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Baygi F, Djalalinia S, Qorbani M, Larrabee Sonderlund A, Kousgaard Andersen MK, Thilsing T, Heitmann BL, Nielsen JB. The effect of psychological interventions targeting overweight and obesity in school-aged children: a systematic review and meta-analysis. BMC Public Health 2023; 23:1478. [PMID: 37537523 PMCID: PMC10398924 DOI: 10.1186/s12889-023-16339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Multi-component psychological interventions may mitigate overweight and obesity in children and adolescents. Evidence is, however, scattered on the effectiveness of such interventions. This study aims to review the available evidence on the effectiveness of multi-component psychological interventions on anthropometric measures of school-aged children with overweight or obesity. METHODS We systematically searched international databases/search engines including PubMed and NLM Gateway (for MEDLINE), Web of Science, SCOPUS, and Google Scholar up to November 2022 for relevant articles pertaining to psychological weight-loss interventions targeting school-aged children. Two reviewers screened and extracted pertinent data. The quality of included studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. Random effect meta-analysis was used to calculate, and pool standardized mean differences (SMD). We distinguished between intervention and maintenance effects. Intervention effects were defined as the mean change in outcome measurement detected between baseline and post-treatment. Maintenance effects were defined as the mean change in outcome measurement between post-treatment and last follow-up. RESULTS Of 3,196 studies initially identified, 54 and 30 studies were included in the qualitative and quantitative syntheses, respectively. Most studies reported on group-based interventions. The significant effects of intervention on BMI z-score (SMD -0.66, 95% CI: -1.15, -0.17) and WC (SMD -0.53, 95% CI: -1.03, -0.04) were observed for interventions that centered on motivational interviewing and cognitive behavioral therapy, respectively. Mean BMI and WC did not differ significantly between post-treatment and last follow-up measurement (maintenance effect), indicating that an initial weight loss obtained through the intervention period could be maintained over time. CONCLUSIONS Findings indicate that motivational interviewing and cognitive behavioral therapy as interventions to reduce BMI z-score (generalized obesity) and waist circumference (abdominal obesity) are effective and durable. However, detailed analyses on individual components of the interventions are recommended in future effectiveness studies.
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Affiliation(s)
- Fereshteh Baygi
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Shirin Djalalinia
- Ministry of Health and Medical Education, Deputy of Research & Technology, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Anders Larrabee Sonderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, the Parker Institute, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Feldman MA, Yardley HL, Bulan A, Kamboj MK. Role of Psychologists in Pediatric Endocrinology. Pediatr Clin North Am 2022; 69:905-916. [PMID: 36207101 DOI: 10.1016/j.pcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The care of youth managed within pediatric endocrine clinics is complex and requires a multi- or interdisciplinary approach. Psychosocial aspects of chronic health conditions are well-documented. Clinical practice guidelines outline the importance of routine psychosocial screening and support for youth with diabetes and obesity. This article outlines the diverse role of psychologists in pediatric endocrinology, including screening, in-clinic intervention, outpatient psychological services, and inpatient consultation. Although research exists documenting the effectiveness of behavioral interventions to improve adherence and health-related quality of life, cost analysis research is emerging.
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Affiliation(s)
- Marissa A Feldman
- Department of Psychology, Johns Hopkins All Children's Hospital, Saint Petersburg, 880 Sixth Street South, Suite 460, Saint Petersburg, FL 33701, USA.
| | - Heather L Yardley
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ayse Bulan
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Manmohan K Kamboj
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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Rashid R, Condon L, Gluud C, Jakobsen JC, Lindschou J, Lissau I. Psychotherapy versus treatment as usual and other control interventions in children and adolescents with overweight and obesity: a protocol for systematic review with meta-analysis and Trial Sequential Analysis. BMJ Open 2020; 10:e036058. [PMID: 33154043 PMCID: PMC7646330 DOI: 10.1136/bmjopen-2019-036058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The prevalence of children with overweight and obesity is increasing worldwide. Multicomponent interventions incorporating diet, physical activity and behavioural change have shown limited improvement to body mass index (BMI). However, the impact of psychotherapy is poorly explored. This systematic review aims to assess the effects of psychotherapeutic approaches for children with all degrees of overweight. METHODS AND ANALYSIS We will include randomised clinical trials involving children and adolescents between 0 and 18 years with overweight and obesity, irrespective of publication type, year, status or language up to April 2020. Psychotherapy will be compared with no intervention; wait list control; treatment as usual; sham psychotherapy or pharmaceutical placebo. The following databases will be searched: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, Embase, PsycINFO, PubMed, Web of Science, CINAHL and LILACS. Primary outcomes will be BMI z-score, quality of life measured by a validated scale and proportion of patients with serious adverse events. Secondary outcomes will be body weight, self-esteem, anxiety, depression and proportion of patients with non-serious adverse events. Exploratory outcomes will be body fat, muscle mass and serious adverse events. Study inclusion, data extraction and bias risk assessments will be conducted independently by at least two authors. We will assess risk of bias according to Cochrane guidelines and the Cochrane Effective Practice and Organisation of Care guidance. We will use meta-analysis and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool. The systematic review will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. ETHICS AND DISSEMINATION As individual patient data will not be included, we do not require ethics approval. This review will be published in a peer review journal. PROSPERO REGISTRATION NUMBER CRD42018086458.
