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Pallan M, Mason F, Parretti HM, Adab P, Abbott S, Jolly K. Supporting healthcare professionals to address child weight with parents: a qualitative study. Br J Gen Pract 2024; 74:e417-e425. [PMID: 38575182 PMCID: PMC11005922 DOI: 10.3399/bjgp.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/06/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Primary care and community healthcare professionals (HCPs) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about addressing this issue. There is a need to understand the factors that influence HCPs in initiating these conversations to inform strategies to support them. AIM To explore with HCPs, working in primary care and community settings, their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations. DESIGN AND SETTING A qualitative study with GPs, primary care nurses (PNs), and school nurses (SNs) in England. METHOD GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach. RESULTS Thirteen GPs, seven PNs, and 20 SNs participated. The following three themes were identified regarding barriers to HCPs having conversations about child excess weight: structural and organisational; HCP related; and parent or family related. The themes identified for the factors that facilitate these conversations were: structural changes (for example, dedicated appointments, access to weight assessment data, joined-up working across agencies); HCP approaches (for example, providing appropriate dietary and physical activity advice); and HCP knowledge and skills (for example, enhancing HCPs' general and weight management-related skills and knowledge of child weight management services). CONCLUSION A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these barriers.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Frances Mason
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Sally Abbott
- Research Centre for Healthcare and Communities, Institute for Health and Wellbeing, Coventry University, Coventry; Department of Dietetics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham
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2
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Foor K, Ravuri S, Persky S. How shared versus unshared parental contribution to child risk influences guilt responses. J Health Psychol 2024:13591053241233336. [PMID: 38385176 DOI: 10.1177/13591053241233336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
The extent to which parents experience guilt related to their child's health may depend on their perceptions of their contribution to these outcomes. The impact of the child's "other" biological parent's (OBP) contribution to child health on guilt responses is understudied. Some models posit a diffusion-of-responsibility process, while others favor a heightened-risk-heightened-guilt model. The present study examines how perceived OBP contribution to child risk affects guilt among a sample of parents with self-reported overweight. Parents who perceived their child's OBP to also have overweight experienced more guilt for passing down genetic and family environment-based obesity risk to their child, which suggests that perceptions of shared risk contribution promote guilt-related outcomes. Additionally, risk information endorsing a gene-environment interaction liability framing was the most responsive to OBP weight status. These results support a heightened-risk-heightened-guilt process. Future work should consider guilt when developing child health interventions to avoid undesirable emotional outcomes among parents.
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Skantze C, Almqvist-Tangen G, Nyholm M, Karlsson S. Parents' Experiences of Communication With School Nurses About Their Child's Weight Development in Sweden. J Sch Nurs 2023:10598405231221050. [PMID: 38130128 DOI: 10.1177/10598405231221050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This study aimed to describe parents' experiences of communication with school nurses concerning the growth data and weight development of their children aged 8 and 10 years old in Sweden. Eighteen interviews with parents were conducted and analyzed through qualitative content analysis. The result showed a need for improved dialogue where the parents viewed the health visit's purpose as unclear and lacked feedback. The parents desired access to their child's growth data and described the need for an improved channel for receiving information. The parents moreover experienced the lack of a child-centered perspective, described the child's context as not in focus, and desired collaboration around their child. This study shows the need for the development of evidence-based methods for communicating growth data and weight development between School Health Service (SHS) and parents, as well as the need for a reformed SHS perspective towards parents and children.
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Affiliation(s)
- Caroline Skantze
- School of Health and Welfare, Halmstad University, Halmstad, Halland, Sweden
| | - Gerd Almqvist-Tangen
- Department of Paediatrics, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
| | - Maria Nyholm
- School of Health and Welfare, Halmstad University, Halmstad, Halland, Sweden
| | - Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Halland, Sweden
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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4
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Rossiter C, Cheng H, Denney-Wilson E. Primary healthcare professionals' role in monitoring infant growth: A scoping review. J Child Health Care 2023:13674935231165897. [PMID: 36963017 DOI: 10.1177/13674935231165897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Excessive weight gain in infancy is an established risk for childhood obesity. Primary healthcare professionals have regular contact with infants and are well placed to monitor their growth. This review explores primary healthcare professionals' practice in monitoring growth for infants from birth to 2 years, addressing assessment methods, practitioner confidence and interventions for unhealthy weight gain. Reviewers searched four databases for studies of primary healthcare professionals working in high-income countries that reported on practice monitoring infant growth. Thirty-six eligible studies documented health professionals' practice with infants. While most clinicians regularly weighed and measured infants, some did not record measurements comprehensively. Growth monitoring occurred regularly during well-child visits but was less common during unscheduled visits. Some participants were less proficient at interpreting growth trajectories or lacked confidence in detecting excessive weight gain and in communicating concerns to parents. Few interventions addressed unhealthy growth among infants. Primary healthcare professionals require support to monitor growth trajectories effectively, to communicate appropriately with parents and to engage them in developing healthy behaviours early. Strategies are also required to monitor infants not regularly attending primary health care.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Australia
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5
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Koivumäki T, Jallinoja P. The good, the bad, and the blameless in parenting: a thematic analysis of discussions of childhood obesity on an internet forum. BMC Public Health 2023; 23:452. [PMID: 36890492 PMCID: PMC9993749 DOI: 10.1186/s12889-023-15314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/23/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Childhood obesity is affecting an increasing percentage of families globally. For families, obesity is often a tense issue, not least because of the negative stigma and cultural perceptions associated with it. Discussions around childhood obesity do not take place only at home or in healthcare, but increasingly on social media, such as Internet discussion forums. Our aim was to analyse how childhood obesity is discussed on a Finnish online discussion forum by parents of children with obesity and other commenters. METHOD We gathered and analysed 16 discussion threads on childhood obesity taken from a Finnish Internet discussion forum, vauva.fi, between 2015 and 2021 (a total of 331 posts). For the analysis, we chose threads where the parents of a child with obesity took part. The parents' and other commenters' discussions were analysed and interpreted with inductive thematic analysis. RESULTS In the online discussions, childhood obesity was discussed mostly in the context of parenting, parental responsibility and lifestyle choices within the family. We identified three themes that were used to define parenting. In the theme of proving good parenting, parents and commenters listed healthy elements in their family's lifestyle to show their responsibility and parenting skills. In the theme of blaming bad parents, other commenters pointed out mistakes in the parents' behaviour or offered them advice. Moreover, many acknowledged that some factors causing childhood obesity were outside the parents' influence, forming the theme of lifting the blame from parents. In addition, many parents brought up that they were genuinely ignorant of the reasons for their child's overweight. CONCLUSIONS These results are in line with previous studies suggesting that in Western cultures obesity - including childhood obesity - is typically seen as the individual's fault and is associated with negative stigma. Consequently, counselling parents in healthcare should be expanded from supporting a healthy lifestyle to strengthening parents' identity as being good enough parents who are already making many health enhancing efforts. Situating the family in a wider context of the obesogenic environment could ease the parents' feelings that they have failed at parenting.
