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Luppino G, Wasniewska M, Casto C, Ferraloro C, Li Pomi A, Pepe G, Morabito LA, Alibrandi A, Corica D, Aversa T. Treating Children and Adolescents with Obesity: Predictors of Early Dropout in Pediatric Weight-Management Programs. CHILDREN (BASEL, SWITZERLAND) 2024; 11:205. [PMID: 38397317 PMCID: PMC10887674 DOI: 10.3390/children11020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Possible therapeutic failure of pediatric obesity is influenced by the high dropout rate. The aim of this study was to evaluate the rate of dropout and the rate of weight loss over the 24 months of follow-up. METHODS The retrospective, single-center study, involved 489 patients followed for obesity in the period 2016-2020. Patients' auxological data and blood samples were collected during the first (V1) and last visit (V2). Dropout was defined as a follow-up of less than 12 months and/or including less than one visit every 6 months. Patients were divided into two groups and compared: Group A of dropout (297 patients) and Group B of non-dropout (192 patients). RESULTS In the follow-up period, which had a mean duration of 24 months, the dropout rate was 60.7%. In Group A, the percentage of patients with BMI ≥ 3 SD at V2 was significantly higher than that in Group B. In Group B, the percentage of patients with pathological HOMA-IR and with fasting glucose >100 mg/dL was higher than group A. The probability of dropout was positively associated with pubertal stage and negatively with impaired fasting glycemia and pathological insulinemia at V1. CONCLUSION The study demonstrated a high dropout rate during follow-up, mainly among adolescents and patients with no glucometabolic alterations.
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Affiliation(s)
- Giovanni Luppino
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Celeste Casto
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Chiara Ferraloro
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Letteria Anna Morabito
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Angela Alibrandi
- Department of Economics, University of Messina, 98125 Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
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Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Soegondo S, Somasundaram N, Yong AML, Ashkenas J, Webster N, Oldfield B. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev 2023; 24:e13520. [PMID: 36453081 PMCID: PMC10078503 DOI: 10.1111/obr.13520] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.
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Affiliation(s)
- Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Sioksoan C Cua
- Division of Pediatric Endocrinology, Philippine General Hospital, Metro Manila, Philippines.,Department of Pediatrics, Chinese General Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, Metro Manila, Philippines
| | | | - Mia Fojas
- Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila, Philippines
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - June Lee
- Upper Gastrointestinal and Bariatric Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Tran Quang Nam
- Department of Endocrinology, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Faruque Pathan
- Department of Endocrinology, Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Sidartawan Soegondo
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Diabetes Connection and Care, Eka Hospitals, Jakarta, Indonesia
| | | | - Alice M L Yong
- Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | | | - Brian Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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Soares R, Brasil I, Monteiro W, Farinatti P. Effects of physical activity on body mass and composition of school-age children and adolescents with overweight or obesity: Systematic review focusing on intervention characteristics. J Bodyw Mov Ther 2023; 33:154-163. [PMID: 36775513 DOI: 10.1016/j.jbmt.2022.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 04/18/2022] [Accepted: 09/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The characteristics of physical activity (PA) interventions to improve body mass and composition in pediatric populations are unclear. This systematic review summarized the effects of PA on those outcomes in school-age children and adolescents with overweight or obesity, focusing on training components (frequency, intensity, duration, and type - FITT). METHODS Databases were searched for controlled trials applying exclusive PA and including children (5-12 y) or adolescents (13-17 y) with overweight/obesity. RESULTS Twenty-seven trials yielding 34 interventions were included. PA was recreational (children: k = 9, n = 478), systematized (children: k = 18, n = 565); or combined (children: k = 7, n = 205). Successful interventions were performed for 6- to 35 weeks (mostly 12-14 weeks), 2- to 5 d/wk (mostly 3 d/wk), during 8- to 60 min (mainly 60 min) with moderate to high intensity (60-90% maximal heart rate or 40-70% heart rate reserve). Half of the interventions applying recreational (4 out of 8), 59% of systematized (10 out of 17), and 57% of combined (4 out of 7) interventions reported improvements in body mass or composition, especially body fat. Benefits were more often reported for body composition (18 out of 34 interventions) than body mass (8 out of 34 interventions), irrespective of the age group. CONCLUSION Recreational and systematized PA may improve body mass, and particularly body composition in school-age children and adolescents with overweight or obesity. Successful programs were performed for at least six weeks and applied a PA amount consistent with the minimum recommended for pediatric populations (≥60 min of moderate-to-vigorous PA at least 3 d/wk).
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Affiliation(s)
- Raphael Soares
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil.
| | - Iedda Brasil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil.
| | - Walace Monteiro
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil.
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil.
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Risk Factors, Clinical Consequences, Prevention, and Treatment of Childhood Obesity. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121975. [PMID: 36553418 PMCID: PMC9776766 DOI: 10.3390/children9121975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Obesity might adversely affect the health and well-being of children and their families. Childhood obesity has crucial implications for health, both during childhood and as they age. It is highly associated with many acute problems and is commonly present during childhood, making visits and hospital admissions polarized in this group of children. The problems that may affect these children can be medical, such as asthma, chronic inflammation, orthopedic abnormalities, liver disease, diabetes mellitus or dyslipidemia. Long-term consequences of cardiovascular risk factors, the persistence of obesity and premature mortality are common among adults who had obesity during their early lives. Additionally, they could also suffer from psychological issues, such as low self-esteem, which puts them at risk of a much more serious psychosocial problem that may lead to depression, as well as a disruption in educational achievements and social relationships. A healthy diet, physical activity, adequate sleep, and limited screen time are all preventive measures that should be implemented at the family and community levels, preferably through well-structured programs. Furthermore, pharmacological management of childhood obesity is limited and only used after non-pharmacological interventions have failed or in the late stages of obesity. However, recent guidelines advocate the early use of medical interventions. Approved pharmacotherapeutic options include orlistat, phentermine/topiramate combination and liraglutide. There are several other options approved primarily for other specific forms of obesity or for other indications, including setmelanotide, metformin, lisdexamfetamine, zonisamide and fluoxetine. Bariatric surgery is a safe and effective option in cases with extreme obesity and comorbidities considering the need for long-term monitoring and support for cases and their families post-surgery. This review aims to discuss and highlight the recent evidence regarding risk factors, clinical consequences, prevention, and treatment of childhood obesity.