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Affiliation(s)
- Rajeeb Rashid
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Laura Condon
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Sygehus, Holbaek, Sjaelland, Denmark
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Inge Lissau
- Clinical Research Centre, University Hospital Copenhagen, Copenhagen, Hvidovre, Denmark
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Vanden Brink H, Pacheco LS, Bahnfleth CL, Green E, Johnson LM, Sanderson K, Demaio AR, Farpour-Lambert N, Ells LJ, Hill AJ. Psychological interventions delivered as a single component intervention for children and adolescents with overweight or obesity aged 6 to 17 years. Hippokratia 2020. [DOI: 10.1002/14651858.cd013688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lorena S Pacheco
- Department of Nutrition; Harvard T.H. Chan School of Public Health; Boston MA USA
| | | | - Erin Green
- Division of Nutritional Sciences; Cornell University; Ithaca NY USA
| | - Lynn M Johnson
- Cornell Statistical Consulting Unit; Cornell University; Ithaca NY USA
| | | | - Alessandro R Demaio
- Melbourne School of Population and Global Health; University of Melbourne; Melbourne Australia
- Center for a Livable Future; Johns Hopkins Bloomberg School of Public Health; Baltimore USA
| | | | - Louisa J Ells
- School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - Andrew J Hill
- Division of Psychological and Social Medicine; University of Leeds; Leeds UK
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Miri SF, Javadi M, Lin CY, Griffiths MD, Björk M, Pakpour AH. Effectiveness of cognitive-behavioral therapy on nutrition improvement and weight of overweight and obese adolescents: A randomized controlled trial. Diabetes Metab Syndr 2019; 13:2190-2197. [PMID: 31235156 DOI: 10.1016/j.dsx.2019.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Abstract
AIM To assess the effectiveness of a cognitive-behavioral treatment (CBT) program on weight reduction among Iranian adolescents who are overweight. METHODS Using a randomized controlled trial design, 55 adolescents who were overweight (mean [SD] age = 14.64 [1.69] years; zBMI = 2.18 [0.65]) were recruited in the CBT program and 55 in the treatment as usual (TAU; mean age = 14.88 [1.50]; zBMI = 2.09 [0.57]) group. All the participants completed several questionnaires (Child Dietary Self-Efficacy Scale; Weight Efficacy Lifestyle questionnaire; Physical Exercise Self-Efficacy Scale; Pediatric Quality of Life Inventory; and self-reported physical activity and diet) and had their anthropometrics measured (height, weight, waist and hip circumferences, and body fat). RESULTS The CBT group consumed significantly more fruits and juice, vegetables, and dairy in the 6-month follow-up as compared with the TAU group (p-values <0.001). The CBT group consumed significantly less sweet snacks, salty snacks, sweet drinks, sausages/processed meat, and oils in the six-month follow-up compared with the TAU group (p-values<0.001). Additionally, the waist circumference, BMI, waist-hip ratio, and fat mass were significantly decreased in the CBT group in the six-month follow-up compared with the TAU group (p-values<0.005). The CBT group significantly improved their psychosocial health, physical activity, and health-related quality of life (p-values<0.001). CONCLUSION The CBT program showed its effectiveness in reducing weight among Iranian adolescents who were overweight. Healthcare providers may want to adopt this program to treat excess weight problems among adolescents.