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6
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Hawking MKD, Dezateux C, Swinglehurst D. Weighing up the future: a meta-ethnography of household perceptions of the National Child Measurement Programme in England. CRITICAL PUBLIC HEALTH 2023. [DOI: 10.1080/09581596.2023.2169599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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7
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Eli K, Neovius C, Nordin K, Brissman M, Ek A. Parents' experiences following conversations about their young child's weight in the primary health care setting: a study within the STOP project. BMC Public Health 2022; 22:1540. [PMID: 35962359 PMCID: PMC9375316 DOI: 10.1186/s12889-022-13803-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In primary healthcare, conversations between clinicians and parents about young children's overweight are key to providing support and initiating weight management. However, given the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents' experiences following conversations with primary care nurses about their child's overweight. METHODS Participants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (n = 12/17), had a university degree (n = 14/17) and were born in Sweden (n = 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (n = 7) or obesity (n = 10). The interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Two main themes were developed. Theme 1, 'Receiving the overweight/obesity diagnosis', explores parents' reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child's and the family's needs (subtheme Conversations that empower), or felt limited, uncomfortable, or belittling (subtheme Conversations that provoke resistance). Theme 2, 'Parenting a child with a formal diagnosis of obesity', explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme Fear of transferring weight anxiety), dealing with others' reactions (subtheme Involve family and manage surroundings) and asking for and receiving support from health care professionals (subtheme Obtain support from health care professionals). CONCLUSIONS While conversations with primary care nurses about children's weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03800823 ; 11 Jan 2019.
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Affiliation(s)
- Karin Eli
- Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Catharina Neovius
- Regional Unit for the Well-Baby Clinics, Sachsska Children's Hospital, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Markus Brissman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska, University Hospital, Stockholm, Sweden
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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8
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Butler ÉM, Derraik JGB, Burge A, Cutfield WS, Leversha A. Caregiver Perception of Weight Status in 5-Year-Old Children From a Community of High Socioeconomic Deprivation in New Zealand. Front Public Health 2022; 10:641418. [PMID: 35844895 PMCID: PMC9280196 DOI: 10.3389/fpubh.2022.641418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Early childhood obesity is highly prevalent in Aotearoa New Zealand (NZ). Little is known about caregiver perception of children's weight status among those living in areas of high socioeconomic deprivation, particularly Māori and Pacific children. Aims To explore caregiver perception of weight status among children starting school in areas of high socioeconomic deprivation and examine potential associations between the child's body mass index (BMI) z-score and their caregiver's perception of their child's body size or health. Methods Participants were 5-year-old children living in a community of high socioeconomic deprivation and their caregivers. Children had their weight and height measured. BMI z-scores were calculated according to World Health Organization standards. Caregivers were asked to assess their child's BMI and health status, and choose a silhouette that best represented their child's body size. Results One hundred and six children (>75% Māori or Pacific) were included. Over half (58%) had overweight or obesity, with only 16% correctly perceived by their caregiver as overweight. These children tended to have higher BMI z-scores than those not correctly perceived as overweight. Caregivers chose larger silhouettes to represent children's body sizes as children's BMI z-scores increased. There was no discernible association between children's BMI z-scores and caregiver perception of children's health. Conclusions Caregivers appeared to judge their child's body size in comparison to other children. The normalization of childhood obesity and infrequent caregiver recognition of this condition in children in communities with a high prevalence may impact the uptake and efficacy of intervention initiatives.