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Weghuber D, Barrett T, Barrientos-Pérez M, Gies I, Hesse D, Jeppesen OK, Kelly AS, Mastrandrea LD, Sørrig R, Arslanian S. Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med 2022; 387:2245-2257. [PMID: 36322838 PMCID: PMC9997064 DOI: 10.1056/nejmoa2208601] [Citation(s) in RCA: 169] [Impact Index Per Article: 84.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A once-weekly, 2.4-mg dose of subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist, is used to treat obesity in adults, but assessment of the drug in adolescents has been lacking. METHODS In this double-blind, parallel-group, randomized, placebo-controlled trial, we enrolled adolescents (12 to <18 years of age) with obesity (a body-mass index [BMI] in the 95th percentile or higher) or with overweight (a BMI in the 85th percentile or higher) and at least one weight-related coexisting condition. Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68. RESULTS A total of 201 participants underwent randomization, and 180 (90%) completed treatment. All but one of the participants had obesity. The mean change in BMI from baseline to week 68 was -16.1% with semaglutide and 0.6% with placebo (estimated difference, -16.7 percentage points; 95% confidence interval [CI], -20.3 to -13.2; P<0.001). At week 68, a total of 95 of 131 participants (73%) in the semaglutide group had weight loss of 5% or more, as compared with 11 of 62 participants (18%) in the placebo group (estimated odds ratio, 14.0; 95% CI, 6.3 to 31.0; P<0.001). Reductions in body weight and improvement with respect to cardiometabolic risk factors (waist circumference and levels of glycated hemoglobin, lipids [except high-density lipoprotein cholesterol], and alanine aminotransferase) were greater with semaglutide than with placebo. The incidence of gastrointestinal adverse events was greater with semaglutide than with placebo (62% vs. 42%). Five participants (4%) in the semaglutide group and no participants in the placebo group had cholelithiasis. Serious adverse events were reported in 15 of 133 participants (11%) in the semaglutide group and in 6 of 67 participants (9%) in the placebo group. CONCLUSIONS Among adolescents with obesity, once-weekly treatment with a 2.4-mg dose of semaglutide plus lifestyle intervention resulted in a greater reduction in BMI than lifestyle intervention alone. (Funded by Novo Nordisk; STEP TEENS ClinicalTrials.gov number, NCT04102189.).
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Affiliation(s)
- Daniel Weghuber
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Timothy Barrett
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Margarita Barrientos-Pérez
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Inge Gies
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Dan Hesse
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Ole K Jeppesen
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Aaron S Kelly
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Lucy D Mastrandrea
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Rasmus Sørrig
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
| | - Silva Arslanian
- From the Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria (D.W.); the Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom (T.B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels (I.G.); Novo Nordisk, Søborg, Denmark (D.H., O.K.J., R.S.); the Department of Pediatrics and the Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis (A.S.K.); the Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (L.D.M.); and the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, and UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.)
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Luca AC, Curpan AS, Braha EE, Ţarcă E, Iordache AC, Luca FA, Adumitrachioaiei H. Increasing Trends in Obesity-Related Cardiovascular Risk Factors in Romanian Children and Adolescents-Retrospective Study. Healthcare (Basel) 2022; 10:2452. [PMID: 36553976 PMCID: PMC9777914 DOI: 10.3390/healthcare10122452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Childhood obesity has become a global public health issue and its assessment is essential, as an obese child is a future overweight or obese adult. Obesity is no longer a matter of exercising more and eating less, with several factors coming into play and dictating the pattern of fat accumulation and the ease/difficulty of reducing it. In the current paper, we aimed to analyze the cardiovascular impact of obesity in a large number of patients alongside the paraclinical changes that occur due to weight gain, and to perform an analysis on the increase in prevalence throughout our research. The main cardiovascular conditions identified were hypertension (15.36%), septal or concentric hypertrophic cardiomyopathy (11.15%), atherosclerosis risk (13.04%), and hypercholesterolemia (20.94%). We have used echocardiography to measure the thickness of epicardial adipose tissue (useful for assessing the patient's cardiovascular risk), and we observed that it was greater in children with moderate and severe obesity alongside diastolic dysfunction of the left ventricle in the whole group, without any connection with hypertension or coronary impairment. Obese children will be affected by increased cardiovascular mortality and morbidity in adulthood and they may experience early cardiovascular dysfunction. We want to strongly underline the importance and necessity of programs for the early detection and prevention of obesity and its complications, especially since interesting phenomena such as the "obesity paradox" exist and prove that obesity is far less understood than it is at a first glance.
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Affiliation(s)
- Alina-Costina Luca
- Department of Mother and Child Medicine–Pediatric Cardiology, Faculty of Medicine, Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Sfânta Maria’ Emergency Children’s Hospital, 700309 Iasi, Romania
| | - Alexandrina-Stefania Curpan
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Bd. Carol I, 20A, 700505 Iasi, Romania
| | - Elena Emanuela Braha
- National Institute of Endocrinology CI Parhon, Department of Genetics Endocrinology, B–dul Aviatorilor, nr. 34–38, Sector 1, 011863 Bucureşti, Romania
| | - Elena Ţarcă
- Department of Surgery II–Pediatric Surgery, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin-Constantin Iordache
- Department of Mother and Child Medicine–Pediatric Cardiology, Faculty of Medicine, Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Florin-Alexandru Luca
- Department BMTM, “Gheorghe Asachi” Technical University, Bulevardul Profesor Dimitrie Mangeron 67, 700050 Iaşi, Romania
| | - Heidrun Adumitrachioaiei
- Department of Mother and Child Medicine–Pediatric Cardiology, Faculty of Medicine, Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
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Calcaterra V, Rossi V, Mari A, Casini F, Bergamaschi F, Zuccotti GV, Fabiano V. Medical treatment of weight loss in children and adolescents with obesity. Pharmacol Res 2022; 185:106471. [PMID: 36174963 DOI: 10.1016/j.phrs.2022.106471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.
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Affiliation(s)
- Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Alessandra Mari
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Francesca Casini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy.