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Affiliation(s)
- Seyedeh Fatemeh Miri
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Javadi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Maria Björk
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran; Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
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Rankin A, Blood-Siegfried J, Vorderstrasse A, Chlebowy DO. Implementation of childhood obesity identification and prevention strategies in primary care: A quality improvement project. Int J Pediatr Adolesc Med 2015; 2:59-63. [PMID: 30805438 PMCID: PMC6372395 DOI: 10.1016/j.ijpam.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/28/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Abstract
The high incidence and prevalence of childhood obesity, coupled with significant morbidity and financial burden, clearly suggest the need for identification and implementation of effective pediatric obesity prevention strategies in primary care. A solution to this problem includes evidence based clinical guidelines that provide concise, culturally appropriate information on the identification and prevention of childhood obesity in primary care settings. The objective of this quality improvement project was to implement childhood obesity identification and prevention guidelines from evidence-based recommendations into practice. Guidelines were implemented during preventative care visits through the use of a tracking form. The development of the tracking form included input from practice staff resulting in increased fidelity. The tracking form included directions for clear and concise guideline implementation and provided opportunities to record patient BMI, nutritional intake, physical activity, familial obesity prevention education and motivational interviewing and facilitated a practice increase in childhood obesity identification and education. Presence of chart indicators, including nutrition and exercise history, were analyzed to determine the fidelity of the practice change in obesity identification and prevention education. Key outcomes included a significant (p < .0001) practice increase in childhood obesity identification as well as a significant increase (p < .05) in documentation of obesity prevention education through motivational interviewing. Practice change incorporating childhood obesity identification and familial prevention guidelines had positive effects in a pediatric population. Implementation of evidence-based guidelines can result in increased identification of children at risk for childhood obesity and enhanced familial obesity prevention education; leading to the long-term goal of creating healthier lifestyles and decreasing risk factors in a vulnerable population.
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Affiliation(s)
- Audra Rankin
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States
- University of Louisville, School of Nursing, Health Sciences Campus, K-Wing, 555 South Floyd Street, Louisville, KY 40202, United States
| | - Jane Blood-Siegfried
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States
| | - Allison Vorderstrasse
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States
| | - Diane Orr Chlebowy
- University of Louisville, School of Nursing, Health Sciences Campus, K-Wing, 555 South Floyd Street, Louisville, KY 40202, United States
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McGrath Davis A, Sampilo M, Gayes LA, Smith C, Steele RG. The Effect of Visual Cues on Dietary Behavior: A Pilot Study. CHILDRENS HEALTH CARE 2013. [DOI: 10.1080/02739615.2013.842462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jacobson D, Melnyk BM. A primary care healthy choices intervention program for overweight and obese school-age children and their parents. J Pediatr Health Care 2012; 26:126-38. [PMID: 22360932 DOI: 10.1016/j.pedhc.2010.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/28/2010] [Accepted: 07/10/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The escalating crisis of childhood overweight and obesity creates an urgent demand for evidence-based interventions that can be used by primary care providers. Therefore, the purpose of this study was to test the feasibility, acceptability, and preliminary efficacy of a theory-based Healthy Choices Intervention (HCI) Program with fifteen 9-12 year old overweight and obese children and their parents in a primary care setting. METHODS A 1-group, 7-week pre-/posttest study design was used. Outcome measures included: body mass index (BMI) percentile, physical activity and nutrition knowledge, beliefs, choices and behaviors, anxiety, depression, self-concept, and social competence. RESULTS Children and parents found the HCI to be useful and informative. Positive effects of the HCI for the children included decreased BMI percentile, increased knowledge, beliefs, choices and behaviors, and self-control. Positive effects of the intervention for the parents included increased knowledge, beliefs, behaviors, and decreased anxiety. DISCUSSION This study provides evidence to support the feasibility, acceptability, and preliminary effects of the HCI with overweight and obese school-age children and their parents within a primary care setting.
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Affiliation(s)
- Diana Jacobson
- Arizona State University College of Nursing and Health Innovation, Phoenix, AZ 85004, USA.
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Klesges LM, Williams NA, Davis KS, Buscemi J, Kitzmann KM. External validity reporting in behavioral treatment of childhood obesity: a systematic review. Am J Prev Med 2012; 42:185-92. [PMID: 22261216 PMCID: PMC4573550 DOI: 10.1016/j.amepre.2011.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 08/19/2011] [Accepted: 10/05/2011] [Indexed: 01/26/2023]
Abstract
CONTEXT To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity. EVIDENCE ACQUISITION Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2-18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors. EVIDENCE SYNTHESIS 1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%-100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability. CONCLUSIONS Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.
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Affiliation(s)
- Lisa M Klesges
- School of Public Health, University of Memphis, Tennessee 38152, USA.
