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Kao TSA, Ling J, Vu C, Hawn R, Christodoulos H. Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioral Outcomes. Ann Behav Med 2023:7169372. [PMID: 37195909 PMCID: PMC10354860 DOI: 10.1093/abm/kaad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Currently, the effects of motivational interviewing (MI) on children's behavioral changes remain obscure. PURPOSE This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes (fruits and vegetables [F/V], dairy, sugary beverages, calories, snacks, fat intake, moderate vigorous physical activity [MVPA], and screen time). METHODS Six databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2022 were searched. Thirty-one intervention studies with a comparison group met the criteria. Random-effects models were performed to estimate the pooled effects; exploratory moderation analyses with mixed-effects models were used to explore potential intervention moderators. RESULTS The pooled effect size was 0.10 (p = .334) on ↑F/V, 0.02 (p = .724) on ↑dairy, -0.29 (p < .001) on ↓calories, -0.16 (p = .054) on ↓sugary beverages, -0.22 (p = .002) on ↓snacks, -0.20 (p = .044) on ↓fat, 0.22 (p = .001) on ↑MVPA, and -0.06 (p = .176) on ↓screen time. The effects of MIs were moderated by ↑MI sessions regarding ↓snacks (B = -0.04, p = .010). Multicomponent and clinical programs had greater effects on dairy intake than their counterparts (0.09 vs. -0.21, p = .034; 0.12 vs. -0.14, p = .027, respectively). Similarly, interventions with a fidelity check resulted in greater dairy intake than those without a check (0.29 vs. -0.15, p = .014). A few long-term follow-up assessments revealed effects on ↓F/V (-0.18; p = .143, k = 2), ↓dairy (-0.13, p = .399, k = 4), ↓MVPA (-0.04; p = .611, k = 6), and ↑screen time (0.12; p = .242, k = 4). CONCLUSIONS Our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.
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Affiliation(s)
| | - Jiying Ling
- College of Nursing, Michigan State University, USA
| | - Christina Vu
- College of Nursing, Michigan State University, USA
| | - Rachel Hawn
- College of Nursing, Michigan State University, USA
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Enö Persson J, Leo Swenne C, von Essen L, Bohman B, Rasmussen F, Ghaderi A. Experiences of nurses and coordinators in a childhood obesity prevention trial based on motivational interviewing within Swedish child health services. Int J Qual Stud Health Well-being 2022; 17:2096123. [PMID: 35838058 PMCID: PMC9291662 DOI: 10.1080/17482631.2022.2096123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity. Methods Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis. Results Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses’ commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended. Conclusions Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints. .
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Affiliation(s)
- Johanna Enö Persson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christine Leo Swenne
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and eHealth, Department of Women and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Johnson BJ, Hunter KE, Golley RK, Chadwick P, Barba A, Aberoumand M, Libesman S, Askie L, Taylor RW, Robledo KP, Mihrshahi S, O'Connor DA, Hayes AJ, Wolfenden L, Wood CT, Baur LA, Rissel C, Staub LP, Taki S, Smith W, Sue-See M, Marschner IC, Espinoza D, Thomson JL, Larsen JK, Verbestel V, Odar Stough C, Salvy SJ, O'Reilly SL, Karssen LT, Rasmussen FE, Messito MJ, Gross RS, Bryant M, Paul IM, Wen LM, Hesketh KD, González Acero C, Campbell K, Øverby NC, Linares AM, Wasser HM, Joshipura KJ, Palacios C, Maffeis C, Thompson AL, Ghaderi A, Lakshman R, Banna JC, Oken E, Campos Rivera M, Pérez-Expósito AB, Taylor BJ, Savage JS, Røed M, Goran M, de la Haye K, Anzman-Frasca S, Seidler AL. Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol. BMJ Open 2022; 12:e048165. [PMID: 35058255 PMCID: PMC8783827 DOI: 10.1136/bmjopen-2020-048165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. METHODS AND ANALYSIS Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. ETHICS AND DISSEMINATION The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study's findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. PROSPERO REGISTRATION NUMBER CRD42020177408.
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Affiliation(s)
- Brittany J Johnson
- Caring Fututures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca K Golley
- Caring Fututures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Angie Barba
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mason Aberoumand
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Charles T Wood
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Louise A Baur
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lukas P Staub
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Wendy Smith
- Canterbury Community Health Centre, Campsie, New South Wales, Australia
- Consumer Representative, Sydney, New South Wales, Australia
| | | | - Ian C Marschner
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Junilla K Larsen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Cathleen Odar Stough
- Department of Psychology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Levie T Karssen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Finn E Rasmussen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Mary Jo Messito
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Rachel S Gross
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, UK
| | - Ian M Paul
- College of Medicine, Penn State, Hershey, Pennsylvania, USA
| | - Li Ming Wen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Carolina González Acero
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Santo Domingo, Dominican Republic
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nina Cecilie Øverby
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Ana M Linares
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Heather M Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Universita degli Studi di Verona, Verona, Italy
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, UK
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rajalakshmi Lakshman
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jinan C Banna
- Human Nutrition, Food and Animal Sciences, University of Hawaii System, Honolulu, Hawaii, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA
| | | | - Ana B Pérez-Expósito
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Washington DC, District of Columbia, USA
| | - Barry J Taylor
- Better Start National Science Challenge, University of Otago, Dunedin, New Zealand
| | - Jennifer S Savage
- Department of Nutritional Sciences and Center for Childhood Obesity Research, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Margrethe Røed
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Michael Goran
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Kayla de la Haye
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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Timm A, Kragelund Nielsen K, Joenck L, Husted Jensen N, Jensen DM, Norgaard O, Terkildsen Maindal H. Strategies to promote health behaviors in parents with small children-A systematic review and realist synthesis of behavioral interventions. Obes Rev 2022; 23:e13359. [PMID: 34734473 DOI: 10.1111/obr.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0-3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context-mechanism-outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home-based activities to change home environment, and (3) offering flexible delivery, for example, phone or website-based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home-based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020.
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Affiliation(s)
- Anne Timm
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Larke Joenck
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Norgaard
- Department of Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Associations of preschoolers' dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment. Appetite 2022; 168:105724. [PMID: 34606942 DOI: 10.1016/j.appet.2021.105724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022]
Abstract
Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI -0.63, -0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.