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8
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Face-to-face physical activity incorporated into dietary intervention for overweight/obesity in children and adolescents: a Bayesian network meta-analysis. BMC Med 2022; 20:325. [PMID: 36056358 PMCID: PMC9438135 DOI: 10.1186/s12916-022-02462-6] [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: 11/30/2021] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adolescent obesity has been reported to have deleterious consequences but is considered a promising modifiable risk factor. We aimed to investigate the optimal intervention for obese and overweight children and adolescents. METHODS We searched the Medline (PubMed, 1946-December 2020), PsycINFO (Ovid, 1927-December 2020), Cochrane library (1966-December 2020), Web of Science (1900-December 2020), Embase (1974-December 2020), CINAHL (1937-December 2020), Chinese Biomedical Literature (1978-December 2020), and ClinicalTrials.gov (December 2020) databases. We included randomized controlled trials (RCTs) reporting the association between various interventions and obese/overweight children and adolescents. The quality of the included studies was judged by two independent reviewers using the Cochrane Collaboration Risk of Bias Tool. A Bayesian network meta-analysis was conducted to summarize the comparative effectiveness of interventions based on several outcomes. RESULTS We included 118 RCTs comprising 71,064 participants in our analyses. Based on the outcome of the body mass index (BMI), face-to-face physical activity (FTF PA) combined with dietary intervention (DI) (mean difference [MD] = - 0.98; 95% credible interval [CrI] - 1.19, - 0.77), FTF multi-lifestyle intervention (MLI) (MD = - 0.95; 95% CrI - 1.14, - 0.75), and mobile health (MH)-delivered MLI (MD = - 0.87; 95% CrI - 1.63, - 0.09) showed significant benefits over the named control group (NCG). For the outcome of BMI z-score, FTF PA+DI (MD = - 0.10; 95% CrI - 0.15, - 0.04) and MH-delivered PA+DI (MD = - 0.09; 95% CrI - 0.14, - 0.04) were more effective than the NCG. Sensitivity analyses revealed similar findings after exclusion of studies with < 12-month and 24-month outcome assessments for the intervention, which indicated the results were stable. CONCLUSIONS Based on limited quality evidence and limited direct evidence, our preliminary findings showed that FTF-PA+DI, FTF-MLI, and MH-delivered MLI improved the health-related parameters in obese adolescents, in comparison with NCG. Owing to the absence of strong, direct evidence of a significant difference between the various interventions for the four outcomes, we can only cautiously suggest that FTF-PA+DI is likely the most effective intervention.
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9
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Yang L, Liang C, Yu Y, Xiao Q, Xi M, Tang L. Family sports interventions for the treatment of obesity in childhood: a meta-analysis. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:40. [PMID: 36056414 PMCID: PMC9440531 DOI: 10.1186/s41043-022-00317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Obesity in children has become one of the key concerns of the World Health Organization, and the incidence of related non-communicable diseases is also rising. This study evaluates the effect of family sports participation on the treatment and prevention of obesity in children aged 0–14 years by systematic analysis. Method A literature review from 2000 to 2020 was conducted. According to PRISMA-IPD (Preferred Reporting Items for MetaAnalyses of individual participant data) guidelines. The two researchers independently assessed the risk and bias of the articles, obtained a comprehensive, high-quality result, and extracted the data based on the Cochrane intervention system review manual. Randomized controlled trials (RCTs) were selected from the searches that used family sports interventions or family sports combined with dietary adjustments and behavioral habits change. Only studies targeting overweight or obese children aged 0–14 years were included. Results The search resulted in a total of 16 studies. Across all 16 studies, there were a total of 1680 participants in the experimental groups and 1701 participants in the control groups. The results are as follows: body mass index (BMI) (SMD-RE = − 4.10, 95% CI (− 0.84 to 0.02), Z = 1.88, p = 0.06); Body weight (SMD-RE = − 0.77, 95% CI (− 1.53 to − 0.01), Z = 2.00, p = 0.05); Waist circumference (SMD-RE = − 0.45, 95% CI (− 1.36 to 0.47), Z = 0.96, p = 0.34); and Body fat rate (SMD-FE = − 0.06, 95% CI (− 0.22 to 0.11), Z = 0.69, p = 0.49). Hence, through family sports intervention among obese children, juvenile and obese body composition—BMI, body weight, waist circumference, and body fat rate—are all reduced. But only body weight was statistically significant. Conclusions Compared with the samples without family sports, the weight of obese children participating in family sports decreased, but there were no significant differences in other relevant physical indicators. Follow-up research should examine large-scale clinical trials with family sports as a single factor intervention, which are needed to provide stronger evidence of the intervention effect. However, family activities can help obese children grow and develop by improving their exercise capacity, enhancing their lifestyles, and facilitating communication and relationships with their parents. In the future, long-term sports training plans for children with obesity should be implemented.
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10
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Apperley LJ, Blackburn J, Erlandson-Parry K, Gait L, Laing P, Senniappan S. Childhood obesity: A review of current and future management options. Clin Endocrinol (Oxf) 2022; 96:288-301. [PMID: 34750858 DOI: 10.1111/cen.14625] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option.
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Affiliation(s)
- Louise J Apperley
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - James Blackburn
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | | | - Lucy Gait
- Department of Paediatric Clinical Psychology, Alder Hey Children's Hospital, Liverpool, UK
| | - Peter Laing
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - Senthil Senniappan
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
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11
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Treat Obesity in Mexican Children and Adolescents: Systematic Review and Meta-Analysis. Nutr Rev 2022; 80:544-560. [PMID: 34339511 PMCID: PMC8829677 DOI: 10.1093/nutrit/nuab041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Prevalence of overweight and obesity has been rising in the past 3 decades among Mexican children and adolescents. OBJECTIVE To systematically review experimental studies evaluating interventions to treat obesity in Mexican children and adolescents (≤18 years old). DATA SOURCES For this study, 13 databases and 1 search engine were searched. DATA ANALYSIS A total of 29 studies met the inclusion criteria. Overall, 2302 participants (age range, 8-16 years) from 11 states in Mexico were included. Most of the studies (n = 17 of 29) were provided in a clinical setting. A random-effect meta-analysis of 4 randomized controlled trials was conducted and a significant effect was found on body mass index reduction that favored the intervention group (-1.52; 95%CI, -2.15 to -0.89) for short-term (≤6 mo) interventions. CONCLUSIONS A multicomponent, multidisciplinary, and individualized intervention that includes dietary modifications, physical activity practice, behavioral strategies, and active parental involvement might help treat childhood obesity in Mexico. However, long-term results need to be produced to identify effectiveness pointers that might help establish an integrated, long-lasting care model to treat obesity.
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Affiliation(s)
| | - Lizet López-Cruz
- Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Spain
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12
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Tucker JM, Stratbucker W, King EC, Cuda S, Negrete S, Sweeney B, Kumar S, Borzutzky C, Binns HJ, Kirk S. Characteristics of paediatric weight management in the United States: Associations with program retention and BMI outcomes in the paediatric obesity weight evaluation registry (POWER). Pediatr Obes 2022; 17:e12848. [PMID: 34498814 DOI: 10.1111/ijpo.12848] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe characteristics of paediatric weight management (PWM) programs across the United States and evaluate associations with program-specific retention rates and body mass index (BMI) outcomes at 6 months. METHODS A program profile survey was administered to 33 programs within the Paediatric Obesity Weight Evaluation Registry (POWER) to assess program staffing, services, and treatment format. Patient retention and percent of the 95th BMI percentile (%BMIp95) changes were assessed for each program. RESULTS At 6 months program retention rates ranged from 15% to 74% (median: 41%), and program %BMIp95 changes ranged from -9.0 to +0.5 percentage points (median: -1.7). Percent of patients with ≥5 percentage-point decrease in %BMIp95 ranged from 17% to 71% across programs (median: 29%). No associations were detected between program characteristics and retention or %BMIp95 changes. CONCLUSIONS Six-month patient retention and BMI outcomes vary substantially in PWM programs across the United States. Yet, no associations were found between PWM treatment factors and these program-level patient outcomes.