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Jacobson D, Melnyk BM. Psychosocial correlates of healthy beliefs, choices, and behaviors in overweight and obese school-age children: a primary care healthy choices intervention pilot study. J Pediatr Nurs 2011; 26:456-64. [PMID: 21930032 DOI: 10.1016/j.pedn.2011.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
The relationships among weight, mental health, social competence, healthy lifestyle beliefs, choices, and behaviors in overweight and obese school-age children (9 to 12 years) who were participating in a pilot Healthy Choices Intervention Program were examined using a descriptive correlational design. Results indicated that the children's weight negatively correlated with the children's self-concept, social skills, and, most importantly, healthy lifestyle choices. Their healthy lifestyle beliefs demonstrated positive correlations with their intentions to choose a healthy lifestyle. The children's healthy lifestyle beliefs and choices also were associated with increased cooperation and empathy behaviors. A positive self-concept was associated with decreased anxiety and depressive symptomology. These data support the need for health care providers to understand the psychological and social issues that overweight and obese school-age children experience. Cognitive behavior skills building techniques, such as those in the Healthy Choices Intervention Program, may promote healthy lifestyle choices and behaviors.
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Affiliation(s)
- Diana Jacobson
- Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA.
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Croker H, Viner RM, Nicholls D, Haroun D, Chadwick P, Edwards C, Wells JCK, Wardle J. Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial. Int J Obes (Lond) 2011; 36:16-26. [PMID: 21931327 PMCID: PMC3272466 DOI: 10.1038/ijo.2011.182] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The best outcomes for treating childhood obesity have come from comprehensive family-based programmes. However there are questions over their generalisability. Objective To examine the acceptability and effectiveness of ‘family-based behavioural treatment’ (FBBT) for childhood obesity in an ethnically and socially diverse sample of families in a UK National Health Service (NHS) setting. Methods In this parallel group, randomised controlled trial, 72 obese children were randomised to FBBT or waiting list control. Primary outcomes were body mass index (BMI) and BMI standard deviation scores (SDS). Secondary outcomes were weight, weight SDS, height, height SDS, waist, waist SDS, fat mass index, fat free mass index, blood pressure, and psychosocial measures. Outcomes were assessed at baseline and post-treatment, with analyses on the 6 month data done on an intent-to-treat (ITT) basis. Follow-up anthropometric data were collected at twelve months for the treatment group. Results ITT analyses included all children with baseline data (n=60). There were significant BMI SDS changes (p<0.01) for the treatment and control groups of −0.11 (0.16) and −0.10 (1.6). The treatment group showed a significant reduction in systolic blood pressure (−0.24 (0.7), p<0.05) and improvements in quality of life and eating attitudes (p<0.05), with no significant changes for the control group. However the between-group treatment effects for BMI, body composition, blood pressure and psychosocial outcomes were not significant. There was no overall change in BMI or BMI SDS from 0-12 months for the treatment group. No adverse effects were reported. Conclusions Both treatment and control groups experienced significant reductions in level of overweight, but with no significant difference between them. There were no significant group differences for any of the secondary outcomes.
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Affiliation(s)
- H Croker
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK.
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Steele RG, Aylward BS, Jensen CD, Cushing CC, Davis AM, Bovaird JA. Comparison of a family-based group intervention for youths with obesity to a brief individual family intervention: a practical clinical trial of positively fit. J Pediatr Psychol 2011; 37:53-63. [PMID: 21852343 DOI: 10.1093/jpepsy/jsr057] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of a family-based behavioral group intervention (Positively Fit; PF) for pediatric obesity relative to a brief family intervention (BFI) in a sample of treatment-seeking children and adolescents. METHODS Families (n = 93) were randomized to treatment condition. Assessments were conducted at pre- and posttreatment and at 12-month follow-up. Outcome indices included standardized body mass index (BMI) and quality of life (QOL). RESULTS Results indicated a significant reduction in zBMI at posttreatment and follow-up across both conditions. At follow-up, BFI and PF participants evidenced average reductions of .12 and .19 zBMI units, respectively. Children demonstrated better outcomes than adolescents across both conditions. Results indicated clinically significant improvements in parent-reported QOL at postintervention and in self-reported QOL at follow-up for PF participants. CONCLUSIONS Results suggest the effectiveness of family-based interventions for pediatric obesity in clinical settings among younger children. Neither intervention was effective in terms of reducing zBMI among adolescents.
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Affiliation(s)
- Ric G Steele
- Clinical Child Psychology Program, University of Kansas, USA.