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Kao TSA, Ling J, Hawn R, Vu C. The effects of motivational interviewing on children's body mass index and fat distributions: A systematic review and meta-analysis. Obes Rev 2021; 22:e13308. [PMID: 34170612 DOI: 10.1111/obr.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
Currently, the effects of motivational interviewing (MI) on children's anthropometric changes remain unclear. This systematic review and meta-analysis examined the effects of MI on children's anthropometric changes (body mass index [BMI], waist circumference [WC], and body fat percentage [BF%]). We also assessed potential moderators of MI on children's BMI changes. This systematic review searched five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2020 to evaluate the effects of MI interventions that had a comparison group on children's anthropometric change as outcomes (BMI, WC, or BF%). Thirty-three articles met the inclusion criteria. We performed random-effects models and exploratory moderation analyses with mixed-effects models. The pooled effect size of MI was -0.18 (p = 0.002) on BMI, -0.65 (p < 0.001) on WC, and -0.44 (p = 0.005) on children's BF%. The relationship between MI and BMI changes was significantly moderated by the types of intervener (Q = 9.71, p = 0.021) and the existence of supplemental intervention activities (Q = 9.21, p = 0.002). Other potential moderators included children's age, weight status, intervention setting, and targeted behaviors (eating and/or physical activity). Our findings support the effectiveness of MI interventions on improving children's anthropometric outcomes (i.e., BMI, WC, and BF%).
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Affiliation(s)
- Tsui-Sui Annie Kao
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Jiying Ling
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rachel Hawn
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Christina Vu
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Döring N, Ghaderi A, Enö Persson J, Tynelius P, Rasmussen F, Bohman B. Effects of the PRIMROSE prevention trial of childhood obesity on parental self-efficacy. BMC Pediatr 2021; 21:388. [PMID: 34493259 PMCID: PMC8422655 DOI: 10.1186/s12887-021-02862-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Parental self-efficacy (PSE) has been suggested as a key factor for enabling parents to support children in the development of healthy dietary and physical activity behaviors and to prevent childhood obesity. However, studies of intervention effects on PSE are lacking. The present study involved a secondary analysis of data on PSE collected in a previous primary prevention trial of childhood obesity called the PRIMROSE trial. The trial involved a family-based intervention using motivational interviewing and principles of cognitive-behavioral therapy within a social-cognitive theory framework. Methods In the PRIMROSE trial, parents and their children were randomly allocated to the intervention or usual care. In the present study, 928 mothers who responded to the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD) at follow-up assessment were included. Data were analyzed using linear regression based on generalized estimating equations, with adjustment made for PSE at baseline. Results At follow-up assessment, there was a statistically significant difference of 1.4 units, 95% CI [0.4, 2.4], p = 0.009, between the intervention and control conditions on the subscale of the PSEPAD concerning PSE for promoting healthy dietary behaviors in children. However, this difference was deemed as without clinical importance. On the total scale or other subscales of the PSEPAD there were no statistically significant differences in PSE between conditions. Conclusions There was a statistically significant, but not clinically meaningful, intervention effect on PSE. However, because previous research repeatedly has shown positive associations of PSE with dietary and physical activity behaviors in children and that self-efficacy mediates behaviors, the construct may be important for influencing dietary and physical behaviors in children. Therefore, more research is warranted evaluating the effects of interventions on PSE in the context of childhood obesity prevention. Trial registration Retrospectively registered 9 October 2013 at ISRCTN (ISRCTN16991919).
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Affiliation(s)
- Nora Döring
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Enö Persson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden. .,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
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Mihrshahi S, Jawad D, Richards L, Hunter KE, Ekambareshwar M, Seidler AL, Baur LA. A Review of Registered Randomized Controlled Trials for the Prevention of Obesity in Infancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052444. [PMID: 33801485 PMCID: PMC7967587 DOI: 10.3390/ijerph18052444] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Childhood overweight and obesity is a worldwide public health issue. Our objective was to describe planned, ongoing and completed randomized controlled trials (RCTs) designed for the prevention of obesity in early childhood. Two databases (World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) were searched to identify RCTs with the primary aim of preventing childhood obesity and at least one outcome related to child weight. Interventions needed to start in the first two years of childhood or earlier, continue for at least 6 months postnatally, include a component related to lifestyle or behaviours, and have a follow up time of at least 2 years. We identified 29 unique RCTs, implemented since 2008, with most being undertaken in high income countries. Interventions ranged from advice on diet, activity, sleep, emotion regulation, and parenting education through to individual home visits, clinic-based consultations, or group education sessions. Eleven trials published data on child weight-related outcomes to date, though most were not sufficiently powered to detect significant effects. Many trials detected improvements in practices such as breastfeeding, screen time, and physical activity in the intervention groups compared to the control groups. Further follow-up of ongoing trials is needed to assess longer-term effects.
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Affiliation(s)
- Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
- Correspondence: ; Tel.: +61-2-9850-2468
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Louise Richards
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Kylie E. Hunter
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- NHMRC Clinical Trials Centre, The University of Sydney, Locked bag 77, Camperdown, NSW 1450, Australia
| | - Mahalakshmi Ekambareshwar
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Anna Lene Seidler
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- NHMRC Clinical Trials Centre, The University of Sydney, Locked bag 77, Camperdown, NSW 1450, Australia
| | - Louise A. Baur
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Ekambareshwar M, Ekambareshwar S, Mihrshahi S, Wen LM, Baur LA, Laws R, Taki S, Rissel C. Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review. Int J Behav Nutr Phys Act 2021; 18:10. [PMID: 33422066 PMCID: PMC7796572 DOI: 10.1186/s12966-020-01074-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders' acceptability of interventions. METHODS A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers' behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. RESULTS Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants' perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. CONCLUSION There is limited reporting of stakeholders' experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants' acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. TRIAL REGISTRATION PROSPERO registration: CRD42019108658.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.