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Affiliation(s)
- Jared M Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - William Stratbucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Suzanne Cuda
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Sylvia Negrete
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Brooke Sweeney
- General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Children's Center for Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Helen J Binns
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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13
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Manzanarez B, Garcia S, Iverson E, Lipton-Inga MR, Blaine K. Lessons in Adapting a Family-Based Nutrition Program for Children With Autism. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1038-1047. [PMID: 34895557 DOI: 10.1016/j.jneb.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the adaptation and implementation of an existing, evidence-based nutrition program for children with autism and their parents. METHODS Children aged 7-12 years with autism and their parent participated in 6 weekly sessions. Recruitment, intervention, and data collection took place in a community health center in an urban area. RESULTS Of the 50 referred participants, 38% attended the first classes, and 26% completed the program. Families and staff expressed satisfaction; parents reported increased physical activity, fruit, and vegetable intake in their children. Parents also desired continued learning and individualized recommendations. CONCLUSIONS AND IMPLICATIONS Adapting family-centered nutrition programs can positively influence diet behaviors in children with autism. As many children with autism battle with obesity, the findings from this pilot provide important insight into supporting these families and can further inform the development of evidence-based practices currently lacking for children with autism and their families.
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Affiliation(s)
- Brenda Manzanarez
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Samantha Garcia
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ellen Iverson
- The Diabetes and Obesity Program and Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Megan R Lipton-Inga
- The Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kevin Blaine
- California-based Nurse-led Discharge Learning (CANDLE) Collaborative, Institute for Nursing and Interprofessional Research, Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA
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14
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Calcaterra V, Verduci E, Pascuzzi MC, Magenes VC, Fiore G, Di Profio E, Tenuta E, Bosetti A, Todisco CF, D'Auria E, Zuccotti G. Metabolic Derangement in Pediatric Patient with Obesity: The Role of Ketogenic Diet as Therapeutic Tool. Nutrients 2021; 13:2805. [PMID: 34444964 PMCID: PMC8400548 DOI: 10.3390/nu13082805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
Obesity is defined as a condition characterized by an excessive fat accumulation that has negative health consequences. Pediatric obesity is associated with an increased risk for many diseases, including impaired glycemic and lipidic control that may lead to the development of chronic, and potentially disabling, pathologies, such as type 2 diabetes mellitus (T2DM) and cardiovascular events, in adult life. The therapeutic strategy initially starts with interventions that are aimed at changing lifestyle and eating behavior, to prevent, manage, and potentially reverse metabolic disorders. Recently, the ketogenic diet (KD) has been proposed as a promising dietary intervention for the treatment of metabolic and cardiovascular risk factors related to obesity in adults, and a possible beneficial role has also been proposed in children. KD is very low in carbohydrate, high in fat, and moderate to high in protein that may have the potential to promote weight loss and improve lipidic derangement, glycemic control, and insulin sensitivity. In this review, we present metabolic disorders on glycemic and lipidic control in children and adolescents with obesity and indication of KD in pediatrics, discussing the role of KD as a therapeutic tool for metabolic derangement. The results of this review may suggest the validity of KD and the need to further research its potential to address metabolic risk factors in pediatric obesity.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Martina Chiara Pascuzzi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Vittoria Carlotta Magenes
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Giulia Fiore
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Elisabetta Di Profio
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Elisavietta Tenuta
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Bosetti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Carolina Federica Todisco
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
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15
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Darling KE, Warnick J, Hadley W, Guthrie K, Jelalian E. Reactions to the U.S. Preventive Services Task Force guidelines for the management of adolescent obesity: A multi-informant qualitative approach. Clin Obes 2021; 11:e12451. [PMID: 33780999 PMCID: PMC10680043 DOI: 10.1111/cob.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/20/2021] [Accepted: 03/08/2021] [Indexed: 12/01/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6-18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi-informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In-depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families.
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Affiliation(s)
- Katherine E. Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer Warnick
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wendy Hadley
- Counseling and Human Services, College of Education, University of Oregon, Eugene, Oregon
| | - Kate Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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16
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Vlaev I, Taylor MJ, Taylor D, Gately P, Gunn LH, Abeles A, Kerkadi A, Lothian J, Jreige SK, Alsaadi A, Al-Kuwari MG, Ghuloum S, Al-Kuwari H, Darzi A, Ahmedna M. Testing a multicomponent lifestyle intervention for combatting childhood obesity. BMC Public Health 2021; 21:824. [PMID: 33926412 PMCID: PMC8082655 DOI: 10.1186/s12889-021-10838-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity. METHODS Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8-14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in. RESULTS Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively). CONCLUSIONS Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02972164 , November 23, 2016.
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Affiliation(s)
- Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK.
| | - Michael J Taylor
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Taylor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Laura H Gunn
- Department of Public Health Sciences & School of Data Science, University of North Carolina at Charlotte, Charlotte, USA.,School of Public Health, Imperial College London, London, UK
| | - Aliza Abeles
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abdelhamid Kerkadi
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mohamed Ahmedna
- North Carolina Agricultural and Technical State University, Greensboro, USA
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17
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Arlinghaus KR, Ledoux TA, Johnston CA. Randomized Controlled Trial to Increase Physical Activity Among Hispanic-American Middle School Students. THE JOURNAL OF SCHOOL HEALTH 2021; 91:307-317. [PMID: 33655526 DOI: 10.1111/josh.13004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined. METHODS Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI. RESULTS Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p < .01). Intervention girls increased weekday MVPA; whereas TAU girls decreased weekday MVPA (F(1,99) = 7.36, p < .01). Among those with obesity, there was no difference in MVPA between conditions (F(1, 56) = 0.33, p = .57), but Intervention decreased zBMI significantly more than TAU (F(1, 56) = 6.16, p < .05). CONCLUSIONS Structured PE classes grounded in behavioral theory may be an important strategy to prevent typical decreases in MVPA during adolescence, particularly among girls and for youth with obesity.