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Hopkins KF, DeCristofaro C, Elliott L. How can primary care providers manage pediatric obesity in the real world? ACTA ACUST UNITED AC 2011; 23:278-88. [DOI: 10.1111/j.1745-7599.2011.00614.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wilfley DE, Kolko RP, Kass AE. Cognitive-behavioral therapy for weight management and eating disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am 2011; 20:271-85. [PMID: 21440855 PMCID: PMC3065663 DOI: 10.1016/j.chc.2011.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Eating disorders and obesity in children and adolescents involve harmful behavior and attitude patterns that infiltrate daily functioning. Cognitive-behavioral therapy (CBT) is well suited to treating these conditions, given the emphasis on breaking negative behavior cycles. This article reviews the current empirically supported treatments and the considerations for youth with weight control issues. New therapeutic modalities (ie, enhanced CBT and the socioecologic model) are discussed. Rationale is provided for extending therapy beyond the individual treatment milieu to include the family, peer network, and community domains to promote behavior change, minimize relapse, and support healthy long-term behavior maintenance.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA.
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Cushing CC, Jensen CD, Steele RG. An evaluation of a personal electronic device to enhance self-monitoring adherence in a pediatric weight management program using a multiple baseline design. J Pediatr Psychol 2010; 36:301-7. [PMID: 20719751 DOI: 10.1093/jpepsy/jsq074] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of a personal electronic device (PED) in order to improve adherence to self-monitoring of dietary intake and physical activity. METHOD The impact of a PED on adherence to self-monitoring goals was examined in a multiple baseline design across three overweight adolescents. During baseline, a traditional paper-and-pencil method of self-monitoring was utilized. The subsequent study phase introduced a PED for self-monitoring. Percent self-monitoring goal attainment was the outcome of interest. RESULTS During baseline, attainment of self-monitoring goals was low for all three participants (3-4%). Each subject's percent attainment of self-monitoring goal increased upon the introduction of the PED. For two of the three subjects this increase was stable (~75 and 100%) post-intervention. For the third subject the increase in percent attainment of self-monitoring goal was more variable but remained above baseline levels. CONCLUSION PEDs have potential for improving self-monitoring in the context of behavioral weight management treatment for adolescents.
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Affiliation(s)
- Christopher C Cushing
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555, USA
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Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. Cochrane review: Interventions for treating obesity in children. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/ebch.462] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nelson TD, Benson ER, Jensen CD. Negative Attitudes Toward Physical Activity: Measurement and Role in Predicting Physical Activity Levels Among Preadolescents. J Pediatr Psychol 2009; 35:89-98. [DOI: 10.1093/jpepsy/jsp040] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009:CD001872. [PMID: 19160202 DOI: 10.1002/14651858.cd001872.pub2] [Citation(s) in RCA: 586] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood. SEARCH STRATEGY We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information. MAIN RESULTS We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs. AUTHORS' CONCLUSIONS While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.
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Affiliation(s)
- Hiltje Oude Luttikhuis
- Beatrix Children's Hospital and Department of Epidemiology, University Medical Center Groningen, PO Box 30.001 (CA80), 9700RB, Groningen, Netherlands.
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19
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Karlson CW, Rapoff MA. Attrition in randomized controlled trials for pediatric chronic conditions. J Pediatr Psychol 2008; 34:782-93. [PMID: 19064607 DOI: 10.1093/jpepsy/jsn122] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine attrition variables in randomized controlled trials of cognitive behavioral interventions for children with chronic illnesses. METHODS We examined attrition rates reported on 40 randomized cognitive behavioral interventions published in six pediatric research journals, during the years 2002-2007. Intervention focus was limited to children with a chronic medical condition, such as asthma, obesity, arthritis, diabetes, cancer, sickle cell disease, and cystic fibrosis. RESULTS Mean rate of enrollment refusal was 37% (range 0-75%). Mean attrition rate was 20% (range 0-54%) for initial follow-up and 32% (range 0-59%) for extended follow-up. Of the reviewed articles, 40% included a CONSORT diagram. CONCLUSIONS Strategies that can be used to limit attrition include tailoring recruitment to the study population, providing personalized feedback, maintaining consistent study procedures, providing incentives, and using intensive tracking measures. There is a need for standardized definitions and reporting of attrition rates in randomized cognitive behavioral intervention studies.
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Affiliation(s)
- Cynthia W Karlson
- Department of Psychology, University of Kansas, Lawrence, Kansas 66045, USA.