| | - Swathi Ekambareshwar
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rachel Laws
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
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10
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Somaraki M, Eli K, Sorjonen K, Ek A, Sandvik P, Nowicka P. Changes in parental feeding practices and preschoolers’ food intake following a randomized controlled childhood obesity trial. Appetite 2020; 154:104746. [DOI: 10.1016/j.appet.2020.104746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/03/2020] [Accepted: 05/16/2020] [Indexed: 12/14/2022]
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11
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Askie LM, Espinoza D, Martin A, Daniels LA, Mihrshahi S, Taylor R, Wen LM, Campbell K, Hesketh KD, Rissel C, Taylor B, Magarey A, Seidler AL, Hunter KE, Baur LA. Interventions commenced by early infancy to prevent childhood obesity-The EPOCH Collaboration: An individual participant data prospective meta-analysis of four randomized controlled trials. Pediatr Obes 2020; 15:e12618. [PMID: 32026653 DOI: 10.1111/ijpo.12618] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood obesity is a significant global problem. Childhood obesity prevention interventions may be more effective when started very early in life before metabolic and behavioural patterns are established. METHODS AND FINDINGS A prospectively planned, individual participant data meta-analysis of four randomized controlled trials. Participants were first-time mothers of term infants. Trial interventions commenced during pregnancy or early infancy and comprised education and support delivered via group sessions and/or home visits. Control group families accessed existing local well-child health care. The primary outcome was body mass index (BMI) z score at 18 to 24 months; 2196 mother-child dyads were available for analysis. Intervention children had lower BMI z scores at 18 to 24 months than control children (-0.12 adjusted mean; 95% confidence interval, -0.22 to -0.02, P = .017). There was some evidence that the BMI z score reduction was greater in settings with limited well-child health care programmes (interaction P value = .03). Improvements were also detected in television viewing time, feeding practices, and breastfeeding duration. CONCLUSIONS Parent-focused intervention programmes that commence by early infancy and which aim to establish a trajectory of healthy lifestyle behaviours produced a modest but statistically significant reduction in BMI z score, which if replicated on a wider scale may have important public health implications.
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Affiliation(s)
- Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Lynne A Daniels
- Center Child Health Research, School Exercise Nutrition Sciences, Queensland University Technology, Brisbane, Queensland, Australia
| | - Seema Mihrshahi
- School of Public Health, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Li Ming Wen
- Health Promotion Unit, Sydney Local Health District, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Barry Taylor
- Dunedin School of Medicine, Office of the Dean, University of Otago, Dunedin, New Zealand
| | - Anthea Magarey
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie E Hunter
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Louise A Baur
- Discipline of Child and Adolescent Health, University of Sydney, Clinical School, The Children's Hospital at Westmead, Camperdown, New South Wales, Australia
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12
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Brustad M, Sara Bongo AK, Hansen KL, Trovik TA, Oscarson N, Jönsson B. Oral health in the indigenous Sámi population in Norway - the dental health in the North study. Acta Odontol Scand 2020; 78:98-108. [PMID: 31512933 DOI: 10.1080/00016357.2019.1654615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aims at presenting the feasibility of using the public oral health clinics in indigenous Sámi communities, as arena for a comprehensive data collection for population-based epidemiological oral health research among adults (age, 18-75 years) in a multi-ethnic setting.Material and methods: The study design was cross-sectional. The data collection was incorporated into the clinical procedure at six public dental clinics situated in the Administrative Area for the Sámi Language in Finnmark County, Northern Norway, during 2013-2014. Both clinical- and questionnaire-data were collected. The quality of clinical data was thoroughly calibrated and validated.Results: Altogether, 2235 people participated in the study gave a crude response rate at 88.7%. In the final data sample (n = 2034), 56.9% were female. We constructed three ethnic groups (Sámi, Mixed Sámi/Norwegian and Norwegian). Altogether, 67.7% reported Sámi or mixed Sámi ethnicity. The internal validity of the clinical data was found to be satisfactory when assessed by comprehensive quality procedure, calibration and reliability assessments.Conclusion: This study design and method assessments provide solid documentation that public dental clinics are suitable as arenas for data collection in epidemiological oral health studies in the Sámi population in this region.
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Affiliation(s)
- Magritt Brustad
- Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Ann-Kristine Sara Bongo
- Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
- The Public Dental Service Competence Centre of Northern Norway, Tromsø, Norway
- Sámi Allaskuvla, Sámi University of Applied Science, Tromsø, Norway
| | - Ketil Lenert Hansen
- Regional Centre for Child, Youth Mental Health and Child Welfare North (RKBU Nord), UiT The Arctic University of Norway, Tromsø, Norway
| | - Tordis A. Trovik
- Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Nils Oscarson
- The Public Dental Service Competence Centre of Northern Norway, Tromsø, Norway
| | - Birgitta Jönsson
- The Public Dental Service Competence Centre of Northern Norway, Tromsø, Norway
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Armstrong B, Trude ACB, Johnson C, Castelo RJ, Zemanick A, Haber-Sage S, Arbaiza R, Black MM. CHAMP: A cluster randomized-control trial to prevent obesity in child care centers. Contemp Clin Trials 2019; 86:105849. [PMID: 31525490 DOI: 10.1016/j.cct.2019.105849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023]
Abstract
Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.
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Affiliation(s)
- Bridget Armstrong
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Angela C B Trude
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Candace Johnson
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Romulus J Castelo
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Amy Zemanick
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Sophie Haber-Sage
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Raquel Arbaiza
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Maureen M Black
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America; RTI International, Department of Pediatrics, United States of America.