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Affiliation(s)
- Katherine R Arlinghaus
- Assistant Professor, , Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South Second Street Suite 300, Minneapolis, MN, 55454., USA
| | - Tracey A Ledoux
- Associate Professor, , Department of Health and Human Performance, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015., USA
| | - Craig A Johnston
- Associate Professor, , Department of Health and Human Performance, University of Houston, 3875 Holman St. Rm 104 Garrison, Houston, TX, 77204-6015., USA
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18
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Smith KE, Luo S, Mason TB. A systematic review of neural correlates of dysregulated eating associated with obesity risk in youth. Neurosci Biobehav Rev 2021; 124:245-266. [PMID: 33587960 DOI: 10.1016/j.neubiorev.2021.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/23/2022]
Abstract
Dysregulated eating among children and adolescents is associated with a wide range of negative mental and physical health outcomes, including obesity. However, less is known regarding underlying neural mechanisms underlying such behaviors. Therefore, the present manuscript systematically reviewed neuroimaging research examining dysregulated eating behavior linked to excess weight in children and adolescents. A systematic literature search identified 23 eligible studies, the majority of which were cross-sectional functional magnetic resonance imaging (fMRI) studies and excluded participants with psychiatric disorders. Dysregulated eating was captured by measures of eating styles and eating self-regulation, eating disorder behaviors, food addiction, objective measures of non-homeostatic eating and caloric restriction. While preliminary, findings suggested eating dysregulation was related to aberrant functioning within the frontostriatal and frontoparietal regions involved in self-regulatory processes, as well as regions involved in satiety signaling and interoception. This heterogeneous body of research is continually growing and may have potential to inform future prevention and intervention approaches. Results also identified several important limitations to consider and highlight key areas for future research.
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Affiliation(s)
- Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
| | - Shan Luo
- Department of Psychology, University of Southern California, Los Angeles, CA, United States; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tyler B Mason
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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19
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Facets of Impulsivity in Relation to Diet Quality and Physical Activity in Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020613. [PMID: 33445815 PMCID: PMC7828222 DOI: 10.3390/ijerph18020613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/05/2022]
Abstract
Although the construct of impulsivity has generally been found to be associated with obesity and health behaviors in adults, research among adolescents is more limited and studies have yet to elucidate which facets of impulsivity may be most salient with regard to different eating and physical activity behaviors. Therefore, the present cross-sectional study assessed facets of impulsivity, measured by the UPPS-P questionnaire, in relation to health behaviors among adolescents. A sample of 2797 high school students from Los Angeles, California completed self-report measures during the ninth grade. The UPPS-P subscales (i.e., (lack of) premeditation, sensation seeking, (lack of) perseverance, negative urgency, positive urgency) were examined as predictors of unhealthy diet quality (i.e., frequency of consumption of high-fat foods and sweet food and drinks, measured by the National Cancer Institute (NCI) Quick Food Scan) and frequency of vigorous physical activity (measured by the Youth Risk Behavior Surveillance System). Greater sensation seeking, positive urgency, and negative urgency was associated with greater unhealthy diet quality (ps < 0.001). Greater negative urgency and lack of perseverance was associated with less frequent vigorous physical activity, whereas greater sensation seeking, lack of premeditation, and positive urgency was associated with more frequent vigorous physical activity (ps < 0.05). While negative urgency (i.e., impulsivity in the context of negative emotions) was consistently associated with poor health behaviors, other facets of impulsivity may potentiate vigorous physical activity in youth. Together these findings underscore the importance of considering the multidimensional nature of impulsivity in relation to adolescents’ health behaviors and highlight areas for future longitudinal research.
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20
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Sriram K, Mulder HS, Frank HR, Santanam TS, Skinner AC, Perrin EM, Armstrong SC, Peterson ED, Pencina MJ, Wong CA. The Dose-Response Relationship Between Physical Activity and Cardiometabolic Health in Adolescents. Am J Prev Med 2021; 60:95-103. [PMID: 33341183 PMCID: PMC7769140 DOI: 10.1016/j.amepre.2020.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/14/2020] [Accepted: 06/22/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study examines the dose-response relationship between moderate-to-vigorous physical activity and cardiometabolic measures in adolescents. METHODS Cross-sectional spline analyses were performed using 2003-2016 National Health and Nutrition Examination Survey data among adolescents (aged 12-19 years, N=9,195) on objectively measured (2003-2006) and self-reported (2007-2016) weekly mean minutes of moderate-to-vigorous physical activity and cardiometabolic measures (systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein, BMI, and cardiorespiratory fitness). Inflection points were determined for nonlinear relationships. RESULTS For objective moderate-to-vigorous physical activity, female adolescents had significant nonlinear associations with inflection points at 90 minutes/week for BMI percentile and systolic blood pressure. Male adolescents had inflection points at 150 weekly minutes of objective activity for BMI percentile and cardiorespiratory fitness. BMI percentile was about 7% lower for female and male adolescents at 150 weekly minutes of objectively measured moderate-to-vigorous physical activity than at 0 minutes. For self-reported moderate-to-vigorous physical activity, inflection points were at 375 minutes/week (diastolic blood pressure for female adolescents) and 500 minutes/week (systolic blood pressure for male adolescents). CONCLUSIONS Among several significant dose-response relationships between physical activity and cardiometabolic health in adolescents, consistent and often nonlinear relationships were identified for BMI, with inflection points at 90-150 minutes of objective moderate-to-vigorous physical activity. Notable differences in associations and linearity were identified by sex and physical activity measure (objective or self-reported). These results support calls for any increase in physical activity among adolescents and suggest that recommendations closer to the adult guidelines of 150 weekly minutes of physical activity may be health promoting and more attainable for youth than the current recommendation of 420 weekly minutes.
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Affiliation(s)
| | | | | | - Taruni S Santanam
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Asheley C Skinner
- Duke Clinical Research Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, North Carolina
| | - Eliana M Perrin
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah C Armstrong
- Duke Clinical Research Institute, Durham, North Carolina; Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael J Pencina
- Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Charlene A Wong
- Duke Clinical Research Institute, Durham, North Carolina; Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Duke Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina
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21
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Yerges AL, Snethen JA, Carrel AL. Adolescent Girls With Overweight and Obesity Feel Physically Healthy and Highlight the Importance of Mental Health. SAGE Open Nurs 2021; 7:23779608211018523. [PMID: 34104716 PMCID: PMC8165867 DOI: 10.1177/23779608211018523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/27/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Obesity in adolescence is a significant ongoing public health problem that has not improved over the past decade. OBJECTIVE This descriptive qualitative study explores the perspective of female adolescents who are overweight or obese regarding their views on health and weight within the clinic setting. METHODS In-depth interviews were conducted with female adolescents (age 13-19 years old; BMI ≥85th percentile) from the mid-west region of the United States (N = 28). Inductive thematic analysis using Braun & Clarke's methods was utilized. RESULTS The findings from this study revealed that the adolescents' view of health encompasses physical, mental, and psychosocial health dimensions, and despite being overweight and obese, the participants felt healthy. Participants discussed the need to eat healthier and increase their daily physical activity, but were unable to transform this into action. Within the clinical setting, the adolescents were sensitive to weight discussions. CONCLUSION Results from this study can increase providers' understanding of the adolescent, increase awareness of adolescent sensitivity, and assist researchers in developing age-appropriate interventions for effective treatment and prevention of childhood obesity.