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Affiliation(s)
- Éadaoin M. Butler
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start – National Science Challenge, University of Auckland, Auckland, New Zealand
| | - José G. B. Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Environmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Alison Burge
- Starship Community Services, Auckland District Health Board, Auckland, New Zealand
| | - Wayne S. Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start – National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Alison Leversha
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Starship Community Services, Auckland District Health Board, Auckland, New Zealand
- *Correspondence: Alison Leversha
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9
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Canfell OJ, Littlewood R, Wright ORL, Walker JL. "We'd be really motivated to do something about it": a qualitative study of parent and clinician attitudes towards predicting childhood obesity in practice. Health Promot J Austr 2022; 34:398-409. [PMID: 35504851 DOI: 10.1002/hpja.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/25/2022] [Accepted: 04/27/2022] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED In Australia, one-in-four (24.9%) children live with overweight or obesity (OW/OB). Identifying infants at-risk of developing childhood OW/OB is a potential preventive pathway but its acceptability is yet to be investigated in Australia. This study aimed to (1) investigate acceptability of predicting childhood OW/OB with parents of infants (aged 0-2 years) and clinicians and (2) explore key language to address stigma and maximise the acceptability of predicting childhood OW/OB in practice. METHODS Cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants were multidisciplinary paediatric clinicians (n=18) and parents (n=13) recruited across public hospitals and health services in Queensland, Australia. Data were analysed under the Framework Method using an inductive, thematic approach. RESULTS Five main themes were identified: (1) Optimism for prevention and childhood obesity prediction (2) Parent dedication to child's health (3) Adverse parent response to risk for childhood obesity (4) Language and phrasing for discussing weight and risk (5) Clinical delivery. Most participants were supportive of using a childhood OW/OB prediction tool in practice. Parents expressed dedication to their child's health that superseded potential feelings of judgment or blame. When discussing weight in a clinical setting, the use of sensitive (i.e. 'overweight', 'above average', 'growth' versus 'obesity') and positive, health-focused language was mostly supported. CONCLUSIONS Multidisciplinary paediatric clinicians and parents generally accept the concept of predicting childhood OW/OB in practice in Queensland, Australia. SO WHAT?: Clinicians, public health and health promotion professionals and policymakers can act now to implement sensitive communication strategies concerning weight and obesity risk.
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Affiliation(s)
- Oliver J Canfell
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia.,Children's Health Queensland Hospital and Health Service, Department of Health, Queensland Government, South Brisbane, QLD, Australia.,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD, Australia.,Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton QLD, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia.,Children's Health Queensland Hospital and Health Service, Department of Health, Queensland Government, South Brisbane, QLD, Australia.,Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton QLD, Australia
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Jacqueline L Walker
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia.,Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton QLD, Australia
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10
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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Communicating Risk for Obesity in Early Life: Engaging Parents Using Human-Centered Design Methodologies. Front Pediatr 2022; 10:915231. [PMID: 35837240 PMCID: PMC9273946 DOI: 10.3389/fped.2022.915231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Pediatricians are well positioned to discuss early life obesity risk, but optimal methods of communication should account for parent preferences. To help inform communication strategies focused on early life obesity prevention, we employed human-centered design methodologies to identify parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. METHODS We conducted a series of virtual human-centered design research sessions with 31 parents of infants <24 months old. Parents were recruited with a human intelligence task posted on Amazon's Mechanical Turk, via social media postings on Facebook and Reddit, and from local community organizations. Human-centered design techniques included individual short-answer activities derived from personas and empathy maps as well as group discussion. RESULTS Parents welcomed a conversation about infant weight and obesity risk, but concerns about health were expressed in relation to the future. Tone, context, and collaboration emerged as important for obesity prevention discussions. Framing the conversation around healthy changes for the entire family to prevent adverse impacts of excess weight may be more effective than focusing on weight loss. CONCLUSIONS Our human-centered design approach provides a model for developing and refining messages and materials aimed at increasing parent/provider communication about early life obesity prevention. Motivating families to engage in obesity prevention may require pediatricians and other health professionals to frame the conversation within the context of other developmental milestones, involve the entire family, and provide practical strategies for behavioral change.
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Affiliation(s)
- Erika R Cheng
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney Moore
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Lisa Parks
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Elsie M Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, United States.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah E Wiehe
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States.,Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Aaron E Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
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11
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Parental feeding and childhood genetic risk for obesity: exploring hypothetical interventions with causal inference methods. Int J Obes (Lond) 2022; 46:1271-1279. [PMID: 35306528 PMCID: PMC9239906 DOI: 10.1038/s41366-022-01106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Parental-feeding behaviors are common intervention targets for childhood obesity, but often only deliver small changes. Childhood BMI is partly driven by genetic effects, and the extent to which parental-feeding interventions can mediate child genetic liability is not known. Here we aim to examine how potential interventions on parental-feeding behaviors can mitigate some of the association between child genetic liability and BMI in early adolescence, using causal inference methods. METHODS Data from the Avon Longitudinal Study of Parents and Children were used to estimate an interventional disparity measure for a child polygenic score for BMI (PGS-BMI) on BMI at 12 years. The approach compares counterfactual outcomes for different hypothetical interventions on parental-feeding styles applied when children are 10-11 years (n = 4248). Results are presented as adjusted total association (Adj-Ta) between genetic liability (PGS-BMI) and BMI at 12 years, versus the interventional disparity measure-direct effect (IDM-DE), which represents the association that would remain, had we intervened on parental-feeding under different scenarios. RESULTS For children in the top quintile of genetic liability, an intervention shifting parental feeding to the levels of children with lowest genetic risk, resulted in a difference of 0.81 kg/m2 in BMI at 12 years (Adj-Ta = 3.27, 95% CI: 3.04, 3.49; versus IDM-DE = 2.46, 95% CI: 2.24, 2.67). CONCLUSIONS Findings suggest that parental-feeding interventions have the potential to buffer some of the genetic liability for childhood obesity. Further, we highlight a novel way to analyze potential interventions for health conditions only using secondary data analyses, by combining methodology from statistical genetics and social epidemiology.