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14
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Sandvik P, Ek A, Eli K, Somaraki M, Bottai M, Nowicka P. Picky eating in an obesity intervention for preschool-aged children - what role does it play, and does the measurement instrument matter? Int J Behav Nutr Phys Act 2019; 16:76. [PMID: 31481062 PMCID: PMC6724280 DOI: 10.1186/s12966-019-0845-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/27/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Research on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used. This study examines the role of picky eating in a randomized controlled obesity intervention for preschoolers using subscales from two instruments: The Child Eating Behavior Questionnaire (CEBQ) and the Lifestyle Behavior Checklist (LBC). METHOD The study includes 130 children (mean age 5.2 years (SD 0.7), 54% girls, mean Body Mass Index (BMI) z-score 2.9 (SD 0.6)) and their parents (nearly 60% of non-Swedish background, 40% with university degree). Families were randomized to a parent-group treatment focusing on evidence-based parenting practices or to standard treatment focusing on lifestyle changes. The children's heights and weights (BMI z-score) were measured at baseline, and at 3, 6 and 12 months post baseline. At these time-points, picky eating was reported by parents using the CEBQ (Food Fussiness scale, 6 items) and 5 items from the LBC. Child food intake was reported with a Food Frequency Questionnaire (FFQ). Pearson correlation was used to study associations between baseline picky eating and baseline BMI z-scores and food intake. Mixed effects models were used to study associations between the two measurements of picky eating and changes in picky eating, to assess the effects of changes in picky eating on BMI z-scores, and to evaluate baseline picky eating as a predictor of changes in BMI z-scores. RESULTS Neither the standard treatment nor the parent-group treatment reduced the degree of picky eating (measured with CEBQ or LBC). Baseline picky eating measured with the CEBQ was associated with a lower BMI z-score and lower intake of vegetables. Children with a higher degree of picky eating at baseline (measured with the CEBQ) displayed a lower degree of weight loss. When degree of picky eating was examined, for 25% of the children, the CEBQ and the LBC yielded diverging results. CONCLUSIONS Baseline picky eating may weaken the effectiveness of obesity treatment, and assessments should be conducted before treatment to adjust the treatment approach. Different measurements of picky eating may lead to different results. The CEBQ seems more robust than the LBC in measuring picky eating. TRIAL REGISTRATION Clinicaltrials.gov , NCT01792531. Registered 15 February 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01792531.
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Affiliation(s)
- Pernilla Sandvik
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Box 560, 751 22, Uppsala, Sweden.
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Social Science and Systems in Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, England.,Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, England
| | - Maria Somaraki
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Box 560, 751 22, Uppsala, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Box 560, 751 22, Uppsala, Sweden.,Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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15
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Enö Persson J, Bohman B, Tynelius P, Rasmussen F, Ghaderi A. Prevention of Childhood Obesity in Child Health Services: Follow-Up of the PRIMROSE Trial. Child Obes 2019; 14:99-105. [PMID: 29232526 DOI: 10.1089/chi.2017.0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI). METHODS A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect. RESULTS There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons. CONCLUSIONS A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.
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Affiliation(s)
- Johanna Enö Persson
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - Benjamin Bohman
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,2 Centre for Psychiatry Research , Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Tynelius
- 3 Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden .,4 Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services , Stockholm, Sweden
| | - Finn Rasmussen
- 5 Department of Health Sciences, Lund University , Lund, Sweden
| | - Ata Ghaderi
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
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16
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Rohde JF, Bohman B, Berglind D, Hansson LM, Frederiksen P, Mortensen EL, Heitmann BL, Rasmussen F. Cross-sectional associations between maternal self-efficacy and dietary intake and physical activity in four-year-old children of first-time Swedish mothers. Appetite 2018; 125:131-138. [PMID: 29408332 DOI: 10.1016/j.appet.2018.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Healthy dietary and physical activity behaviours are established early in life where children learn by observing their parents. Therefore, parents can act as role models and influence their children toward a healthier lifestyle. Besides a strong association between parental and child health behaviours, parents also influence their children's health behaviours through socio-cognitive processes, where perceived self-efficacy is the central component. The objective was to examine if parental self-efficacy among Swedish mothers was associated with their four-year-old children's dietary and physical activity behaviours. METHODS This cross-sectional study was based on information from control participants that took part in the Swedish primary prevention trial of childhood obesity (PRIMROSE) (n = 420 mother-child pairs). Linear regression models were used to examine the associations between parental self-efficacy (Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviours in Children Scale) and children's dietary intake (parent reported) and levels of physical activity (accelerometer) with adjustments for potential confounders. RESULTS Mothers' efficacy beliefs in promoting healthy dietary or physical activity behaviours in their children were associated with a slightly higher consumption of fruit and vegetables among their children (β: 0.03 [95%CI: 0.01; 0.04] P < 0.001) and slightly higher levels of moderate-to-vigorous activity (β: 0.43 [95%CI: 0.05; 0.81] P = 0.03). Mothers' belief in their ability to limit unhealthy dietary and physical activity behaviours was inversely associated with children's intake of unhealthy snacks (β: -0.06 [95%CI: -0.10; -0.02] P < 0.01). CONCLUSION Our cross-sectional study suggests weak positive correlations between maternal self-efficacy and healthy dietary and physical activity behaviours, and weak inverse associations between maternal self-efficacy and unhealthy dietary and physical activity behaviours among their children.
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Affiliation(s)
- Jeanett Friis Rohde
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Nordre Fasanvej 57, Street 8, Entrance 11, 2000 Frederiksberg, Denmark; Department of Research and Development, Health Science, University College UCC, Carlsbergvej 14, 3400 Hillerød, Denmark.
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; Centre for Psychiatric Research, Stockholm Health Care Services, Liljeholmstorget 7 B, 117 63 Stockholm, Sweden.
| | - Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, 171 77 Stockholm, Sweden.
| | - Lena M Hansson
- Department for Knowledge-Based Policy of Health Care, The National Board of Health and Welfare, 106 30 Stockholm, Sweden.
| | - Peder Frederiksen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Nordre Fasanvej 57, Street 8, Entrance 11, 2000 Frederiksberg, Denmark.
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Nordre Fasanvej 57, Street 8, Entrance 11, 2000 Frederiksberg, Denmark; The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, NSW 2006, Australia; National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5 A, 1353 Copenhagen, Denmark.
| | - Finn Rasmussen
- Department of Health Sciences, Lund University, Box 117, SE-221 00 Lund, Sweden.
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Döring N, Zethraeus N, Tynelius P, de Munter J, Sonntag D, Rasmussen F. Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity. Front Endocrinol (Lausanne) 2018; 9:104. [PMID: 29593658 PMCID: PMC5861136 DOI: 10.3389/fendo.2018.00104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.