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Affiliation(s)
- April L. Yerges
- University of Wisconsin-Milwaukee, College of Nursing, Madison, United States
| | - Julia A. Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Madison, United States
| | - Aaron L. Carrel
- School of Medicine and Public Health, University of Wisconsin, Madison, United States
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22
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Liberali R, Del Castanhel F, Kupek E, Assis MAAD. Latent Class Analysis of Lifestyle Risk Factors and Association with Overweight and/or Obesity in Children and Adolescents: Systematic Review. Child Obes 2021; 17:2-15. [PMID: 33306451 DOI: 10.1089/chi.2020.0115] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Multiple modifiable lifestyle factors are well-known contributors to many health problems. Objectives: This study aims to determine the association between latent class analysis (LCA) of modifiable lifestyle risk factors with being overweight and/or obese for children and/or adolescents. Methods: Articles were selected from six databases, without limitation regarding language or date. The review included studies that identify latent classes of modifiable lifestyle risk factors [e.g., physical activity (PA), diet, sedentary behavior (SB), and/or unhealthy behavior] by LCA to determine the association between latent classes with being overweight and/or obese. The methodology of the selected studies was evaluated using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Owing to the heterogeneity between latent classes of modifiable lifestyle risk factors with obesity and/or being overweight, the results are described narratively. Results: Using a selection process in two phases, nine articles were included. All of the included studies were of high methodological quality. The studies were conducted in six different countries: the USA, Brazil, Canada, Portugal, Italy, and Australia. Sample sizes ranged from 166 to 18.587 children and adolescents, and in terms of age (range 5-19 years). Across study clusters characterized by low consumption of fruit and vegetables, and high consumption of fatty foods, sugar snack foods, sweets, chips and fries, low PA (<1 hour each day), and high SB (screen time and TV >2 hours/day), sleep time (<10 hours/day) were positively associated with being overweight and/or obese. Conclusion: Overall there is good evidence to support that the modifiable lifestyle risk factors clustered together by LCA should be novel targets for the treatment of obesity and its associated comorbidities.
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Affiliation(s)
- Rafaela Liberali
- Post-graduation Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Flavia Del Castanhel
- Post-graduation Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Emil Kupek
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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23
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Leerkes EM, Buehler C, Calkins SD, Shriver LH, Wideman L. Protocol for iGrow (Infant Growth and Development Study): biopsychosocial predictors of childhood obesity risk at 2 years. BMC Public Health 2020; 20:1912. [PMID: 33317498 PMCID: PMC7734916 DOI: 10.1186/s12889-020-10003-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background Childhood obesity remains a significant public health problem. To date, most research on the causes and correlates of obesity has focused on a small number of direct predictors of obesity rather than testing complex models that address the multifactorial nature of the origins of obesity in early development. We describe the rationale and methods of iGrow (Infant Growth and Development Study) which will test multiple pathways by which (a) prenatal maternal psychobiological risk predicts infant weight gain over the first 6 months of life, and (b) this early weight gain confers risk for obesity at age 2. Infant hormonal and psychobiological risk are proposed mediators from prenatal risk to early weight gain, though these are moderated by early maternal sensitivity and obesogenic feeding practices. In addition, higher maternal sensitivity and lower obesogenic feeding practices are proposed predictors of adaptive child self-regulation in the second year of life, and all three are proposed to buffer/reduce the association between high early infant weight gain and obesity risk at age 2. Methods iGrow is a prospective, longitudinal community-based study of 300 diverse mothers and infants to be followed across 5 data waves from pregnancy until children are age 2. Key measures include (a) maternal reports of demographics, stress, well-being, feeding practices and child characteristics and health; (b) direct observation of maternal and infant behavior during feeding, play, and distress-eliciting tasks during which infant heart rate is recorded to derive measures of vagal withdrawal; (c) anthropometric measures of mothers and infants; and (d) assays of maternal prenatal blood and infant saliva and urine. A host of demographic and other potential confounds will be considered as potential covariates in structural equation models that include tests of mediation and moderation. Efforts to mitigate the deleterious effects of COVID-19 on study success are detailed. Discussion This study has the potential to inform (1) basic science about early life processes casually related to childhood obesity and (2) development of targeted intervention and prevention approaches that consider mother, infant, and family risks and resources.
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Affiliation(s)
- Esther M Leerkes
- UNC Greensboro, Department of Human Development and Family Studies, Greensboro, NC, 27402-6170, USA.
| | - Cheryl Buehler
- UNC Greensboro, Department of Human Development and Family Studies, Greensboro, NC, 27402-6170, USA
| | - Susan D Calkins
- UNC Greensboro, Office of Research and Engagement, Greensboro, NC, 27402-6170, USA
| | - Lenka H Shriver
- UNC Greensboro, Department of Nutrition, Greensboro, NC, 27402-6170, USA
| | - Laurie Wideman
- UNC Greensboro, Department of Kinesiology, Greensboro, NC, 27402-6170, USA
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24
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Ohrt TK, Perez M, Liew J, Hernández JC, Yu KY. The influence of temperament on stress-induced emotional eating in children. Obes Sci Pract 2020; 6:524-534. [PMID: 33082994 PMCID: PMC7556421 DOI: 10.1002/osp4.439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/31/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022] Open
Abstract
Background Stress‐induced emotional eating is a risk factor for overweight and obesity. Previous research proposes both the human serotonin transporter gene (5‐HTTLPR) and child's reactive temperament are promising candidates to help explain individual differences in stress‐induced emotional eating and weight. Understanding the association between specific genotypes, reactive temperament factors, and stress‐induced emotional eating may inform the development of personalized and effective treatment for children who may be at risk for overweight and obesity. Objective The current study explored the conditional indirect effect of genetic and environmental susceptibility (i.e., the interaction between 5‐HTTLPR and reactive temperament) on weight (as measured by percent body fat) mediated by stress‐induced emotional eating. Method One hundred and forty‐seven children (4 to 6 years old; 50.3% female; 22.4% Hispanic), along with their primary caregiver, completed laboratory tasks and questionnaires that assessed the child's reactive temperament, stress‐induced emotional eating, and percent body fat. Results The interaction between 5‐HTTLPR and impulsivity as well as with negative affectivity significantly predicted percent body fat. The interaction between 5‐HTTLPR and impulsivity as well as with negative affectivity significantly predicted both total calorie consumption and rate of total calorie consumption. However, the mediation aspect of this statistical model was not supported. Conclusions Child reactive temperament is an important indicator of how children approach eating when stressed. Mental health providers may consider prescribing strategies to reduce emotional eating among children with the SL variant and moderate to high impulsivity as well as children with the LL variant and high negative affectivity.