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12
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Rotevatn TA, Mortensen RN, Ullits LR, Torp-Pedersen C, Overgaard C, Høstgaard AMB, Bøggild H. Early-life childhood obesity risk prediction: A Danish register-based cohort study exploring the predictive value of infancy weight gain. Pediatr Obes 2021; 16:e12790. [PMID: 33783137 DOI: 10.1111/ijpo.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/06/2021] [Accepted: 03/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information on postnatal weight gain is important for predicting later overweight and obesity, but it is unclear whether inclusion of this postnatal predictor improves the predictive performance of a comprehensive model based on prenatal and birth-related predictors. OBJECTIVES To compare performance of prediction models based on predictors available at birth, with and without information on infancy weight gain during the first year when predicting childhood obesity risk. METHODS A Danish register-based cohort study including 55.041 term children born between January 2004 and July 2011 with birthweight >2500 g registered in The Children's Database was used to compare model discrimination, reclassification, sensitivity and specificity of two models predicting risk of childhood obesity at school age. Each model consisted of eight predictors available at birth, one additionally including information on weight gain during the first 12 months of life. RESULTS The area under the receiving operating characteristic curve increased from 0.785 (95% confidence interval (CI) [0.773-0.798]) to 0.812 (95% CI [0.801-0.824]) after adding weight gain information when predicting childhood obesity. Adding this information correctly classified 30% more children without obesity and 21% with obesity and improved sensitivity from 0.42 to 0.48. Specificity remained unchanged at 0.91. CONCLUSION Adding infancy weight gain information improves discrimination, reclassification and sensitivity of a comprehensive prediction model based on predictors available at birth.
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Affiliation(s)
- Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | | | - Line Rosenkilde Ullits
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Investigation, Nordsjaellands Hospital, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Anna Marie Balling Høstgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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13
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Paediatric teams in front of childhood obesity: A qualitative study within the STOP project. An Pediatr (Barc) 2021; 95:174-185. [PMID: 34362718 DOI: 10.1016/j.anpede.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem. OBJECTIVE To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care. PARTICIPANTS AND METHOD Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n = 57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done. RESULTS Three themes emerged from the data: "Parents' attitude in childhood obesity" (sub-themes "The conscience of parents", "The parents ask for help"), "Paediatric staff and childhood obesity" (sub-themes "Approaching to the problem: The interview with parents", "Looking together for the solution"), and "System barriers" (sub-themes "Improving teamwork and health policy", "Family participation in addressing childhood obesity"). CONCLUSIONS Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel.
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14
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Serban CL, Putnoky S, Ek A, Eli K, Nowicka P, Chirita-Emandi A. Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment. Front Public Health 2021; 9:652491. [PMID: 34336760 PMCID: PMC8321411 DOI: 10.3389/fpubh.2021.652491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed. Trial Registration:ClinicalTrials.gov, NCT03800823; 11 Jan 2019.
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Affiliation(s)
- Costela Lacrimioara Serban
- Functional Sciences Department, "Victor Babes" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Salomeia Putnoky
- Microbiology Department, Centre for Studies in Preventive Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, Regional Center of Medical Genetics Timis, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Regional Center of Medical Genetics, "Louis Turcanu" Clinical Emergency Hospital for Children, Timişoara, Romania
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15
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Abdin S, Heath G, Welch RK. Health professionals' views and experiences of discussing weight with children and their families: A systematic review of qualitative research. Child Care Health Dev 2021; 47:562-574. [PMID: 33565647 DOI: 10.1111/cch.12854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/23/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Healthcare professionals are ideally placed to discuss weight management with children and families to treat and prevent childhood obesity. The aim of this review was to collect and synthesize primary research evidence relating to health professional's views and experiences of discussing weight with children and their families. METHODS Systematic searches were conducted using the following databases: MEDLINE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE (OVID), PsycINFO (OVID) and Healthcare Management Information Consortium (HMIC). Twenty-six full text qualitative studies published in English Language journals since inception to October 2019 were included. Papers were quality assessed and synthesized using an inductive thematic analysis approach. RESULTS Data analysis generated five themes: sensitivity of the issue, family-professional relationships, whole systems approach, professional competency and sociocultural context. CONCLUSION Supporting behaviour change through discussion of healthy weight with children and families is an important part of the health professional's role. Tailored information for professionals, including resources and training, facilitates them to confidently talk to children and families about weight prioritized within interventions. The success of such interventions requires commitment from a range of professionals to ensure healthy weight is tackled through a whole system approach.