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Affiliation(s)
- Nora Döring
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Nora Döring,
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jeroen de Munter
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Diana Sonntag
- Medical Faculty of Heidelberg University, Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Mannheim, Germany
- Department of Health Science, University of York, York, United Kingdom
| | - Finn Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
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18
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Effects of the Healthy Start randomized intervention on dietary intake among obesity-prone normal-weight children. Public Health Nutr 2017; 20:2988-2997. [PMID: 28879820 DOI: 10.1017/s1368980017002026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The study aimed to evaluate the impact of a 15-month intervention on dietary intake conducted among obesity-prone normal-weight pre-school children. DESIGN Information on dietary intake was obtained using a 4 d diet record. A diet quality index was adapted to assess how well children's diet complied with the Danish national guidelines. Linear regression per protocol and intention-to-treat analyses of differences in intakes of energy, macronutrients, fruit, vegetables, fish, sugar-sweetened beverages and diet quality index between the two groups were conducted. SETTING The Healthy Start study was conducted during 2009-2011, focusing on changing diet, physical activity, sleep and stress management to prevent excessive weight gain among Danish children. SUBJECTS From a population of 635 Danish pre-school children, who had a high birth weight (≥4000 g), high maternal pre-pregnancy BMI (≥28·0 kg/m2) or low maternal educational level (<10 years of schooling), 285 children completed the intervention and had complete information on dietary intake. RESULTS Children in the intervention group had a lower energy intake after the 15-month intervention (group means: 5·29 v. 5·59 MJ, P=0·02) compared with the control group. We observed lower intakes of carbohydrates and added sugar in the intervention group compared with the control group after the intervention (P=0·002, P=0·01). CONCLUSIONS The intervention resulted in a lower energy intake, particularly from carbohydrates and added sugar after 15 months of intervention, suggesting that dietary intake can be changed in a healthier direction in children predisposed to obesity.
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Berglind D, Tynelius P. Objectively measured physical activity patterns, sedentary time and parent-reported screen-time across the day in four-year-old Swedish children. BMC Public Health 2017; 18:69. [PMID: 28764730 PMCID: PMC5540346 DOI: 10.1186/s12889-017-4600-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background Physical activity (PA) improves health outcomes accumulating evidence suggests that sedentary time (ST), especially parent-reported screen-time, is associated with negative health outcomes in children. The aim of the present study is to describe levels and patterns of PA and ST across the day and week and activity pattern differences between the sexes, across all weekdays and time spent in and outside the preschool in four-year old children. Methods In total 899 four-year old Swedish children who had both complete questionnaire data on screen-time behaviors and objective activity variables and at least 4 days, including one weekend day, with more than 10 h of GT3X+ Actigraph accelerometer wear time data were included in the study. Patterns of PA and ST across the day and week and differences between sexes, weekdays vs. weekend days and time in preschool vs. time spent outside preschool were assessed. Results Children engaged in 150 min (SD 73) and 102 min (SD 60) of screen-time on weekend days and weekdays, with 97% and 86% of children exceeding the 1 h guideline for screen-time on weekend days and weekdays, respectively. Accelerometer data showed that boys are more active and less sedentary compared with girls and both sexes were more active and less sedentary on weekdays compared with weekend days, while parent-reported data showed that boys engage in more screen-time compared with girls. Children accumulated 24.8 min (SD. 19) MVPA during preschool time and 26.6 min (SD. 16) outside preschool hours on weekdays, compared with 22.4 min (SD. 18) MVPA during preschool time and 25.3 min (SD. 22) outside preschool hours on weekend days. Conclusions Four-year old Swedish children display different activity patterns across the day on weekdays compared to weekend days, with preschool hours during weekdays being the most active segments and preschool hours during weekend days being the least active segments of the day. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4600-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
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20
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Chahal N, Rush J, Manlhiot C, Boydell KM, Jelen A, McCrindle BW. Dyslipidemia management in overweight or obese adolescents: A mixed-methods clinical trial of motivational interviewing. SAGE Open Med 2017; 5:2050312117707152. [PMID: 28567283 PMCID: PMC5438108 DOI: 10.1177/2050312117707152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 03/29/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Lifestyle management for dyslipidemic adolescents often occurs in the context of family-centered care, which necessitates adaptation of counseling strategies. Objective: To determine the effectiveness of motivational interviewing for lifestyle behavior change for dyslipidemic adolescents in a dyad with a parent versus alone. Methods: A total number of 32 adolescents were randomized 1:1 to receive a series of motivational interviewing sessions either together with a parent or alone for a 6-month intervention, with both quantitative and qualitative assessment of outcomes. Results: Both groups were similar at baseline. Following the intervention, there were no significant differences between groups in physical, laboratory, lifestyle or psychosocial measures, except for a reduction in dietary fats/sugars (p = 0.02) and in screen time (p = 0.02) in the alone group. When both groups were combined, significant reductions at 6 months were noted for body mass index (p < 0.001), waist circumference (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein cholesterol (p < 0.001), triglycerides (p = 0.01), non–high-density lipoprotein cholesterol (p < 0.001), fasting insulin (p = 0.01), and homeostatic model (p = 0.02). Reduced screen time and increased fruit and vegetable intake were also noted for both groups combined. These changes were also reflected in self-efficacy (p = 0.004), self-esteem (p = 0.03), and improvement in quality of life measures. Interview data provided insights into the utility and acceptability of the motivational interviewing intervention. Conclusion: Motivational interviewing was an efficient strategy for inspiring healthy lifestyle and physiological changes among adolescents in both groups. Family centered pediatric approaches should consider the autonomy and individual preferences of the adolescent prior to counseling.
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Affiliation(s)
- Nita Chahal
- Labatt Family Heart Centre, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Janet Rush
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Cedric Manlhiot
- Labatt Family Heart Centre, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katherine M Boydell
- School of Psychiatry, Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Ahlexxi Jelen
- Labatt Family Heart Centre, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
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Abstract
BACKGROUND Although supervision is believed to be an important strategy for training practitioners in evidence-based practice, little is known about how it should be organized and conducted to promote implementation fidelity. AIMS To explore supervisor behaviours that might facilitate supervisees' proficiency in motivational interviewing. METHOD In this exploratory study, ten supervisors from a primary prevention intervention of childhood obesity responded to semi-structured interviews about their supervision behaviours. A mixed method approach was used; both qualitative and quantitative data were collected and analysed. RESULTS The supervisors reported using several sources of information for evaluating and providing systematic feedback on supervisees' performance. However, the majority did not use the available objective measures of proficiency as the primary source. Moreover, half of the supervisors argued that objective feedback might have a punishing effect on the supervisees. CONCLUSIONS Variation in the use of supervision components that previous research has proposed to be potentially influential to the process and outcome may lead to less efficient supervision. Findings suggest that appropriate supervision activities conducted in each supervision session require clear supervision principles that specify the content and procedure of the supervision, as well as regular adherence monitoring of the supervision sessions.
