavioral Therapy versus Psychoeducation Interventions. Child Obes 2023; 19:71-87. [PMID: 35442813 DOI: 10.1089/chi.2021.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Obesity interventions for parents of children with obesity can improve children's weight and health. This randomized controlled trial (RCT) evaluated whether a parent-based intervention based on cognitive behavioral therapy (CBT) principles was superior to a parent-based intervention based on a psychoeducation program (PEP) in improving children's obesity. Methods: This study was a pragmatic, two-armed, parallel, superiority RCT. Conducted at a Canadian outpatient pediatric obesity management clinic (September 2010-January 2014), this trial included families with children 8-12 years with an age- and sex-specific BMI ≥85th percentile. The 16-week manualized interventions were similar in content and delivered to parents exclusively, with different theoretical underpinnings. The primary outcome was children's BMI z-score at postintervention (4 months). Secondary outcomes included anthropometric, lifestyle, psychosocial, and cardiometabolic variables. Data were collected at preintervention (0 months), postintervention (4 months), 10, and 16 months. Intention-to-treat analysis using linear mixed models was used to assess outcomes. Results: Among 52 randomly assigned children, the mean age (standard deviation) was 9.8 (1.7) years and BMI z-score was 2.2 (0.3). Mean differences in BMI z-score were not significantly different between the CBT (n = 27) and PEP (n = 25) groups from 0 to 4-, 10-, and 16-month follow-up. At 4 months, the mean difference in BMI z-score from preintervention between the CBT (-0.05, 95% CI = -0.09 to 0.00) and PEP (-0.04, 95% CI = -0.09 to 0.01) groups was -0.01 (95% CI = -0.08 to 0.06, p = 0.80). Similar results were found across all secondary outcomes. Conclusions: Our CBT-based intervention for parents of children with obesity was not superior in reducing BMI z-score vs. our PEP-based intervention.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada.,Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel A Keaschuk
- Alberta Health Services, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kathryn A Ambler
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas L Holt
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Mary M Jetha
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aislin R Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John C Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Fidjeland TG, Øen KG. Parents' Experiences Using Digital Health Technologies in Paediatric Overweight and Obesity Support: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010410. [PMID: 36612733 PMCID: PMC9819819 DOI: 10.3390/ijerph20010410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 05/08/2023]
Abstract
This study aimed to explore parents' perspectives regarding the use of digital health technologies in paediatric overweight and obesity weight support. A systematic search in 'Academic Search Premier', 'British Nursing Index', 'Cumulative Index to Nursing and Allied Health', and 'Health Research Premium Collection' was conducted in November 2021. Inclusion criteria were English or Nordic peer-reviewed articles published after 2010, overweight and obese children aged 2-10, weight support using digital health technologies, and parental experiences examined. An integrative review was conducted using Joanna Briggs Institute quality appraisal checklists and a constant comparison analysis method. In total, 14 articles were analysed that included SMS, telephone, apps, websites, and social media as the main technology groups. A limitation of this review was the heterogenicity of the studies. The results indicate that parents, mostly mothers, had a positive experience, finding technologies helpful and easy to use, and expressed optimism toward future use. An option for interacting with others and the possibility of personalising support were enjoyed or requested. In conclusion, digital health technologies can be a suitable tool to empower the parents of children with overweight and obesity concerns, whose perspective should be considered during the design and support phases.
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5
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Step Count Associations Between Adults at Risk of Developing Diabetes and Their Children: The Feel4Diabetes Study. J Phys Act Health 2021; 18:374-381. [PMID: 33714194 DOI: 10.1123/jpah.2020-0123] [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: 02/28/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Shared risk factors of type 2 diabetes mellitus (T2DM) between parents at risk and their children, such as low physical activity levels, should be addressed to prevent the development of the disease. The aim of this study was to determine the association of objectively measured step counts per day between parents at risk of developing T2DM and their 6- to 10-year-old children. METHODS The baseline data from the Feel4Diabetes study were analyzed. Dyads of children and one parent (n = 250, 54.4% girls and 77.6% mothers) from Belgium were included. Step counts per day during 5 consecutive days from parents and their children were objectively measured with ActiGraph accelerometers. RESULTS Adjusted linear regression models indicated that parents' and children's step counts were significantly associated during all days (β = 0.245), weekdays (β = 0.205), and weekend days (β = 0.316) (P ≤ .002 in all cases). Specifically, mother-daughter associations during all days and weekend days and father-son step counts during weekdays and when considering all days were significant. CONCLUSION There is a positive association between step counts from adults at risk of developing T2DM and their children, especially in the mother-daughter and father-son dyads.