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Affiliation(s)
- Shanara Abdin
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, Bristol, UK.,Public Health and Wellbeing, City of Wolverhampton Council, Wolverhampton, UK
| | - Gemma Heath
- Department of Psychology, University of Wolverhampton, Wolverhampton, UK
| | - Richard K Welch
- Public Health and Wellbeing, City of Wolverhampton Council, Wolverhampton, UK
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16
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Rossman H, Shilo S, Barbash-Hazan S, Artzi NS, Hadar E, Balicer RD, Feldman B, Wiznitzer A, Segal E. Prediction of Childhood Obesity from Nationwide Health Records. J Pediatr 2021; 233:132-140.e1. [PMID: 33581105 DOI: 10.1016/j.jpeds.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate body mass index (BMI) acceleration patterns in children and to develop a prediction model targeted to identify children at high risk for obesity before the critical time window in which the largest increase in BMI percentile occurs. STUDY DESIGN We analyzed electronic health records of children from Israel's largest healthcare provider from 2002 to 2018. Data included demographics, anthropometric measurements, medications, diagnoses, and laboratory tests of children and their families. Obesity was defined as BMI ≥95th percentile for age and sex. To identify the time window in which the largest annual increases in BMI z score occurs during early childhood, we first analyzed childhood BMI acceleration patterns among 417 915 adolescents. Next, we devised a model targeted to identify children at high risk before this time window, predicting obesity at 5-6 years of age based on data from the first 2 years of life of 132 262 children. RESULTS Retrospective BMI analysis revealed that among adolescents with obesity, the greatest acceleration in BMI z score occurred between 2 and 4 years of age. Our model, validated temporally and geographically, accurately predicted obesity at 5-6 years old (area under the receiver operating characteristic curve of 0.803). Discrimination results on subpopulations demonstrated its robustness across the pediatric population. The model's most influential predictors included anthropometric measurements of the child and family. Other impactful predictors included ancestry and pregnancy glucose. CONCLUSIONS Rapid rise in the prevalence of childhood obesity warrant the development of better prevention strategies. Our model may allow an accurate identification of children at high risk of obesity.
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Affiliation(s)
- Hagai Rossman
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Smadar Shilo
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel; Pediatric Diabetes Unit, Ruth Rappaport Children's Hospital of Haifa, Rambam Healthcare Campus, Haifa, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Shalom Artzi
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; Department of Public Health, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Becca Feldman
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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17
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Wu Y, Ma X, Fraser WD, Li M, Wang W, Huang H, Landry M, Hao Y, Liu H, Semenic S, Zhang Y, Wang H, Zhang J, Yu J, La X, Zhang C, Marc I, Jiang H. Caregivers' perceptions, challenges and service needs related to tackling childhood overweight and obesity: a qualitative study in three districts of Shanghai, China. BMC Public Health 2021; 21:768. [PMID: 33882878 PMCID: PMC8061052 DOI: 10.1186/s12889-021-10744-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background Childhood overweight and obesity (OWO) has become a major public concern worldwide including in Shanghai, one of the most developed areas of China. Understanding perceptions and challenges of tackling childhood OWO among caregivers of children is critical to provide services in need. Methods A qualitative descriptive study including in-depth interviews with seven parents and six focus group discussions with a total of 32 parents or grandparents of children zero to 6 years of age. Participants lived in three districts of Shanghai and indexed children included both those with OWO or non-OWO children. Data were analyzed using qualitative thematic analysis. Results Caregivers tended to underestimate children’s weight status, and to regard chubby children as a sign of good parental care. Some caregivers even suggested that there were positive effects of childhood overweight. Caregivers identified a number of challenges to prevention of OWO in children, including difficulties in controlling dietary intake or increasing children’s physical activities; discordant views between parents and grandparents, and barriers to accessing professional guidance. Caregivers desired more detailed advice regarding children’s nutrition intake and physical activity, and preferred online approaches. Conclusions Misconceptions regarding childhood overweight were found in caregivers of children in Shanghai. Professional guidance on childhood weight control for caregivers is desired via digital applications such as mobile phone applications and social media.
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Affiliation(s)
- Yanting Wu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road., Shanghai, 200030, China.,Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China
| | - Xiaoying Ma
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Center for Disease Control and Prevention, No.1380 West Zhongshan Road, Shanghai, 200336, China
| | - William D Fraser
- Department of Obstetrics and Gynecology, Université de Sherbrooke Centre de recherche du CHUS, CIUSSS de l'Estrie - CHUS, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Mu Li
- School of Public Health, China Studies Centre, University of Sydney, Room 313, Edward Ford Building, Sydney, 2006, Australia
| | - Wei Wang
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China
| | - Hefeng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road., Shanghai, 200030, China.,Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China
| | - Myriam Landry
- Department of Pediatrics, CHU de Quebec Université Laval research center, 2705 Boulevard Laurier, G1V 4G2, Quebec City, Quebec, Canada
| | - Yanhui Hao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road., Shanghai, 200030, China
| | - Han Liu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road., Shanghai, 200030, China
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Suite 1800, Montreal, QC, H3A 2M7, Canada
| | - Yan Zhang
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China.,Jiading District Center for Disease Control and Prevention, No.264 Tacheng road, Shanghai, 201800, China
| | - Haiqin Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road., Shanghai, 200030, China
| | - Jingya Zhang
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Health Promotion Center, No.122 South Shaanxi road, Shanghai, 200040, China
| | - Jiale Yu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road., Shanghai, 200030, China
| | - Xuena La
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China
| | - Congcong Zhang
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China
| | - Isabelle Marc
- Department of Pediatrics, CHU de Quebec Université Laval research center, 2705 Boulevard Laurier, G1V 4G2, Quebec City, Quebec, Canada.
| | - Hong Jiang
- School of Public Health, Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China.
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18
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Butler ÉM, Pillai A, Morton SMB, Seers BM, Walker CG, Ly K, Tautolo ES, Glover M, Taylor RW, Cutfield WS, Derraik JGB. A prediction model for childhood obesity in New Zealand. Sci Rep 2021; 11:6380. [PMID: 33737627 PMCID: PMC7973754 DOI: 10.1038/s41598-021-85557-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/24/2021] [Indexed: 11/09/2022] Open
Abstract
Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4-5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex ≥ 95th percentile. Data on GUiNZ children were used for derivation (n = 1731) and internal validation (n = 713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n = 383) and Pacific Islands Families Study (PIF, n = 135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC = 0.74 (0.71-0.77)], remained so when validated internally [AUROC = 0.73 (0.68-0.78)] and externally on PIF [AUROC = 0.74 [0.66-0.82)] and POI [AUROC = 0.80 (0.71-0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19-54%; GUiNZ validation 19-48%; and POI 8-24%), although more consistent in the PIF cohort (52-61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.