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Affiliation(s)
| | - Marisol Perez
- Department of PsychologyArizona State UniversityTempeArizonaUSA
| | - Jeffrey Liew
- Department of Educational PsychologyTexas A&M UniversityCollege StationTexasUSA
| | | | - Kimberly Yim Yu
- Department of PsychologyArizona State UniversityTempeArizonaUSA
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Park J, Woo S, Ju YS, Seo YG, Lim HJ, Kim YM, Noh HM, Lee HJ, Park SI, Park KH. Factors associated with dropout in a lifestyle modification program for weight management in children and adolescents. Obes Res Clin Pract 2020; 14:566-572. [PMID: 33004301 DOI: 10.1016/j.orcp.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Significant dropout rates remain a serious concern in pediatric weight control program, but few studies have identified predictors of dropout. AIMS The objective of the study is to identify factors associated with dropout from a pediatric lifestyle modification weight control program at different phases. METHODS Data on overweight and obese participants (n = 242) aged 11-18 years in the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition (ICAAN) study were collected at baseline, 6-months, and 24-months through self-report and a laboratory test. Logistic regression analysis was performed for those who dropped out during the first 6-months, and multivariate generalized estimating equation analysis identified longitudinal factors associated with those who dropped out after 24 months. RESULTS Lower family functioning (OR = 2.30, 95% CI [1.18-4.46]), exercise group (OR = 0.36, 95% CI [0.15-0.86]), lower initial attendance rate (OR = 6.09, 95% CI [2.94-12.6]), and non-self -referral pathways (OR = 2.35, 95% CI [1.05-5.27]) were significantly associated with 6-month dropouts. For late dropout, lower family functioning (OR = 1.71, 95% CI [1.06-2.77]) and lower initial attendance rates (OR = 2.06, 95% CI [1.12-3.81]) remained significant. CONCLUSION Family function and initial attendance rate were associated with lower dropout rates. Developing a supportive family environment and focusing on the early-stage factors at the intervention's outset may reduce overall dropout rates in obesity prevention intervention.
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Affiliation(s)
- Jane Park
- Department of Social Welfare, College of Social Sciences, Seoul National University, Seoul, Republic of Korea.
| | - Sarah Woo
- Major in Biomedical Science, Department of Medical Sciences, College of Medicine, Hallym University, Gangwon-do, Republic of Korea.
| | - Young-Su Ju
- Department of Occupational Medicine, National Medical Center, Seoul, Republic of Korea.
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
| | - Hyun-Jung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin, Republic of Korea.
| | - Yoon-Myung Kim
- University College, Yonsei University International Campus, Incheon, Republic of Korea.
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, Republic of Korea.
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, Republic of Korea.
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do, Republic of Korea.
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26
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Kebbe M, Perez A, Buchholz A, Scott SD, McHugh TLF, Dyson MP, Ball GDC. Health care providers' weight management practices for adolescent obesity and alignment with clinical practice guidelines: a multi-centre, qualitative study. BMC Health Serv Res 2020; 20:850. [PMID: 32912259 PMCID: PMC7488259 DOI: 10.1186/s12913-020-05702-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) include evidence-based recommendations for managing obesity in adolescents. However, information on how health care providers (HCPs) implement these recommendations in day-to-day practice is limited. Our objectives were to explore how HCPs deliver weight management health services to adolescents with obesity and describe the extent to which their reported practices align with recent CPGs for managing pediatric obesity. Methods From July 2017 to January 2018, we conducted a qualitative study that used purposeful sampling to recruit HCPs with experience in adolescent weight management from multidisciplinary, pediatric weight management clinics in Edmonton and Ottawa, Canada. Data were collected using audio-recorded focus groups (4–6 participants/group; 60–90 min in length). We applied inductive, semantic thematic analysis and the congruent methodological approach to analyze our data, which included transcripts, field notes, and memos. Qualitative data were compared to recent CPGs for pediatric obesity that were published by the Endocrine Society in 2017. Of the 12 obesity ‘treatment-related’ recommendations, four were directly relevant to the current study. Results Data were collected through three focus groups with 16 HCPs (n = 10 Edmonton; n = 6 Ottawa; 94% female; 100% Caucasian), including dietitians, exercise specialists, nurses, pediatricians, psychologists, and social workers. We identified three main themes that we later compared with CPG recommendations, including: (i) discuss realistic expectations regarding weight management (e.g., shift focus from weight to health; explore family cohesiveness; foster delayed vs instant gratification), (ii) personalize weight management (e.g., address personal barriers to change; consider developmental readiness), and (iii) exhibit non-biased attitudes and practices (e.g., de-emphasize individual causes of obesity; avoid making assumptions about lifestyle behaviors based on weight). Based on these qualitative findings, HCPs applied all four CPG recommendations in their practices. Conclusions HCPs provided practical insights into what and how they delivered weight management for adolescents, which included operationalizing relevant CPG recommendations in their practices.