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McPherson AC, Perez A, Buchholz A, Forhan M, Ball GDC. "It's not a simple answer." A qualitative study to explore how healthcare providers can best support families with a child with autism spectrum disorder and overweight or obesity. Disabil Rehabil 2021; 44:3540-3546. [PMID: 33399017 DOI: 10.1080/09638288.2020.1867909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This qualitative study aimed to explore the experiences of parents supporting their child with Autism Spectrum Disorder (ASD) and overweight or obesity (OW/OB), including their weight management support needs. METHODS Interview transcripts were analysed using inductive thematic analysis. Nine parents (n = 9 mothers) of ten children with ASD (7 males, 3 females) participated in individual semi-structured interviews. RESULTS The three themes developed were: (1) Our journey to obtain weight management support; (2) I need real-world solutions; and (3) The what, who and how of our weight management needs. Parents reported being proactive in seeking weight management support for their child but were disappointed with the services offered. Resources were not tailored to the child's complex nutrition and behavioural issues or their abilities and functioning. A multidisciplinary approach that integrated both disability and weight management expertise was desired, but not experienced. A range of formal and informal programs were recommended. CONCLUSION This study provides a call to action for supports that ensure children with ASD and OW/OB receive integrated, individualised support to maximise their health and wellness.Implications for rehabilitationChildren with autism spectrum disorder (ASD) are at high risk of developing overweight or obesity.The weight management support needs of parents of children with ASD and overweight or obesity are not being met.Support must be tailored to the child's needs, which are often complex.Health services that integrate expertise in both disability and weight management are needed for children with ASD and their families.
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Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Arnaldo Perez
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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7
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Lappan SN, Carolan M, Parra-Cardona JR, Weatherspoon L. Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice. J Prim Prev 2020; 41:503-528. [PMID: 33125592 PMCID: PMC10732148 DOI: 10.1007/s10935-020-00612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/29/2022]
Abstract
Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.
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Affiliation(s)
- Sara N Lappan
- Department of Human Studies, University of Alabama At Birmingham, 1720 2nd Ave. S, Birmingham, AL 35294, USA.
| | - Marsha Carolan
- Department of Human Development and Family Studies, Michigan State University, East Lansing, USA
| | | | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, USA
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8
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Brown CL, Pratt K, Martin S, Hulshult H, Skelton JA. Weight Control Practices in Children of Parents Participating in Weight Management Programs. Child Obes 2019; 15:451-458. [PMID: 31343259 PMCID: PMC6761581 DOI: 10.1089/chi.2019.0089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Family members influence the behaviors and weight loss of adults in weight management programs (WMPs). Less is known about the weight control practices of children who have a parent participating in a WMP. Thus, we aimed to explore weight control practices in children of parents in WMPs. Methods: We recruited participants who were parents of least one child aged 2-18 living at home from two institution's adult WMPs. Parents reported weight control practices for themselves and their child. We used separate logistic regression models to assess the association of each child weight control practice with parent weight control practice; child age, race, sex, and BMI z-score (BMIz); parent education; and household income. Results: Parents (N = 300) had a mean age of 41 ± 7 and 85% were female. Children (N = 295) had a mean age of 9.3 ± 4.9; 20% had overweight or obesity. Parents reported their child used the following weight control practices in the past year: 12% dieted, 12% ate very little food, 7% used food substitutes, 10% skipped meals, 29% increased fruit and vegetables, 25% reduced calories, 22% reduced snacking, 21% reduced fat intake, and 45% exercised. Children were more likely to utilize weight control practices if their parent utilized the same weight control practice and if children had obesity and were older. Conclusions: Children of parents attending WMPs commonly utilize weight control practices, especially older children with higher BMIz. Adult WMPs should offer guidance to parents on ways to incorporate new healthy dietary practices into their family.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Keeley Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH
| | - Sarah Martin
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hannah Hulshult
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
- Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC
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Participants' Perceptions of "C.H.A.M.P. Families": A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122171. [PMID: 31248201 PMCID: PMC6617231 DOI: 10.3390/ijerph16122171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 01/07/2023]
Abstract
Background: Recently, our team implemented a 13-week group-based intervention for parents of children with obesity ("C.H.A.M.P. Families"). The primary objective of this study was to explore, qualitatively, parents' perspectives of their experiences in and influence of C.H.A.M.P. Families, as well as their recommendations for future paediatric obesity treatment interventions. Methods: Twelve parents (seven mothers, five fathers/step-fathers) representing seven children (four girls, three boys) with obesity participated in one of two focus groups following the intervention. Focus groups were audio recorded and transcribed verbatim and data were analyzed using inductive thematic analysis. Results: Findings showed that parents perceived their participation in C.H.A.M.P. Families to be a positive experience. Participants highlighted several positive health-related outcomes for children, families, and parents. Parents also underscored the importance and positive impact of the group environment, specific educational content, and additional program components such as free child-minding. Recommendations for future interventions were also provided, including greater child involvement and more practical strategies. Finally, parents identified several barriers including socioenvironmental issues, time constraints, and parenting challenges. Conclusions: Researchers developing family-based childhood obesity interventions should consider the balance of parent and child involvement, as well as emphasize group dynamics strategies and positive family communication.