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20
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Gilles A, Cassano M, Shepherd EJ, Higgins D, Hecker JE, Nangle DW. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2008; 37:886-92. [DOI: 10.1080/15374410802359833] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsiros MD, Sinn N, Coates AM, Howe PRC, Buckley JD. Treatment of adolescent overweight and obesity. Eur J Pediatr 2008; 167:9-16. [PMID: 17973118 DOI: 10.1007/s00431-007-0575-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 07/10/2007] [Indexed: 12/01/2022]
Abstract
Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children, thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese adolescents (aged 12-19 years), published from 1982-2006 in English. Eligible studies had to assess either weight, percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible. The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term. However, obesity interventions appear more effective when strategies are combined, rather than when used in isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in achieving the necessary lifestyle changes for obesity reduction; however, long-term follow-up studies are needed. There were multiple limitations in appraising the literature. Inconsistent definitions of overweight/obesity make comparisons between studies difficult. Many studies have not used direct adiposity measures, have failed to assess pubertal status or have not used an exclusive adolescent sample. We conclude that, despite these limitations, current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity,although long-term follow-up studies are needed.
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Affiliation(s)
- Margarita D Tsiros
- Nutritional Physiology Research Centre and ATN Centre for Metabolic Fitness, School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
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22
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Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120 Suppl 4:S254-88. [PMID: 18055654 DOI: 10.1542/peds.2007-2329f] [Citation(s) in RCA: 531] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.
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Affiliation(s)
- Bonnie A Spear
- Department of Pediatrics, University of Alabama at Birmingham, AL 35233, USA.
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Young KM, Northern JJ, Lister KM, Drummond JA, O'Brien WH. A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev 2006; 27:240-9. [PMID: 17070638 DOI: 10.1016/j.cpr.2006.08.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 08/14/2006] [Accepted: 08/31/2006] [Indexed: 11/22/2022]
Abstract
Childhood obesity is a major concern in the United States. Because children's diets can be significantly influenced by parental behavior (e.g., food purchases, meal preparation), researchers have included family intervention components in some childhood weight-loss programs. The relative benefits of adding the family component have not been well-established. This meta-analysis compared the mean effect sizes of family-behavioral, other treatment, and control weight-loss groups for children. A comprehensive literature review identified 16 studies with a total of 44 treatment groups. Results indicated that interventions containing a family-behavioral component produced larger effect sizes than the alternative treatment groups. This demonstrates that the inclusion of a family component may be advantageous to a child's weight-loss treatment.
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Affiliation(s)
- Kathleen M Young
- Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, USA.
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Johnston CA, Steele RG. Treatment of pediatric overweight: an examination of feasibility and effectiveness in an applied clinical setting. J Pediatr Psychol 2006; 32:106-10. [PMID: 16809794 DOI: 10.1093/jpepsy/jsl010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the effectiveness and feasibility of an evidence-based treatment for weight loss in children. METHODS A total of 41 children who were overweight and their families were provided a modified version of the Traffic Light Diet (TLD) in an applied setting. Children who received treatment as usual (TAU) constituted a comparison sample. RESULTS Children receiving the modified TLD demonstrated a significantly greater reduction in standardized body mass index (z-BMI) than children receiving TAU. CONCLUSIONS The TLD is a feasible treatment that can be implemented in applied settings that include samples often excluded from treatment efficacy studies. Results are discussed in the context of bridging the gap between science and service.
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Affiliation(s)
- Craig A Johnston
- Department of Pediatrics-Nutrition, 6655 Travis, Baylor College of Medicine, Houston, Texas 77030, USA.
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Snethen JA, Broome ME, Cashin SE. Effective weight loss for overweight children: a meta-analysis of intervention studies. J Pediatr Nurs 2006; 21:45-56. [PMID: 16428013 DOI: 10.1016/j.pedn.2005.06.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Childhood overweight has increased in the United States. Success of weight-loss programs has been limited (Barlow, S.E., & Dietz, W.H. (1998). Obesity evaluation and treatment: Expert committee recomendations. Pediatrics, 102, e29.). The purpose of this investigation was to systematically examine the effectiveness of weight-loss interventions for children. For this meta-analysis, seven weight-loss intervention studies were coded and quality index scores calculated. The interventions had a significant positive effect on weight-loss average d = 0.95, with a 95% confidence interval of 0.79 to 1.11. Limited interventional studies with effective long-term maintenance of weight loss in children are available in the literature. However, there are effective methods for weight loss in children.
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Affiliation(s)
- Julia A Snethen
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA
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