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22
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Braga VAS, Jesus MCPD, Conz CA, Tavares RE, Silva MHD, Merighi MAB. Nursing interventions with people with obesity in Primary Health Care: an integrative review. Rev Esc Enferm USP 2017; 51:e03293. [PMID: 29562034 DOI: 10.1590/s1980-220x2017019203293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 09/28/2017] [Indexed: 01/30/2023] Open
Abstract
Objective Identify the knowledge produced on nursing interventions with people suffering from obesity in Primary Health Care. Method Integrative literature review of publications indexed in the databases: CINAHL, LILACS, MEDLINE, SciELO, SCOPUS and WEB OF SCIENCE, between 2011 and 2016. Results Thirty-three articles were selected. The knowledge produced covered two themes: "Counseling aimed at weight control and promotion of healthy lifestyle habits" and "Perception of Primary Health Care nurses regarding interventions with people with obesity." Conclusion The results may help prompt reflections on professional training, management, and health services in terms of the relevance of nurses working with people suffering from obesity, with the support of digital technologies, motivational techniques, and nursing consultations. This could enhance their activities in the multiprofessional teams in which they participate at this healthcare level.
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Affiliation(s)
| | - Maria Cristina Pinto de Jesus
- Departamento de Enfermagem Básica, Faculdade de Enfermagem, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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Bohman B, Rasmussen F, Ghaderi A. Development and psychometric evaluation of a context-based parental self-efficacy instrument for healthy dietary and physical activity behaviors in preschool children. Int J Behav Nutr Phys Act 2016; 13:110. [PMID: 27765049 PMCID: PMC5072306 DOI: 10.1186/s12966-016-0438-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 10/17/2016] [Indexed: 12/11/2022] Open
Abstract
Background Parental self-efficacy (PSE) refers to beliefs of parents to effectively engage in behaviors that result in desired outcomes for their children. There are several instruments of PSE for promoting healthy dietary or physical activity (PA) behaviors in children. These measures typically assess PSE in relation to some quantity or frequency of behavior, for example, number of servings or times per week. However, measuring PSE in relation to contextual circumstances, for example, psychological states and situational demands, may be a more informative approach. The purpose of the present study was to develop and psychometrically evaluate a context-based PSE instrument. Methods Swedish mothers of five-year-old children (n = 698) responded to the Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors in Preschoolers Scale (PDAP) and a questionnaire on dietary and PA behaviors in children. Interviews were conducted to explore participant perceptions of the quality of the PDAP items. Psychometric evaluation was conducted using exploratory and confirmatory factor analyses. Spearman correlations between PSE and child behaviors were examined. Results Twenty-seven interviews were conducted with participants, who perceived the items as highly comprehensible, relevant and acceptable. A four-factor model of a revised 21-item version of the PDAP fitted the data, with different factors of PSE for promoting healthy dietary or PA behaviors in children depending on whether circumstances were facilitating or impeding successful performance. Internal consistency was excellent for total scale (Cronbach’s α = .94), and good for factors (α = .84–.88). Correlations were in the expected direction: positive correlations between PSE and healthy behaviors, and negative correlations between PSE and unhealthy behaviors (all rss ≤ .32). Conclusions Psychometric evaluation of the PDAP provided preliminary support of construct validity and internal consistency.
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Affiliation(s)
- Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,Centre for Psychiatric Research, Stockholm Health Care Services, Stockholm County Council, Liljeholmstorget 7 B, SE-117 63, Stockholm, Sweden.
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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24
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Enö Persson J, Bohman B, Forsberg L, Beckman M, Tynelius P, Rasmussen F, Ghaderi A. Proficiency in Motivational Interviewing among Nurses in Child Health Services Following Workshop and Supervision with Systematic Feedback. PLoS One 2016; 11:e0163624. [PMID: 27685152 PMCID: PMC5042524 DOI: 10.1371/journal.pone.0163624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on training in motivational interviewing (MI) has shown eroding skills after workshops not followed by additional training input (supervision/coaching). There is a need for more research evaluating different types and lengths of post-workshop training with follow-up periods extending six months. This study is an extension of a previous evaluation of the level of proficiency in MI after workshop and four sessions of supervision among nurses in Swedish child health services. AIMS To explore the level of MI proficiency among nurses participating in an intervention to prevent childhood obesity (n = 33), after receiving five additional sessions of supervision including feedback on observed practice, as well as level of proficiency at follow-up. METHODS Level of proficiency was measured 4 and 12 months after completed supervision using recorded practice samples coded according to the Motivational Interviewing Treatment Integrity (MITI) Code. Potential predictors of outcome were investigated. RESULTS Proficiency remained on the same levels after nine sessions of supervision as after four sessions, and was generally low. The percentage of nurses reaching the proficiency level ranged from 18.2 to 54.5% across indicators. MI-spirit had increased significantly at follow-up, and the rest of the indicators remained on the same levels. No predictors of outcome were found. CONCLUSIONS Comprehensive training programs with prolonged post-workshop supervision and feedback on observed practice may help to sustain but not improve participants' proficiency in MI. Potential explanations to the results and suggestions for future research are discussed.
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Affiliation(s)
- Johanna Enö Persson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatric Research, Stockholm Health Care Services, Stockholm, Sweden
| | | | - Maria Beckman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hansson LM, Heitmann BL, Larsson C, Tynelius P, Willmer M, Rasmussen F. Associations Between Swedish Mothers' and 3- and 5-Year-Old Children's Food Intake. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:520-529.e1. [PMID: 27422494 DOI: 10.1016/j.jneb.2016.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/23/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate associations between mothers' and children's food intake. DESIGN Cross-sectional study. Background variables collected through self-reports and from the register of the total population. Mothers recorded their own and their children's food intake in a diary during 2 4-day periods. SETTING Eight counties in mid Sweden. PARTICIPANTS Three- and 5-year-old children and their mothers were randomly selected from the register of the total population. A total of 2,045 families were invited, 355 of whom accepted. Mothers who accepted were older and to a larger extent born in Sweden. The final sample of mother-child pairs with complete food records was 189. MAIN OUTCOME MEASURES Mothers' and children's food intake (16 food items). ANALYSIS Spearman rank-order correlation with 95% confidence intervals (2-sided). Moderation was investigated using generalized estimation equations with robust variance. RESULTS The strongest correlations between mothers' and children's food intake were found for pizza and oily fish (r = .70-.80). The weakest correlations were found for sugared drinks and fruit and berries (r = .24-.26). Children's age moderated the relationship between mothers' and children's intake of savoury snacks, as did place of residence for pizza intake. CONCLUSIONS AND IMPLICATIONS There were substantial correlations between children's and mothers' intake of various foods. Modeling of mothers' intake might be more effective in influencing young children's intake of certain foods, whereas other strategies, such as encouraging parents to influence food availability (eg, gatekeeping), might be more useful for some foods.