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10
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Franzen-Castle L, Colby SE, Kattelmann KK, Olfert MD, Mathews DR, Yerxa K, Baker B, Krehbiel M, Lehrke T, Wilson K, Flanagan SM, Ford A, Aguirre T, White AA. Development of the iCook 4-H Curriculum for Youth and Adults: Cooking, Eating, and Playing Together for Childhood Obesity Prevention. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:S60-S68. [PMID: 30851862 DOI: 10.1016/j.jneb.2018.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
The objective was to describe the development process of a curriculum (iCook 4-H) targeted to low-income, rural, and/or diverse youths and their adult primary meal preparer to promote cooking, eating, and playing together. Lessons learned highlighted the importance of grounding the curriculum in Social Cognitive Theory and applying the experiential 4-H learning model using a multiphased, community-based participatory approach with cyclical development and evaluation, and key modifications made for dissemination and distribution. Findings across 4 testing phases over 6 years and 5 states demonstrated the time-intensive, cyclical process that required flexibility with fidelity to form a hands-on, interactive curriculum.
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Affiliation(s)
- Lisa Franzen-Castle
- Nutrition and Health Sciences Department, University of Nebraska-Lincoln, Lincoln, NE.
| | - Sarah E Colby
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Kendra K Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources and Design, West Virginia University, Morgantown, WV
| | | | - Kathryn Yerxa
- School of Food and Agriculture, University of Maine Cooperative Extension, Orono, ME
| | - Barbara Baker
- 4-H Youth Development, University of Maine Cooperative Extension, Bangor, ME
| | | | - Tracey Lehrke
- Roberts County, South Dakota State University, Sisseton, SD
| | - Kimberly Wilson
- Family and Community Health, South Dakota State University, Brookings, SD
| | | | - Amber Ford
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Trina Aguirre
- College of Nursing-Western Nebraska Division, University of Nebraska Medical Center, Scottsbluff, NE
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11
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"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122858. [PMID: 30558152 PMCID: PMC6313348 DOI: 10.3390/ijerph15122858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.
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12
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Song M, Lee CS, Lyons KS, Stoyles S, Winters-Stone KM. Assessing the feasibility of parent participation in a commercial weight loss program to improve child body mass index and weight-related health behaviors. SAGE Open Med 2018; 6:2050312118801220. [PMID: 30302248 PMCID: PMC6170954 DOI: 10.1177/2050312118801220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 08/26/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives: Little is known about how children’s health might be affected by parents’
participation in commercial weight loss programs. Given that more than
3.2 million people subscribe to just one commercial weight loss program,
Weight Watchers, any secondary effects on children’s
weight-related health behaviors (e.g. dietary behaviors, physical activity,
and sedentary time) and body mass index from parent participation in
commercial weight loss programs may have significant public health
implications. This study examined the feasibility of conducting a study to
assess such effects. Methods for recruitment and retention, and perceived
acceptability and satisfaction among participants in small-scale preliminary
study, were evaluated. Changes in body mass index and health behaviors among
the parent–child dyads were also measured to test whether a larger-scale
study would be warranted. Methods: This was an 8-week, pre–post observational feasibility study involving 20
parent–child dyads where both members had overweight or obesity. Physical
and behavioral data were collected at baseline and 8 weeks from both members
of the dyads. Parenting data were collected at the same time periods through
parents’ self-report. Bivariate correlation was used to quantify the
associations in changes for dyad members. Results: Feasibility goals for retention and perceived acceptability/satisfaction
among participants were met. We reached approximately 80% of our enrollment
goal. Parents showed a significant decrease in body mass index of 0.53
points (p < 0.05), while children showed a significant increase in raw
body mass index (0.42, p < 0.05) and body mass index percentile (0.59,
p < 0.05). However, correlation between changes in parent body mass index
and changes in children body mass index percentile was positively correlated
(r = 0.24, p = 0.31). A decrease in parent intake of total fat was
associated with a decrease in the intake of fat in their children (r = 0.47,
p < 0.05). Conclusion: Our findings support the viability of a larger-scale follow-up to assess the
potential of using parent-only commercial weight loss program as a mechanism
for improving health behaviors and body mass index in children with
overweight or obesity.
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Affiliation(s)
- MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Wald ER, Ewing LJ, Moyer SCL, Eickhoff JC. An Interactive Web-Based Intervention to Achieve Healthy Weight in Young Children. Clin Pediatr (Phila) 2018; 57:547-557. [PMID: 29067819 PMCID: PMC10360456 DOI: 10.1177/0009922817733703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This prospective, randomized, controlled trial for parents of overweight and obese 3- to 7-year-olds was performed to assess the feasibility of a program promoting healthy eating and lifestyle by targeting parents as agents of change. The intervention was composed of 6-in-person group sessions and a customized website over 12 months. The control group received customary care. The primary outcome was feasibility of the intervention to promote healthy behavior change measured by attendance. The secondary outcome was effectiveness assessed by attaining reduced body mass index (BMI) z scores, healthy behavior changes and increased parent self-efficacy. Seventy-three child-parent dyads were enrolled; 14 parents never attended any sessions. Participation in follow-up assessments did not meet the hypothesized level. Ultimate BMI z scores did not differ between control and intervention groups. Parenting skills did not improve in the intervention group. This intervention to achieve healthy lifestyle changes in children via their parents as "change agents" was unsuccessful.