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Affiliation(s)
- Éadaoin M Butler
- A Better Start-National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- Growing Up in New Zealand, Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- A Better Start-National Science Challenge, Auckland, New Zealand.,Growing Up in New Zealand, Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Blake M Seers
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Caroline G Walker
- Growing Up in New Zealand, Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Kien Ly
- Growing Up in New Zealand, Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - El-Shadan Tautolo
- A Better Start-National Science Challenge, Auckland, New Zealand.,Department of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Marewa Glover
- A Better Start-National Science Challenge, Auckland, New Zealand.,School of Public Health, College of Health, Massey University, Auckland, New Zealand.,Centre of Research Excellence Indigenous Sovereignty and Smoking, Auckland, New Zealand
| | - Rachael W Taylor
- A Better Start-National Science Challenge, Auckland, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- A Better Start-National Science Challenge, Auckland, New Zealand. .,Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - José G B Derraik
- A Better Start-National Science Challenge, Auckland, New Zealand. .,Liggins Institute, University of Auckland, Auckland, New Zealand. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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19
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Argelich E, Alemany ME, Amengual-Miralles B, Argüelles R, Bandiera D, Barceló MA, Beinbrech B, Bouzas C, Capel P, Cerdà AL, Colom M, Corral H, de Sotto-Esteban D, Fleitas G, Garcias C, Juan D, Juan J, Mateos D, Martín MI, Martínez MÀ, Mínguez M, Moncada E, Nadal M, Pont JM, Puigserver B, Suñer CA, Ugarriza L, Yeste D, Yeste S, Tur JA. [Paediatric teams in front of childhood obesity: a qualitative study within the STOP project]. An Pediatr (Barc) 2021. [PMID: 33478849 DOI: 10.1016/j.anpedi.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem. OBJECTIVE To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care. PARTICIPANTS AND METHOD Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n=57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done. RESULTS Three themes emerged from the data: «Parents' attitude in childhood obesity» (sub-themes «The conscience of parents», «The parents ask for help»), «Paediatric staff and childhood obesity» (sub-themes «Approaching to the problem: The interview with parents», «Looking together for the solution»), and «System barriers» (sub-themes «Improving teamwork and health policy», «Family participation in addressing childhood obesity»). CONCLUSIONS Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel.
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Affiliation(s)
- Emma Argelich
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España; Hospital de Manacor, Manacor, España
| | | | | | | | | | | | | | - Cristina Bouzas
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España
| | | | | | | | | | | | | | | | | | | | - David Mateos
- Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España; Hospital Universitario Son Espases, Palma de Mallorca, España
| | | | | | | | | | | | | | | | | | | | | | | | - Josep A Tur
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España.
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20
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Andersen LM, Thompson DA. Managing Excessive Weight Gain in Children <2 Years of Age: Interviews with Primary Care Providers. Child Obes 2020; 16:332-339. [PMID: 32460526 DOI: 10.1089/chi.2019.0315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Excessive weight gain in the first 2 years of childhood is a risk factor for future obesity. However, the current absence of clear, standardized identification and treatment guidelines may hinder primary care providers' (PCPs) ability to manage early excessive weight gain in children <2. The objective of this study was to explore PCPs' perspectives on evaluating and communicating about early excessive weight gain and to identify PCP-opined barriers to the care of children exhibiting such trends. Methods: A trained interviewer conducted 20 semistructured interviews with PCPs on identifying and communicating with families about early excessive weight gain in children <2 years old. A thematic analysis approach was used to analyze the transcripts. Results: Interviews uncovered three major themes: (1) the approach to identifying excessive weight gain in children <2 showed high variability across participants despite relative consistency in weight assessment methodology, (2) while possessing communication strategies, providers recognized multiple barriers impeding the execution of weight-related conversations with caregivers, and (3) providers perceived the need for additional support to improve their ability to respond to excessive weight gain in children <2 years old. Conclusions: Variability exists in PCP-reported methods used and barriers faced when identifying, communicating, and responding to excessive weight gain in very early childhood. Introducing guidelines and resources to help standardize the assessment and communication of excessive weight gain in children <2 could augment PCPs' strategies for managing accelerated weight-gain trajectories to mitigate rates of childhood obesity.
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Affiliation(s)
- Leisha M Andersen
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Darcy A Thompson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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21
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"They Just Need to Come Down a Little Bit to your Level": A Qualitative Study of Parents' Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103605. [PMID: 32455567 PMCID: PMC7277501 DOI: 10.3390/ijerph17103605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/28/2022]
Abstract
The first 1000 days is a critical window of opportunity to promote healthy growth and associated behaviours. Health professionals can play an important role, in part due to the large number of routine contacts they have with parents. There is an absence of research on the views of parents towards obesity prevention and the range of associated behaviours during this time period. This study aimed to elicit parents’ views on early life interventions to promote healthy growth/prevent childhood obesity, particularly those delivered by health professionals. Semi-structured interviews were conducted with 29 parents (24 mothers, 5 fathers) who were resident in Ireland and had at least one child aged under 30 months. Data were analysed using reflexive thematic analysis. Two central themes were generated: (1) navigating the uncertainty, stress, worries, and challenges of parenting whilst under scrutiny and (2) accessing support in the broader system. Parents would welcome support during this critical time period; particularly around feeding. Such support, however, needs to be practical, realistic, evidence-based, timely, accessible, multi-level, non-judgemental, and from trusted sources, including both health professionals and peers. Interventions to promote healthy growth and related behaviours need to be developed and implemented in a way that supports parents and their views and circumstances.