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Affiliation(s)
- Lena M Hansson
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark; Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders, University of Sydney, Sydney, Australia; National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christel Larsson
- Department of Food and Nutrition, Umeå University, Umeå, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela Willmer
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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26
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Nezami M, Segovia-Siapco G, Beeson WL, Sabaté J. Associations between Consumption of Dairy Foods and Anthropometric Indicators of Health in Adolescents. Nutrients 2016; 8:nu8070427. [PMID: 27420094 PMCID: PMC4963903 DOI: 10.3390/nu8070427] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/11/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022] Open
Abstract
Childhood obesity is associated with a greater chance of a lifetime of obesity. Evidence suggests dairy at recommended levels could be beneficial in maintaining normal weight and body composition. We assessed whether dairy consumption is associated with anthropometric indicators of health (z-scores for weight-for-age (WAZ); height-for-age (HAZ) and body mass index (BMIZ); waist-to-height ratio (WHtR); fat-free mass (FFM); and fat mass (FM)) in adolescents. In a cross-sectional study, 536 males and females ages 12–18 completed a 151-item semi-quantitative web-based food frequency questionnaire that included 34 dairy-containing foods. Dairy foods were categorized into milk, cheese, sweetened dairy, and total dairy. Anthropometrics were measured during school visits. Total dairy intake was associated with WAZ (β = 0.25 (95% CI: 0.01, 0.49), p = 0.045) and HAZ (β = 0.28 (95% CI: 0.04, 0.52), p = 0.021). In boys, total dairy was associated with WHtR (β = 0.02 (95% CI: 0.00, 0.04), p = 0.039), FFM (β = 4.83 (95% CI: 1.79, 7.87), p = 0.002), and FM (β = 3.89 (95% CI: 0.58, 7.21), p = 0.021), and cheese was associated with FFM (β = 4.22 (95% CI: 0.98, 7.47), p = 0.011). Dairy consumption seems to influence growth in both genders, and body composition and central obesity in boys. Prospective studies are needed to identify how types of dairy relate to growth, body composition, and central obesity of adolescents.
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Affiliation(s)
- Manijeh Nezami
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Gina Segovia-Siapco
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda University, Loma Linda, CA 92350, USA.
| | - W Lawrence Beeson
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Joan Sabaté
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda University, Loma Linda, CA 92350, USA.
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Döring N, Ghaderi A, Bohman B, Heitmann BL, Larsson C, Berglind D, Hansson L, Sundblom E, Magnusson M, Blennow M, Tynelius P, Forsberg L, Rasmussen F. Motivational Interviewing to Prevent Childhood Obesity: A Cluster RCT. Pediatrics 2016; 137:peds.2015-3104. [PMID: 27244793 DOI: 10.1542/peds.2015-3104] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective was to evaluate a manualized theory-driven primary preventive intervention aimed at early childhood obesity. The intervention was embedded in Swedish child health services, starting when eligible children were 9 to 10 months of age and continuing until the children reached age 4. METHODS Child health care centers in 8 Swedish counties were randomized into intervention and control units and included 1355 families with 1369 infants. Over ∼39 months, families in the intervention group participated in 1 group session and 8 individual sessions with a nurse trained in motivational interviewing, focusing on healthy food habits and physical activity. Families in the control group received care as usual. Primary outcomes were children's BMI, overweight prevalence, and waist circumference at age 4. Secondary outcomes were children's and mothers' food and physical activity habits and mothers' anthropometrics. Effects were assessed in linear and log-binominal regression models using generalized estimating equations. RESULTS There were no statistically significant differences in children's BMI (β = -0.11, 95% confidence interval [CI]: -0.31 to 0.08), waist circumference (β = -0.48, 95% CI: -0.99 to 0.04), and prevalence of overweight (relative risk = 0.95, 95% CI: 0.69 to 1.32). No significant intervention effects were observed in mothers' anthropometric data or regarding mothers' and children's physical activity habits. There was a small intervention effect in terms of healthier food habits among children and mothers. CONCLUSIONS There were no significant group differences in children's and mothers' anthropometric data and physical activity habits. There was, however, some evidence suggesting healthier food habits, but this should be interpreted with caution.