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Affiliation(s)
- Ellen R Wald
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda J Ewing
- 2 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jens C Eickhoff
- 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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14
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Maatoug J, Fredj SB, Msakni Z, Dendana E, Sahli J, Harrabi I, Chouikha F, Boughamoura L, Slama S, Farpour-Lambert N, Ghannem H. Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014. Int J Adolesc Med Health 2017; 29:/j/ijamh.2017.29.issue-2/ijamh-2015-0035/ijamh-2015-0035.xml. [PMID: 26360490 DOI: 10.1515/ijamh-2015-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/02/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide. OBJECTIVE To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia. METHODS We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups. RESULTS The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups. CONCLUSION This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.
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Affiliation(s)
- Jihen Maatoug
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | - Sihem Ben Fredj
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | - Zeineb Msakni
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | - Emna Dendana
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | - Jihene Sahli
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | - Imed Harrabi
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | - Firas Chouikha
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
| | | | - Slim Slama
- Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva, Geneva
| | | | - Hassen Ghannem
- Department of Epidemiology, University Hospital Farhat Hached, Sousse
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Associations Between Parental BMI and the Family Nutrition and Physical Activity Environment in a Community Sample. J Community Health 2017; 42:1233-1239. [DOI: 10.1007/s10900-017-0375-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Spence ND, Newton AS, Keaschuk RA, Ambler KA, Jetha MM, Holt NL, Rosychuk RJ, Spence JC, Sharma AM, Ball GDC. Predictors of Short- and Long-Term Attrition From the Parents as Agents of Change Randomized Controlled Trial for Managing Pediatric Obesity. J Pediatr Health Care 2017; 31:293-301. [PMID: 27743908 DOI: 10.1016/j.pedhc.2016.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/04/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Attrition in pediatric weight management is a substantial problem. This study examined factors associated with short- and long-term attrition from a lifestyle and behavioral intervention for parents of children with overweight or obesity. METHOD Fifty-two families with children ages 6 to 12 years old and body mass index at or above the 85th percentile participated in a randomized controlled trial focused on parents, comparing parent-based cognitive behavioral therapy with parent-based psychoeducation for pediatric weight management. We examined program attrition using two clinical phases of the intervention: short-term and long-term attrition, modeled using the general linear model. Predictors included intervention type, child/parent weight status, sociodemographic factors, and health of the family system. RESULTS Higher self-assessed health of the family system was associated with lower short-term attrition; higher percentage of intervention sessions attended by parents was associated with lower long-term attrition. DISCUSSION Different variables were significant in our short- and long-term models. Attrition might best be conceptualized based on short- and long-term phases of clinical, parent-based interventions for pediatric weight management.
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Ball GDC, Mushquash AR, Keaschuk RA, Ambler KA, Newton AS. Using Intervention Mapping to develop the Parents as Agents of Change (PAC ©) intervention for managing pediatric obesity. BMC Res Notes 2017; 10:43. [PMID: 28086848 PMCID: PMC5237285 DOI: 10.1186/s13104-016-2361-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 01/01/2023] Open
Abstract
Background Pediatric obesity has become increasingly prevalent over recent decades. In view of the psychosocial and physical health risks, and the high likelihood that children with obesity will grow to become adults with obesity, there is a clear need to develop evidence-based interventions that can be delivered in the health care system to optimize the health and well-being of children with obesity and their families. The aim of this paper is to describe the development, implementation, and planned evaluation of a parent-based weight management intervention designed for parents of 8–12 year olds with obesity. Methods/results The principles of Intervention Mapping (IM) were used to develop an intervention called Parents as Agents of Change (PAC©). From 2006 to 2009, an environmental scan plus qualitative (individual interviews with parents and children), quantitative (medical record reviews), and literature review data were collected to gain broad insight into family factors related to pediatric obesity and its management. Theoretical frameworks and empirical evidence guided curriculum development, which was founded primarily on the tenets of family systems theory and cognitive behavioral theory. PAC was developed as a manualized, 16-session, group-based, health care professional-led intervention for parents to address individual, family, and environmental factors related to the management of pediatric obesity. The intervention was refined based on feedback from local and international experts, and has been implemented successfully in a multi-disciplinary weight management centre in a children’s hospital. Conclusion IM provided a practical framework to guide the systematic development of a pediatric weight management intervention for parents of children with obesity. This logical, step-by-step process blends theory and practice and is broadly applicable in the context of obesity management intervention development and evaluation. Following intervention development, the PAC intervention was evaluated within a randomized clinical trial. Trial registration NCT01267097; clinicaltrials.gov