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22
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Butler ÉM, Derraik JGB, Glover M, Morton SMB, Tautolo ES, Taylor RW, Cutfield WS. Acceptability of early childhood obesity prediction models to New Zealand families. PLoS One 2019; 14:e0225212. [PMID: 31790443 PMCID: PMC6886750 DOI: 10.1371/journal.pone.0225212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE While prediction models can estimate an infant's risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. We aimed to assess the acceptability of these models to New Zealand caregivers. METHODS An anonymous questionnaire was distributed online. The questionnaire consisted of multiple choice and Likert scale questions. Respondents were parents, caregivers, and grandparents of children aged ≤5 years. RESULTS 1,934 questionnaires were analysed. Responses were received from caregivers of various ethnicities and levels of education. Nearly two-thirds (62.1%) of respondents would "definitely" or "probably" want to hear if their infant was at risk of early childhood obesity, although "worried" (77.0%) and "upset" (53.0%) were the most frequently anticipated responses to such information. With lower mean scores reflecting higher levels of acceptance, grandparents (mean score = 1.67) were more receptive than parents (2.10; p = 0.0002) and other caregivers (2.13; p = 0.021); males (1.83) were more receptive than females (2.11; p = 0.005); and Asian respondents (1.68) were more receptive than those of European (2.05; p = 0.003), Māori (2.11; p = 0.002), or Pacific (2.03; p = 0.042) ethnicities. There were no differences in acceptance according to socioeconomic status, levels of education, or other ethnicities. CONCLUSIONS Almost two-thirds of respondents were receptive to communication regarding their infant's risk of childhood obesity. While our results must be interpreted with some caution due to their hypothetical nature, findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand.
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Affiliation(s)
- Éadaoin M. Butler
- A Better Start–National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G. B. Derraik
- A Better Start–National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marewa Glover
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
- Centre of Research Excellence Indigenous Sovereignty & Smoking, Auckland, New Zealand
| | - Susan M. B. Morton
- A Better Start–National Science Challenge, Auckland, New Zealand
- Centre for Longitudinal Research–He Ara ki Mua, The University of Auckland, Auckland, New Zealand
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - El-Shadan Tautolo
- A Better Start–National Science Challenge, Auckland, New Zealand
- Centre for Pacific Health & Development Research, Auckland University of Technology, Auckland, New Zealand
| | - Rachael W. Taylor
- A Better Start–National Science Challenge, Auckland, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S. Cutfield
- A Better Start–National Science Challenge, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
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23
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Sjunnestrand M, Nordin K, Eli K, Nowicka P, Ek A. Planting a seed - child health care nurses' perceptions of speaking to parents about overweight and obesity: a qualitative study within the STOP project. BMC Public Health 2019; 19:1494. [PMID: 31706318 PMCID: PMC6842180 DOI: 10.1186/s12889-019-7852-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses' perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project "Science and Technology in childhood Obesity Policy" (STOP), this study examines CHC nurses' perceptions of speaking to parents about children's overweight/obesity and of their role in referring children to treatment for overweight/obesity. METHODS All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. RESULTS Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children's weights if this could compromise parents' trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child's weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. CONCLUSIONS We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system. TRIAL REGISTRATION ClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
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Affiliation(s)
- My Sjunnestrand
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. .,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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24
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Ek A, Nordin K, Nyström CD, Sandvik P, Eli K, Nowicka P. Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity. Appetite 2019; 145:104488. [PMID: 31626835 DOI: 10.1016/j.appet.2019.104488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 10/10/2019] [Indexed: 12/31/2022]
Abstract
This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Christine Delisle Nyström
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Pernilla Sandvik
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
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25
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Butler ÉM, Derraik JGB, Taylor RW, Cutfield WS. Prediction Models for Early Childhood Obesity: Applicability and Existing Issues. Horm Res Paediatr 2019; 90:358-367. [PMID: 30739117 DOI: 10.1159/000496563] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022] Open
Abstract
Statistical models have been developed for the prediction or diagnosis of a wide range of outcomes. However, to our knowledge, only 7 published studies have reported models to specifically predict overweight and/or obesity in early childhood. These models were developed using known risk factors and vary greatly in terms of their discrimination and predictive capacities. There are currently no established guidelines on what constitutes an acceptable level of risk (i.e., risk threshold) for childhood obesity prediction models, but these should be set following consideration of the consequences of false-positive and false-negative predictions, as well as any relevant clinical guidelines. To date, no studies have examined the impact of using early childhood obesity prediction models as intervention tools. While these are potentially valuable to inform targeted interventions, the heterogeneity of the existing models and the lack of consensus on adequate thresholds limit their usefulness in practice.
