Coaching and/or education intervention for parents with overweight/obesity and their children: study protocol of a single-centre randomized controlled trial

Epidemiological Impact of Metabolic Syndrome in Overweight and Obese European Children and Adolescents: A Systematic Literature Review

The prevalence of overweight and obesity is continuously increasing, both in the adult and pediatric populations, posing a substantial challenge to public health. Understanding the epidemiological burden of metabolic syndrome (MetS) among children, particularly regarding its complications and long-term effects in adulthood, is crucial for identifying effective preventive measures and enhancing the clinical care of obese children. Therefore, by searching two databases, a systematic review was conducted in order to evaluate studies that specifically addressed the epidemiological MetS impact among overweight/obese European children and adolescents. Overall, 15 studies were considered. The epidemiological data concerning the MetS impact were contingent on the diagnostic criteria used and varied across countries, resulting in a prevalence range of 1.44% to 55.8%. Spanish studies were the most numerous (34%), revealing a country prevalence rate ranging from 2.5% to 19.6%. Males (prevalence range: 1.4-55.8%) and subjects with overweight/obesity (prevalence range: 12.9-55.8%) were mainly affected. Obesity emerged as the main risk factor in the MetS development and the consequent onset of cardiovascular complications and diabetes. Knowing the MetS burden and its risk factors could improve their prevention, detection, and treatment, and guide the development of targeted public health interventions to appropriately address the health needs of younger patients.

Parent/caregiver's role in nutrition, physical activity, and food access among children diagnosed with spina bifida

PURPOSE

This pilot study aimed to determine the parent/caregiver's role in nutrition/eating habits, physical activity behaviors, and food access among children diagnosed with spina bifida (SB).

METHODS

Parents/caregivers of children with SB were asked to participate at a single, outpatient SB clinic. Demographic, biomedical data, parent/caregiver nutrition knowledge, family nutrition and physical activity (FNPA), and food security survey scores were compared. Descriptive, regression, and correlational statistics were conducted for analysis via SPSS 29.

RESULTS

Of the 117 parents/caregivers surveyed, completed data suggested most were overweight/obese (average body mass index [BMI] of 30.63 kg/m2±8.40; n = 99) with an average nutrition knowledge score of 71% (17.83±3.33). As FNPA scores decreased, the patient/child's maximum BMI z scores increased (β= -0.043; confidence interval -0.079, -0.007; p = 0.020), suggesting the less active and/or less healthy eating habits, the higher body mass was noted for the child. Forty four percent of children (n = 99) were in the overweight/obese weight range based on maximum BMI z score.

CONCLUSION

These findings suggest there is a need for parental/caregiver nutrition education to assist children with SB with meal and activity planning to achieve optimal health.

Sociodemographic and Socioeconomic Factors Influencing the Body Mass Composition of School-Age Children

The purpose of the study was to evaluate the components of overweight, obesity, and body mass components among children aged 7 to 13 years against important sociodemographic factors. The analyses considered 315 school-age children from 7 to 13 years of age (164 boys and 151 girls). Each subject was assessed for body weight and height, body weight category, and main sociodemographic factors. Body mass components of body mass (body-fat percentage (BFP), muscle tissue, fat-free mass (FFM), and total body water (TBW) levels) were evaluated using the electrical bioimpedance method (BIA) and the TANITA 780 MC analyzer. A statistical analysis showed significant differences between the body composition of children living in cities in relation to children living in small towns and villages, and no significant differences were found between the results of children living in small towns and children living in villages. The presence of statistically significant differences between the values of the parameters of body composition of the studied children was demonstrated depending on the level of education of their fathers. The presence of statistically significant relationships between BMI of mothers and BFP of their children (p = 0.003), FFM (p = 0.003), muscle tissue (p = 0.001), and TBW (p = 0.001) has been demonstrated. The higher content of adipose tissue in children is strongly dependent on the higher BMI and body mass category of the mother, as well as the lower level of education of the father. The place of residence also significantly affects both the body fat content and the total body water content of body hydration. Living in the city is associated with better body composition.

Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts

Adolescent high-performance gymnasts are considered to be at risk for low energy intake. The aim of the present study was to determine the effects of implementing a nutritional education program during the sports season on the nutritional status and nutrition knowledge of the female artistic gymnasts from the Technification Center of the Balearic Islands (n = 24; age, 14.1 ± 2.3 years). A quasi-experimental intervention design was applied, which consisted of implementing a nutritional education program of seven sessions given during eight months. Measurements of nutritional intake, nutrition knowledge, and anthropometric parameters, as well as hematological and biochemical blood parameters, were performed. Gymnasts reported low energy and carbohydrate intakes, with significant increases during the study (energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg⁻¹, p = 0.015, carbohydrate 3.2 ± 0.2 vs. 3.9 ± 0.2 g kg⁻¹, p = 0.004). The average values for parameters such as hemoglobin, ferritin, lipoprotein, and vitamin C and E levels in the plasma were within normal ranges. Low intakes of most of the food groups were observed during the study, with similar initial and final values. Nutrition knowledge did not change as a result of the study (28.0 ± 1.7 vs. 31.1 ± 1.3, p = 0.185). In conclusion, gymnasts reported low energy intakes. However, blood markers and most of the anthropometrical parameters measured were within normal ranges. The nutrition education program implemented did not produce significant improvements in the dietary habits or nutritional knowledge of gymnasts.

Intervention empowerment of families in preventing and controlling overweight and obesity in children: A systematic review

There have been an increasing overweight and obesity in very anxious children. Furthermore, obesity is a condition that occurs due to the accumulation of excess or abnormal fat. This disorder is believed to be the most significant public health problem that affects children in the 21^st century. This study aimed to examine the literature review, articles and research results analyzing the effectiveness of family or parent empowerment interventions through health education. Many research articles were searched on several databases such as PubMed and PreQuest, using the following keywords which include “family empowerment”, “overweight”, “obesity”, “health lifestyle”, “BMI”, “children”, “RCT” starting from 2014 to 2019. The searched results obtained 162 articles on family empowerment, overweight and obesity. Out of the 162 articles, 20 were selected that discussed family empowerment interventions for overweight and obesity. Critical analysis of the 20 articles was carried out based on design, sample, treatment, parameters, findings and conclusions. The literature review analysis showed that family empowerment interventions in the form of health education or promotion activities vary widely in terms of methods, components, duration, individuals involved, specificity and effectiveness. Furthermore, this intervention consists of training activities, courses, and teaching practices. Statistical analysis showed that all these methods significantly increased the ability and independence of the family in controlling overweight and obesity. In conclusion, health education interventions that are packaged in various programs are proven to significantly improve the ability of families or parents in preventing and controlling overweight and obesity in children.

Weight control intentions and mental health among Canadian adolescents: a gender-based analysis of students in the COMPASS study

INTRODUCTION

Little is known about gender differences in associations between weight control intentions and mental health in adolescents. Our objective was to examine these associations in a large sample of adolescent girls and boys.

METHODS

Using data from Year 6 (2017-18) of the COMPASS study (n = 57 324), we performed a series of multivariable linear regressions to examine whether weight control intentions (gain, lose, stay the same, no intention) were associated with depression, anxiety and self-concept, while adjusting for relevant covariates including body mass index. Models were stratified by self-reported gender.

RESULTS

Compared to those with no intentions, girls who intended to lose weight reported higher symptoms of depression (B = 0.52, p < 0.001) and anxiety (B = 0.41, p < 0.001) and poorer self-concept (B = 2.06, p < 0.001). Girls who intended to gain weight also reported higher symptoms of depression (B = 0.54, p < 0.001), anxiety (B = 0.50, p < 0.001) and self-concept (B = 1.25, p < 0.001). Boys who intended to lose weight reported greater symptoms of depression (B = 0.26, p < 0.001) and anxiety (B = 0.33, p < 0.001) and poor self-concept (B = 1.10, p < 0.001). In boys, weight-gain intentions were associated with greater symptoms of anxiety (B = 0.17, p < 0.05), but not depression or self-concept.

CONCLUSION

Intentions to gain or lose weight were associated with symptoms of mental disorder and poor self-concept in our large sample of adolescents, and these relationships differed in boys and girls. These findings have important implications for school-based programs promoting healthy weight and body image.

Efficient Clinical Counseling for Sickle Cell Disease

Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Adherence to national guidelines such as the National Heart Lung and Blood Institute (NHLBI) Expert Panel Report on the Evidence-Based Management of Sickle Cell Disease can be challenging to both the clinician and the patient. Utilizing effective communication strategies with patients and their families can improve clinician/patient relationships, as well as adherence to national guidelines. Aims of this overview are to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.

Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The "4 Your Family" Randomized Controlled Trial

Childhood overweight and obesity prevalence has risen dramatically in the past decades, and family-based interventions may be an effective method to improve children's eating behaviors. This study aimed to evaluate the effectiveness of three different family-based interventions: group-based, individual-based, or by website approach. Parents and school aged overweight or obese children, 8-12 years of age, were eligible for the study. A total of 115 children were randomly allocated in one of the three interventions, and 91 completed the study (79% compliance); Group 1 (n = 36) received group-based interventions by various experts; Group 2 (n = 30) had interpersonal family meetings with a dietitian; and Group 3 (n = 25) received training through a specifically developed website. Anthropometric, dietary, physical activity, and screen time outcomes were measured at baseline and at the end of the study. Within-group comparisons indicated significant improvement in body weight, body mass index (BMI)-z-score, physical activity, and screen time from baseline in all three study groups (p < 0.05). Furthermore, total body fat percentage (%TBF) was also decreased in Groups 2 and 3. Between-group differences varied with body weight and %TBF change, being larger in Group 3 compared to Groups 1 and 2, in contrast to BMI-z-score, screen time, and health behaviors, which were significantly larger in Group 2 than the other two groups. In conclusion, personalized family-based interventions are recommended to successfully improve children's lifestyle and body weight status.

Health Coaching as an Intervention for Picky Eaters

Although childhood "picky eating" or "fussy eating" or "food neophobia" is well established as a subject of research, commentary, and treatment guidelines, there is very little published research exploring the origins and basis of adult food neophobia, much less its treatment. Existing treatment guidelines for picky eating tend to focus on cognitive behavioral interventions. The consequences of picky eating, although not extensively researched, include inadequate nutrition and weight management difficulties-both significant contributors to the worldwide disease burden. Health coaching has a focus on personal choice, reflection on previous successes and current strengths, as well as identification of a personal health vision and achievable goals. As such, it may play a useful role in supporting behavioral change in adult picky eaters. A structured intervention, rooted in health coaching skills and culinary medicine aimed at supporting such change, is proposed.

Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial

Adults and children in Canada are not meeting physical activity guidelines nor consuming sufficient nutrient-rich foods. High engagement in these unhealthy behaviours can lead to obesity and its associated diseases. Parent-child interventions aimed at obesity prevention/treatment have assisted families with making positive changes to their nutrition and physical activity behaviours. Given that the home environment shapes early health behaviours, it is important to target both parents and children when addressing diet and physical activity. One method that has been shown to improve health outcomes is co-active coaching. The current study explored the impact of a three-month co-active coaching and/or health education intervention on the dietary intake and physical activity behaviours of parents with overweight/obesity and their children (ages 2.5-10; of any weight). Body composition (i.e., body mass index [BMI] and waist circumference), changes in parental motivation with respect to physical activity and dietary behaviours, and parental perceptions of program improvements were collected. A concurrent mixed methods study comprised of a randomized controlled trial and a descriptive qualitative design was utilized. Fifty parent-child dyads were recruited and randomly assigned to the control (n = 25) or intervention (n = 25) group. Assessments were completed at baseline, mid-intervention (six weeks), post-intervention (three months), and six-month follow-up. A linear mixed effects model was utilized for quantitative analysis. Inductive content analysis was used to extract themes from parent interviews. No significant results were observed over time for the dependent measures. Parents in both control and intervention groups reported varied program experiences, including developing changes in perspective, increased awareness of habits, and heightened accountability for making positive changes in themselves, and consequently, their families. Parents also shared barriers they faced when implementing changes (e.g., time, weather, stress). Qualitatively, both groups reported benefitting from this program, with the intervention group describing salient benefits from engaging in coaching. This research expands on the utility of coaching as a method for behaviour change, when compared to education only, in parents with overweight/obesity and their children.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden.

OBJECTIVES

To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding.

AUTHORS' CONCLUSIONS

Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

How Did Parents View the Impact of the Curriculum-Based HealthLit4Kids Program Beyond the Classroom?

The HealthLit4Kids program aims to build health literacy in a participatory and contextually relevant way. Whole-of-school and curriculum strategies aim to empower and build capacity to make informed health choices amongst students, teachers, parents, and their local community. The aim of this study was to evaluate the HealthLit4Kids program from the perspective of parents, using a Self-Determination Theory framework. This is one component within a larger evaluation of the program. Parents at four Australian primary schools were interviewed post-program. Qualitative data collected through parent interviews were analyzed thematically to identify themes, and coding checks were completed by experienced qualitative researchers. The three key themes identified were student engagement, behaviour change, and parent engagement. Findings also indicated that parents placed a high value on effective communication from schools and raised a range of health areas such as food and nutrition, physical activity, and mental health with the interviewer. Parent opinions of the HealthLit4Kids program were positive, with many reporting a perceived increase in their children's ability to understand, communicate and act on health-related knowledge at home. The HealthLit4Kids program requires further research to determine its viability as an optimal pedagogical strategy for the health literacy development of primary school-aged children.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden.

OBJECTIVES

To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding.

AUTHORS' CONCLUSIONS

Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.