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, University of Alberta, Room 4-515, Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Aislin R Mushquash
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada
| | - Rachel A Keaschuk
- , #780 Princeton Place, 10339-124th St, Edmonton, AB, T5N 3W1, Canada
| | - Kathryn A Ambler
- Health Technology & Service Policy, Research & Innovation Branch, Strategic Planning & Policy Development Division, Alberta Health, 18th Floor, ATB Building, 10025 Jasper Ave, Edmonton, AB, T5J 1S6, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Room 3-526, Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, AB, T6G 1C9, Canada
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Xu F, Marchand S, Corcoran C, DiBiasio H, Clough R, Dyer CS, Nobles J, White J, Greaney ML, Greene GW. A Community-Based Nutrition and Physical Activity Intervention for Children Who Are Overweight or Obese and Their Caregivers. J Obes 2017; 2017:2746595. [PMID: 29312784 PMCID: PMC5651117 DOI: 10.1155/2017/2746595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 01/06/2023] Open
Abstract
There is a need for efficacious interventions to reduce the prevalence of childhood obesity, and a limited body of research suggests that collaborative community-based programs designed for children and their caregivers may be effective in reducing obesity rates. This paper reports the results of a community-based obesity intervention, South County Food, Fitness and Fun (SCFFF), designed for preadolescent children who are overweight or obese and their caregivers. SCFFF was developed in response to community concerns. Families were referred to the program by their physician and participated in the program at no cost. The 16-week intervention includes weekly group nutrition and physical activity sessions. Analyses determined that 65 out of the 97 children who completed SCFFF provided 2-year follow-up data and had reduced BMI z-scores over 2 years following the intervention. These participants decreased their energy, fat, carbohydrate, saturated fat, and sodium intake and increased core body strength and endurance from baseline to the end of the intervention. SCFFF was effective in reducing relative weight and improving diet and core muscle strength and endurance in children who are overweight or obese.
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Affiliation(s)
- Furong Xu
- Department of Kinesiology, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA
| | | | - Celeste Corcoran
- Coastal Medical Narragansett Bay Pediatrics, 65 Village Square Drive, South Kingstown, RI 02879, USA
| | - Heather DiBiasio
- Wakefield Pediatrics, LLC, 46 Holley Street, Wakefield, RI 02879, USA
| | - Rachel Clough
- Busy Bodies Studio, 12 High Street, South Kingstown, RI 02879, USA
| | - Christopher S. Dyer
- Department of Kinesiology, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA
| | - Jennifer Nobles
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA
| | - Jade White
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA
| | - Mary L. Greaney
- Department of Kinesiology, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA
| | - Geoffrey W. Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA
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Miller A, Franzen-Castle L, Aguirre T, Krehbiel M, Colby S, Kattelmann K, Olfert MD, Mathews D, White A. Food-related behavior and intake of adult main meal preparers of 9–10 year-old children participating in iCook 4-H: A five-state childhood obesity prevention pilot study. Appetite 2016; 101:163-70. [DOI: 10.1016/j.appet.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/29/2016] [Accepted: 03/03/2016] [Indexed: 11/30/2022]
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McPherson AC, Ball GD, Maltais DB, Swift JA, Cairney J, Knibbe TJ, Krog K. A Call to Action: Setting the Research Agenda for Addressing Obesity and Weight-Related Topics in Children with Physical Disabilities. Child Obes 2016; 12:59-69. [PMID: 26716496 PMCID: PMC4753575 DOI: 10.1089/chi.2015.0119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pediatric obesity is a world-wide challenge. Children with physical disabilities are particularly at risk of obesity, which is worrisome because obesity can result in serious secondary conditions that decrease health status, reduce independence, and increase impact on healthcare systems. However, the determinants of obesity and the health promotion needs of children with physical disabilities are relatively unexplored compared with their typically developing peers. METHODS This white paper describes a Canadian multi-stakeholder workshop on the topic of obesity and health in children with physical disabilities and provides recommendations for future research in this understudied area. RESULTS Seventy-one knowledge gaps identified by attendees using a modified nominal group technique clustered into six themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases. Attendees worked together to develop research plans in more detail for three areas identified through consensus as high priority: "early, sustained engagement of families;" "rethinking determinants of obesity and health;" and "evidence informed measurement and outcomes." CONCLUSIONS Using the workshop described here as a call to action, Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.