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Affiliation(s)
- Éadaoin M Butler
- A Better Start - National Science Challenge, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- A Better Start - National Science Challenge, New Zealand, .,Liggins Institute, University of Auckland, Auckland, New Zealand, .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden,
| | - Rachael W Taylor
- A Better Start - National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- A Better Start - National Science Challenge, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
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26
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Glover M, Wong SF, Taylor RW, Derraik JGB, Fa'alili-Fidow J, Morton SM, Cutfield WS. The Complexity of Food Provisioning Decisions by Māori Caregivers to Ensure the Happiness and Health of Their Children. Nutrients 2019; 11:nu11050994. [PMID: 31052332 PMCID: PMC6566933 DOI: 10.3390/nu11050994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/08/2023] Open
Abstract
Obesity in children is a global health concern. In New Zealand, one in three school entrant children are overweight or obese. Māori, the indigenous people, are disproportionately represented among the lowest economic group and have a disproportionately high incidence of obesity. This study explored Māori parents' and caregivers' views of the relative importance of weight to health, and the facilitators and barriers to a healthy weight in children aged 6 months to 5 years. Using a grounded qualitative method, in-depth information was collected in focus groups with mostly urban parents and other caregivers. A general inductive thematic analysis (content driven) was used. Insufficient money was an overriding food provisioning factor, but cost interacted with the lack of time, the number of people to feed, their appetites, and allergies. Other factors included ideologies about healthy food, cultural values relating to food selection, serving, and eating, nutrition literacy, availability of food, cooking skills, and lack of help. Childhood obesity was not a priority concern for participants, though they supported interventions providing education on how to grow vegetables, how to plan and cook cheaper meals. Holistic interventions to reduce the negative effects of the economic and social determinants on child health more broadly were recommended.
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Affiliation(s)
- Marewa Glover
- School of Health Sciences, College of Health, Massey University, Auckland 0632, New Zealand.
| | - Sally F Wong
- School of Health Sciences, College of Health, Massey University, Auckland 0632, New Zealand.
| | - Rachael W Taylor
- Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden.
| | | | - Susan M Morton
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
- Centre for Longitudinal Research⁻He Ara ki Mua, University of Auckland, Auckland 1142, New Zealand.
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
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27
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Rose J, Glazebrook C, Wharrad H, Siriwardena AN, Swift JA, Nathan D, Weng SF, Atkinson P, Ablewhite J, McMaster F, Watson V, Redsell SA. Proactive Assessment of Obesity Risk during Infancy (ProAsk): a qualitative study of parents' and professionals' perspectives on an mHealth intervention. BMC Public Health 2019; 19:294. [PMID: 30866879 PMCID: PMC6417230 DOI: 10.1186/s12889-019-6616-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background Prevention of childhood obesity is a public health priority. Interventions that establish healthy growth trajectories early in life promise lifelong benefits to health and wellbeing. Proactive Assessment of Obesity Risk during Infancy (ProAsk) is a novel mHealth intervention designed to enable health professionals to assess an infant’s risk of future overweight and motivate parental behaviour change to prevent childhood overweight and obesity. The aim of this study was to explore parents’ and health professionals’ experiences of the overweight risk communication and behaviour change aspects of this mHealth intervention. Methods The study was conducted in four economically deprived localities in the UK. Parents (N = 66) were recruited to the ProAsk feasibility study when their infant was 6–8 weeks old. Twenty two health visitors (HVs) used a hand-held tablet device to deliver ProAsk to parents when their infants were 3 months old. Parents (N = 12) and HVs (N = 15) were interviewed when infants in the study were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. Results Four key themes were identified across both parent and health visitor data: Engaging and empowering with digital technology; Unfamiliar technology presents challenges and opportunity; Trust in the risk score; Resistance to targeting. Most participants found the interactivity and visual presentation of information on ProAsk engaging. Health visitors who were unfamiliar with mobile technology drew support from parents who were more confident using tablet devices. There was evidence of resistance to targeting infants at greatest risk of future overweight and obesity, and both parents and health visitors drew on a number of reasons why a higher than average overweight risk score might not apply to a particular infant. Conclusions An mHealth intervention actively engaged parents, enabling them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication are barriers to targeting an intervention at those infants most at risk. Trial registration NCT02314494. Date registered 11th December 2014. Electronic supplementary material The online version of this article (10.1186/s12889-019-6616-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennie Rose
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road Campus, Cambridge, England.
| | - Cris Glazebrook
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, England
| | - Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - A Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Judy Anne Swift
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham, England
| | - Dilip Nathan
- Nottingham University Hospitals Trust, Nottingham, England
| | | | | | - Joanne Ablewhite
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, England
| | - Fiona McMaster
- Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, England
| | - Vicki Watson
- Nottingham City Care Partnership, Nottingham, England
| | - Sarah Anne Redsell
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road Campus, Cambridge, England
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28
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Butler ÉM, Derraik JGB, Taylor RW, Cutfield WS. Childhood obesity: how long should we wait to predict weight? J Pediatr Endocrinol Metab 2018; 31:497-501. [PMID: 29668465 DOI: 10.1515/jpem-2018-0110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/21/2018] [Indexed: 12/17/2022]
Abstract
Obesity is highly prevalent in children under the age of 5 years, although its identification in infants under 2 years remains difficult. Several clinical prediction models have been developed for obesity risk in early childhood, using a number of different predictors. The predictive capacity (sensitivity and specificity) of these models varies greatly, and there is no agreed risk threshold for the prediction of early childhood obesity. Of the existing models, only two have been practically utilized, but neither have been particularly successful. This commentary suggests how future research may successfully utilize existing early childhood obesity prediction models for intervention. We also consider the need for such models, and how targeted obesity intervention may be more effective than population-based intervention.
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Affiliation(s)
- Éadaoin M Butler
- A Better Start - National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- A Better Start - National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rachael W Taylor
- A Better Start - National Science Challenge, Dunedin, New Zealand.,Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- A Better Start - National Science Challenge, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
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