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Affiliation(s)
- Nora Döring
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatric Research, Health Care Services, Stockholm, Sweden
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark; The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia; National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christel Larsson
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Berglind
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and
| | - Lena Hansson
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and
| | - Elinor Sundblom
- Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Solna, Sweden
| | - Margaretha Magnusson
- Department of Women's and Children's Health, Uppsala University and Central Child Healthcare Unit, Uppsala University Hospital, Uppsala, Sweden; and
| | - Margareta Blennow
- Department of Clinical Science and Education, Child Health Services, Södersjukhuset, Stockholm, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Solna, Sweden
| | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, and Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Solna, Sweden;
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Holde GE, Oscarson N, Tillberg A, Marstrander P, Jönsson B. Methods and background characteristics of the TOHNN study: a population-based study of oral health conditions in northern Norway. Int J Circumpolar Health 2016; 75:30169. [PMID: 26900910 PMCID: PMC4762226 DOI: 10.3402/ijch.v75.30169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 12/19/2022] Open
Abstract
Objectives The aim of the Tromstannen – Oral Health in Northern Norway (TOHNN) study was to investigate oral health and dental-related diseases in an adult population. This article provides an overview of the background of the study and a description of the sample characteristics and methods employed in data collection. Study design Cross-sectional population-based study including a questionnaire and clinical dental examination. Methods A randomly selected sample of 2,909 individuals (20–79 years old) drawn from the population register was invited to participate in the study. The data were collected between October 2013 and November 2014 in Troms County in northern Norway. The questionnaire focused on oral health-related behaviours and attitudes, oral health-related quality of life, sense of coherence, dental anxiety and symptoms from the temporomandibular joint. The dental examinations, including radiographs, were conducted by 11 dental teams in 5 dental offices. The examination comprised of registration of dental caries, full mouth periodontal status, temporomandibular disorders, mucosal lesions and height and weight. The participants were grouped by age (20–34, 35–49, 50–64 and 65–79) and ethnicity (Norwegian, Sámi, other European and other world). Results From the original sample of 2,909 individuals, 1,986 (68.3%) people participated, of whom 1,019 (51.3%) were women. The highest attendance rate was among women 20–34 years old (80.3%) and the lowest in the oldest age group of women (55.4%). There was no difference in response rate between rural and urban areas. There was a positive correlation between population size and household gross income (p < 0.001) and education level (p < 0.001). The majority of Sámi resided in smaller municipalities. In larger cities, most participants used private dental health care services, whereas, in rural areas, most participants used the public dental health care service. Conclusion The TOHNN study has the potential to generate new knowledge on a wide range of oral health conditions beneficial to the population in Troms County. Due to the high participation rate, generalization both nationally and to the circumpolar area ought to be possible.
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Affiliation(s)
- Gro Eirin Holde
- The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.,Department of Clinical Dentistry, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway;
| | - Nils Oscarson
- The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway
| | - Anders Tillberg
- The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.,Department of Clinical Dentistry, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Peter Marstrander
- Public Dental Health Care Service, Tromsø County Council, Tromsø, Norway
| | - Birgitta Jönsson
- The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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29
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Delisle Nyström C, Forsum E, Henriksson H, Trolle-Lagerros Y, Larsson C, Maddison R, Timpka T, Löf M. A Mobile Phone Based Method to Assess Energy and Food Intake in Young Children: A Validation Study against the Doubly Labelled Water Method and 24 h Dietary Recalls. Nutrients 2016; 8:nu8010050. [PMID: 26784226 PMCID: PMC4728662 DOI: 10.3390/nu8010050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/25/2015] [Accepted: 01/12/2016] [Indexed: 11/16/2022] Open
Abstract
Mobile phones are becoming important instruments for assessing diet and energy intake. We developed the Tool for Energy Balance in Children (TECH), which uses a mobile phone to assess energy and food intake in pre-school children. The aims of this study were: (a) to compare energy intake (EI) using TECH with total energy expenditure (TEE) measured via doubly labelled water (DLW); and (b) to compare intakes of fruits, vegetables, fruit juice, sweetened beverages, candy, ice cream, and bakery products using TECH with intakes acquired by 24 h dietary recalls. Participants were 39 healthy, Swedish children (5.5 ± 0.5 years) within the ongoing Mobile-based Intervention Intended to Stop Obesity in Preschoolers (MINISTOP) obesity prevention trial. Energy and food intakes were assessed during four days using TECH and 24 h telephone dietary recalls. Mean EI (TECH) was not statistically different from TEE (DLW) (5820 ± 820 kJ/24 h and 6040 ± 680 kJ/24 h, respectively). No significant differences in the average food intakes using TECH and 24 h dietary recalls were found. All food intakes were correlated between TECH and the 24 h dietary recalls (ρ = 0.665-0.896, p < 0.001). In conclusion, TECH accurately estimated the average intakes of energy and selected foods and thus has the potential to be a useful tool for dietary studies in pre-school children, for example obesity prevention trials.
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Affiliation(s)
| | - Elisabet Forsum
- Department of Clinical and Experimental Medicine, Faculty of the Health Sciences, Linköping University, Linköping 581 83, Sweden.
| | - Hanna Henriksson
- Department of Clinical and Experimental Medicine, Faculty of the Health Sciences, Linköping University, Linköping 581 83, Sweden.
| | - Ylva Trolle-Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm 171 77, Sweden.
| | - Christel Larsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, P.O. Box 300, Gothenburg 405 30, Sweden.
| | - Ralph Maddison
- National Institute for Health Innovation, The University of Auckland, P.O. Box 92019, Auckland 1142, New Zealand.
| | - Toomas Timpka
- Department of Medical and Health Sciences, Faculty of the Health Sciences, Linköping University, Linköping 581 83, Sweden.
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge 141 83, Sweden.
- Department of Clinical and Experimental Medicine, Faculty of the Health Sciences, Linköping University, Linköping 581 83, Sweden.
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Changes in eating behaviour and food choices in families where the mother undergoes gastric bypass surgery for obesity. Eur J Clin Nutr 2015; 70:35-40. [PMID: 26330145 DOI: 10.1038/ejcn.2015.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/07/2015] [Accepted: 06/22/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES There is a lack of research exploring the effects of Roux-en-Y gastric bypass (RYGB) surgery on the patient's family's eating behaviour and food choices. The aim of the current study was to investigate changes in partners' and children's eating behaviour and food choices following maternal RYGB. SUBJECTS/METHODS Sixty-nine women and their families were recruited from RYGB waiting lists at five Swedish surgical clinics. Data were collected during home visits 3 months before and 9 months after RYGB. Anthropometrical measures were taken, the adults completed the Three-Factor Eating Questionnaire and the children completed the Children's Eating Attitudes Test (ChEAT). All participants also completed a short food frequency questionnaire. RESULTS Changes in scores were analysed using paired t-tests for unadjusted estimates or linear regression models with robust variance (General Estimating Equations) in order to enable age- and sex-adjusted estimates for the children. There were no meaningful differences in the partners' eating behaviour or food choices. The boys, but not the girls, improved their ChEAT scores, as did the overweight/obese children in comparison with the normal-weight children. The boys, unlike the girls, also decreased their intake of soft drinks, as did the normal-weight children when compared with the overweight/obese children. CONCLUSIONS No clear-cut changes were found in partners' eating behaviour and food choices. Eating attitudes and soft drinks intake were improved among boys but not among girls. Differing modelling behaviour may partially explain these findings, but available data did not allow us to understand the underlying mechanisms.
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