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Affiliation(s)
- Amy C. McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Geoff D.C. Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Désirée B. Maltais
- Department of Rehabilitation, Laval University, Québec City, Québec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Québec, Canada
| | - Judy A. Swift
- School of Biosciences, The University of Nottingham, Nottingham, United Kingdom
| | - John Cairney
- Departments of Family Medicine, Psychiatry and Behavioral Neurosciences, and Kinesiology, Hamilton, Ontario, Canada
- CanChild Center for Studies in Childhood Disability, Hamilton, Ontario, Canada
- INCH Lab, McMaster University, Hamilton, Ontario, Canada
| | - Tara Joy Knibbe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kim Krog
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Toronto, Ontario, Canada
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22
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Loveman E, Al‐Khudairy L, Johnson RE, Robertson W, Colquitt JL, Mead EL, Ells LJ, Metzendorf M, Rees K. Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years. Cochrane Database Syst Rev 2015; 2015:CD012008. [PMID: 26690844 PMCID: PMC8761478 DOI: 10.1002/14651858.cd012008] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Child and adolescent overweight and obesity have increased globally, and are associated with short- and long-term health consequences. OBJECTIVES To assess the efficacy of diet, physical activity and behavioural interventions delivered to parents only for the treatment of overweight and obesity in children aged 5 to 11 years. SEARCH METHODS We performed a systematic literature search of databases including the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS as well trial registers. We checked references of identified trials and systematic reviews. We applied no language restrictions. The date of the last search was March 2015 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity and behavioural interventions delivered to parents only for treating overweight or obesity in children aged 5 to 11 years. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE instrument. Where necessary, we contacted authors for additional information. MAIN RESULTS We included 20 RCTs, including 3057 participants. The number of participants ranged per trial between 15 and 645. Follow-up ranged between 24 weeks and two years. Eighteen trials were parallel RCTs and two were cluster RCTs. Twelve RCTs had two comparisons and eight RCTs had three comparisons. The interventions varied widely; the duration, content, delivery and follow-up of the interventions were heterogeneous. The comparators also differed. This review categorised the comparisons into four groups: parent-only versus parent-child, parent-only versus waiting list controls, parent-only versus minimal contact interventions and parent-only versus other parent-only interventions.Trial quality was generally low with a large proportion of trials rated as high risk of bias on individual risk of bias criteria.In trials comparing a parent-only intervention with a parent-child intervention, the body mass index (BMI) z score change showed a mean difference (MD) at the longest follow-up period (10 to 24 months) of -0.04 (95% confidence interval (CI) -0.15 to 0.08); P = 0.56; 267 participants; 3 trials; low quality evidence. In trials comparing a parent-only intervention with a waiting list control, the BMI z score change in favour of the parent-only intervention at the longest follow-up period (10-12 months) had an MD of -0.10 (95% CI -0.19 to -0.01); P = 0.04; 136 participants; 2 trials; low quality evidence. BMI z score change of parent-only interventions when compared with minimal contact control interventions at the longest follow-up period (9 to 12 months) showed an MD of 0.01 (95% CI -0.07 to 0.09); P = 0.81; 165 participants; 1 trial; low quality evidence. There were few similarities between interventions and comparators across the included trials in the parent-only intervention versus other parent-only interventions and we did not pool these data. Generally, these trials did not show substantial differences between their respective parent-only groups on BMI outcomes.Other outcomes such as behavioural measures, parent-child relationships and health-related quality of life were reported inconsistently. Adverse effects of the interventions were generally not reported, two trials stated that there were no serious adverse effects. No trials reported on all-cause mortality, morbidity or socioeconomic effects.All results need to be interpreted cautiously because of their low quality, the heterogeneous interventions and comparators, and the high rates of non-completion. AUTHORS' CONCLUSIONS Parent-only interventions may be an effective treatment option for overweight or obese children aged 5 to 11 years when compared with waiting list controls. Parent-only interventions had similar effects compared with parent-child interventions and compared with those with minimal contact controls. However, the evidence is at present limited; some of the trials had a high risk of bias with loss to follow-up being a particular issue and there was a lack of evidence for several important outcomes. The systematic review has identified 10 ongoing trials that have a parent-only arm, which will contribute to future updates. These trials will improve the robustness of the analyses by type of comparator, and may permit subgroup analysis by intervention component and the setting. Trial reports should provide adequate details about the interventions to be replicated by others. There is a need to conduct and report cost-effectiveness analyses in future trials in order to establish whether parent-only interventions are more cost-effective than parent-child interventions.
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Affiliation(s)
- Emma Loveman
- Effective Evidence LLP7 Bournemouth RoadEastleighHampshireUKSO53 3DA
| | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Rebecca E Johnson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Wendy Robertson
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Jill L Colquitt
- Effective Evidence LLP7 Bournemouth RoadEastleighHampshireUKSO53 3DA
| | - Emma L Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
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Martarelli CS, Borter N, Bryjova J, Mast FW, Munsch S. The influence of parent's body mass index on peer selection: an experimental approach using virtual reality. Psychiatry Res 2015; 230:5-12. [PMID: 26330307 DOI: 10.1016/j.psychres.2015.05.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 12/31/2022]
Abstract
Relatively little is known about the influence of psychosocial factors, such as familial role modeling and social network on the development and maintenance of childhood obesity. We investigated peer selection using an immersive virtual reality environment. In a virtual schoolyard, children were confronted with normal weight and overweight avatars either eating or playing. Fifty-seven children aged 7-13 participated. Interpersonal distance to the avatars, child's BMI, self-perception, eating behavior and parental BMI were assessed. Parental BMI was the strongest predictor for the children's minimal distance to the avatars. Specifically, a higher mothers' BMI was associated with greater interpersonal distance and children approached closer to overweight eating avatars. A higher father's BMI was associated with a lower interpersonal distance to the avatars. These children approached normal weight playing and overweight eating avatar peers closest. The importance of parental BMI for the child's social approach/avoidance behavior can be explained through social modeling mechanisms. Differential effects of paternal and maternal BMI might be due to gender specific beauty ideals. Interventions to promote social interaction with peer groups could foster weight stabilization or weight loss in children.
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Affiliation(s)
| | - Natalie Borter
- Department of Psychology, University of Bern, Switzerland
| | - Jana Bryjova
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, 2, Rue de Faucigny, CH-1700 Fribourg, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, 2, Rue de Faucigny, CH-1700 Fribourg, Switzerland.
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Holt NL, Neely KC, Newton AS, Knight CJ, Rasquinha A, Ambler KA, Spence JC, Ball GDC. Families' Perceptions of and Experiences Related to a Pediatric Weight Management Intervention: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:427-31.e1. [PMID: 26145758 DOI: 10.1016/j.jneb.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/23/2015] [Accepted: 05/06/2015] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To examine parents' and children's perceptions of and experiences related to a Parents as Agents of Change (PAC) intervention for managing pediatric obesity. METHODS Ten families were recruited from a PAC intervention. Participants were interviewed before (10 adults and 9 children), during (9 adults and 8 children), and after (8 adults) the intervention. RESULTS Before the intervention, families reported goals to increase physical activity, plan and eat healthier meals, reduce screen time, and lose weight. During the intervention, families described different approaches to making behavior changes depending on who assumed responsibility (parent, child, or shared responsibility). After the intervention, group setting, goal setting, and portion size activities were viewed positively. Suggestions for improvement included engaging children and reducing intervention length. CONCLUSIONS AND IMPLICATIONS Practitioners delivering PAC interventions should discuss families' goals and concerns, and who is responsible for making lifestyle changes. Practical activities are valuable. The length of interventions and engagement of children should be considered.
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Affiliation(s)
- Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Kacey C Neely
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Camilla J Knight
- College of Engineering, Swansea University, Singleton Park, Swansea, United Kingdom
| | - Allison Rasquinha
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kathryn A Ambler
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John C Spence
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Type 2 diabetes (T2D) in youth is a relatively novel condition facing paediatric health care providers. Few experimental trials exist to guide clinical management in this population. Supporting and prescribing modifiable lifestyle behaviours is cornerstone in the management of T2D in adults. Clinical trials in obese adolescents suggest that intensive lifestyle interventions that include both dietary changes and increased physical activity elicit clinically meaningful reductions in weight and improve cardiovascular risk profiles. Observational studies in youth with T2D suggest that better diet quality and increased physical activity are associated with better metabolic control; however, the limited experimental data available does not support these observations. Trials evaluating lifestyle monotherapy for the treatment of hyperglycaemia in youth with T2D do not exist, and the only study evaluating combined lifestyle and pharmacologic therapy did not show additional benefit over pharmacologic treatment with metformin alone. Physiological and psychosocial differences between youth and adults with T2D likely contribute to the differences in the effectiveness of lifestyle therapy for improving glycaemic control. The current review describes these topics in detail and provides recommendations for paediatric health care providers for the promotion of lifestyle therapy for the management of hyperglycaemia and cardiovascular risk factors for youth with T2DM.
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Affiliation(s)
- Jonathan McGavock
- Department of Pediatrics and Child Health, Faculty of Medicine, Manitoba Institute of Child Health, University of Manitoba, 511 JBRC 715 McDermot ave., Winnipeg, MB, R3E 3P4, Canada,
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Kelishadi R, Azizi-Soleiman F. Controlling childhood obesity: A systematic review on strategies and challenges. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:993-1008. [PMID: 25538786 PMCID: PMC4274579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/26/2014] [Accepted: 03/03/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Childhood obesity is a global health problem with short- and long-term health consequences. This systematic review presents a summary of the experiences on different family-, school-, and clinic-based interventions. MATERIALS AND METHODS Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases. We included those studies conducted among obese individuals aged up to 18 years. Our search yielded 105 relevant papers, 70 of them were conducted as high quality clinical trials. RESULTS Our findings propose that school-based programs can have long-term effects in a large target group. This can be related to this fact that children spend a considerable part of their time in school, and adopt some parts of lifestyle there. They have remarkable consequences on health behaviors, but as there are some common limitations, their effects on anthropometric measures are not clear. Due to the crucial role of parents in development of children's behaviors, family-based interventions are reported to have successful effects in some aspects; but selection bias and high dropout rate can confound their results. Clinic-based interventions revealed favorable effects. They include dietary or other lifestyle changes like increasing physical activity or behavior therapy. It seems that a comprehensive intervention including diet and exercise are more practical. When they have different designs, results are controversial. CONCLUSION We suggest that among different types of interventional programs, a multidisciplinary approach in schools in which children's family are involved, can be the best and most sustainable approach for management of childhood obesity.
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Affiliation(s)
- Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primary Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Azizi-Soleiman
- School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Fatemeh Azizi-Soleiman, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Salawi HA, Ambler KA, Padwal RS, Mager DR, Chan CB, Ball GDC. Characterizing severe obesity in children and youth referred for weight management. BMC Pediatr 2014; 14:154. [PMID: 24947311 PMCID: PMC4074846 DOI: 10.1186/1471-2431-14-154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background Severe obesity (SO) in pediatrics has become increasing prevalent in recent decades. The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers. Methods A retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99th percentile) and OW/OB (BMI ≥85th and <99th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved. Results Of the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > $50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05). Conclusion Children and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years.
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Affiliation(s)
| | | | | | | | | | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, AB T5K0L4, CANADA.
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Avis JLS, Ambler KA, Jetha MM, Boateng H, Ball GDC. Modest treatment effects and high program attrition: The impact of interdisciplinary, individualized care for managing paediatric obesity. Paediatr Child Health 2013; 18:e59-63. [PMID: 24497784 PMCID: PMC3907354 DOI: 10.1093/pch/18.10.e59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is an urgent need to identify effective weight management interventions in real-world, clinical settings to improve the health of children with obesity. OBJECTIVES To determine the impact of individualized, interdisciplinary care on the weight status of children with obesity; to assess the relationship between clinical interactions and change in participants' weight status; and to document the degree of program attrition. METHODS A retrospective medical record review of clinical and administrative data from a paediatric weight management clinic in Edmonton, Alberta, was performed, which included data from a group of five- to 18-year-olds (body mass index [BMI] ≥85th percentile) collected from 2008 to 2012. Demographic, anthropometric and attendance data were retrieved from baseline and follow-up at three-, seven- and 11-month timepoints. The primary outcomes were participants' BMI z-score and change in BMI z-score over time. RESULTS Data from 165 individuals were included. Among those with follow-up anthropometric data, weight stabilization occurred at three (n=127) and seven months (n=84). For individuals with follow-up anthropometric data at 11 months (n=44), BMI z-score tended to decrease over time (-0.05±0.12 units; P=0.06). Program attrition increased over time (23%, 49% and 73% at three-, seven- and 11-month follow-ups, respectively). Between presentation and three-month follow-up, there was an inverse relationship between the number of clinical appointments attended and change in BMI z-score (r= -0.18; P=0.04), an association that became nonsignificant at seven and 11 months (both P>0.05). CONCLUSION An individualized, interdisciplinary weight management intervention led to weight stabilization and a modest weight reduction in children with obesity. Strategies to minimize program attrition are needed to optimize family engagement in care and success in managing paediatric obesity.
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Affiliation(s)
- Jillian LS Avis
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
| | - Kathryn A Ambler
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| | - Mary M Jetha
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| | - Henrietta Boateng
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
| | - Geoff DC Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta
- Pediatric Centre for Weight and Health, Stollery Children’s Hospital, Alberta Health Services, Edmonton, Alberta
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Oen G, Stormark KM. Participatory action research in the implementing process of evidence-based intervention to prevent childhood obesity: project design of the "Healthy Future" study. J Obes 2013; 2013:437206. [PMID: 23956843 PMCID: PMC3730381 DOI: 10.1155/2013/437206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/17/2013] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To describe the design of the developmental project Healthy Future that aims to implement a new evidence-based program for the prevention of childhood obesity and collaboration and sharing of work between specialist and community health care professionals in parts of a county in western Norway. METHODS Comprehensive participatory planning and evaluation (CPPE) process as an action-oriented research approach was chosen, using mixed data sources, mixed methods, and triangulation. DISCUSSION A bottom-up approach might decrease the barriers when new evidence-based childhood prevention interventions are going to be implemented. It is crucial not only to build partnership and shared understanding, motivation, and vision, but also to consider the frames of the organizations, such as competencies, and time to carry out the interventions at the right level of health care service and adapt to the overweight children and their families needs. CONCLUSION The developmental process of new health care programs is complex and multileveled and requires a framework to guide the process. By CPPE approach evidence-based health care practice can be delivered based on research, user knowledge, and provider knowledge in the field of childhood overweight and obesity in a certain context.
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Affiliation(s)
- Gudbjørg Oen
- Haugesund/Stord University College, Klingenbergveien 8, 5414 Stord, Norway.
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