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Affiliation(s)
- M Kebbe
- Department of Pediatrics, Faculty of Medicine & Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - A Perez
- Department of Pediatrics, Faculty of Medicine & Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - A Buchholz
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - S D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - T-L F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - M P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - G D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
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Bean MK, Caccavale LJ, Adams EL, Burnette CB, LaRose JG, Raynor HA, Wickham EP, Mazzeo SE. Parent Involvement in Adolescent Obesity Treatment: A Systematic Review. Pediatrics 2020; 146:peds.2019-3315. [PMID: 32839242 PMCID: PMC7461263 DOI: 10.1542/peds.2019-3315] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Family-based lifestyle interventions are recommended for adolescent obesity treatment, yet the optimal role of parents in treatment is unclear. OBJECTIVE To examine systematically the evidence from prospective randomized controlled and/or clinical trials (RCTs) to identify how parents have been involved in adolescent obesity treatment and to identify the optimal type of parental involvement to improve adolescent weight outcomes. DATA SOURCES Data sources included PubMed, PsychINFO, and Medline (inception to July 2019). STUDY SELECTION RCTs evaluating adolescent (12-18 years of age) obesity treatment interventions that included parents were reviewed. Studies had to include a weight-related primary outcome (BMI and BMI z score). DATA EXTRACTION Eligible studies were identified and reviewed, following the Preferred Reporting for Systematic Review and Meta-Analyses guidelines. Study quality and risk of bias were evaluated by using the Cochrane Collaboration risk of bias tool. RESULTS This search identified 32 studies, of which 23 were unique RCTs. Only 5 trials experimentally manipulated the role of parents. There was diversity in the treatment target (parent, adolescent, or both) and format (group sessions, separate sessions, or mixed) of the behavioral weight loss interventions. Many studies lacked detail and/or assessments of parent-related behavioral strategies. In ∼40% of unique trials, no parent-related outcomes were reported, whereas parent weight was reported in 26% and associations between parent and adolescent weight change were examined in 17%. LIMITATIONS Only RCTs published in English in peer-reviewed journals were eligible for inclusion. CONCLUSIONS Further research, with detailed reporting, is needed to inform clinical guidelines related to optimizing the role of parents in adolescent obesity treatment.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Laura J. Caccavale
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth L. Adams
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Hollie A. Raynor
- Department of Nutrition, The University of Tennessee,
Knoxville, Knoxville, Tennessee
| | - Edmond P. Wickham
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Internal Medicine, School of Medicine, Virginia
Commonwealth University, Richmond, Virginia; and
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Department of Psychology, College of Humanities and
Sciences and
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28
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Kim HJ, Wilson C, Van Deusen T, Millard H, Qayyum Z, Parke S. Metabolic Syndrome in Child and Adolescent Psychiatry. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200630-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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29
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Lee DH. Physical Activity Component Should be Included when Designing National Child-Obesity Program: The Rapid Review of Multi-Component Child Obesity Intervention Programs. THE ASIAN JOURNAL OF KINESIOLOGY 2020. [DOI: 10.15758/ajk.2020.22.3.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The prevalence of child obesity is steadily increasing in Korea, thus government needs to seek for effective intervention programs to counteract current epidemics. This study sought to find proven effective child obesity programs implemented in other countries in order to provide policy recommendation. We report the results of rapid review of child obesity programs which were implemented outside of Korea.METHODS A search of multiple databases (NICE Evidence Search, Open Grey, Grey Literature Report, National Cancer institute: research-tested intervention programs) was conducted to identify relevant research articles published after January 2010.RESULTS 11 studies met the inclusion criteria after systematic screening. Most of the included studies used physical activity & diet/nutrition at the same time, while school was the most common location for the intervention. 5 studies showed improvement in obesity related outcomes. Interventions contained physical activity & diet/nutrition or physical activity & psychological coaching, and intervention implemented in school, healthcare facility, summer camp, and after-school class were shown effective.CONCLUSIONS Considering the results of current review, multi-component intervention which includes physical activity is recommended when designing child obesity program. The location of the intervention should be school to maximize its effectiveness.
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30
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Caccavale LJ, LaRose JG, Mazzeo SE, Bean MK. An Examination of Adolescents' Values in a Motivational Interviewing-based Obesity Intervention. Am J Health Behav 2020; 44:526-533. [PMID: 32553032 DOI: 10.5993/ajhb.44.4.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this paper, we examine values selected by adolescents as part of a motivational interviewing (MI) weight loss intervention. Methods: During a values clarification activity, adolescents (N = 52; 75.0% girls; 78.4% African-American; mean age = 13.5 ± 1.8 years; mean body mass index (BMI) = 36.8 ± 6.4 kg/m²) selected their top 5 values. Using MI, interventionists explored selected values with adolescents and related them to target behaviors to develop discrepancy and enhance motivation for engagement in behavioral weight loss behaviors. Values were categorized using thematic analysis. Frequencies of value and theme selection were examined. Results: The majority of adolescents selected values in the Health (N = 38; 73.1%), Religion/ Spirituality (N = 36; 69.2%), Personal Achievement (N = 31; 59.6%), Virtuous (N = 28; 53.8%), and Family (N = 27; 51.9%) categories. Conclusions: Values selected by adolescents with obesity can inform intervention development for this difficult to engage population.
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Affiliation(s)
- Laura J. Caccavale
- Laura J. Caccavale, Postdoctoral Health Psychology Fellow, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA;,
| | - Jessica Gokee LaRose
- Jessica Gokee LaRose, Associate Professor, Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Suzanne E. Mazzeo
- Suzanne E. Mazzeo, Professor, Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Melanie K. Bean
- Melanie K. Bean, Associate Professor, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
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31
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Hampton-Anderson JN, Craighead LW. Psychosociocultural Contributors to Maladaptive Eating Behaviors in African American Youth: Recommendations and Future Directions. Am J Lifestyle Med 2020; 15:621-633. [PMID: 34916883 DOI: 10.1177/1559827620936951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/29/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022] Open
Abstract
Childhood overweight and obesity disproportionately affects African Americans, and these children benefit less from standard pediatric weight management treatment programs compared to other racial/ethnic groups. Maladaptive eating behavior has been identified as a behavioral contributor to obesity and is also associated with the development of nonrestrictive eating disorders over time. Unique psychosociocultural factors have been identified that may promote higher risk for maladaptive eating behaviors in African American children beyond the effects of economic disparity. To best treat this group, it is important for practitioners to have a thorough understanding of these factors. We review several of these considerations and describe ways they may interact to contribute to the subsequent development of maladaptive eating behaviors and increased weight. Recommendations are made regarding how attention to these factors could be incorporated into current pediatric weight management treatments to better serve this population via a patient-centered care approach. Future directions will also be discussed.
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Affiliation(s)
- Joya N Hampton-Anderson
- Department of Psychiatry and Behavioral Sciences (JNHA), Emory University, Atlanta, Georgia.,Psychology Department (LWC), Emory University, Atlanta, Georgia
| | - Linda W Craighead
- Department of Psychiatry and Behavioral Sciences (JNHA), Emory University, Atlanta, Georgia.,Psychology Department (LWC), Emory University, Atlanta, Georgia
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The Effects of Physical Activity and Diet Interventions on Body Mass Index in Latin American Children and Adolescents: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12051378. [PMID: 32408483 PMCID: PMC7284900 DOI: 10.3390/nu12051378] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/31/2022] Open
Abstract
The objective of this systematic review and meta-analysis is to compare the effect of physical activity only with that of physical activity plus diet interventions on body mass index (BMI) in Latin American children and adolescents. We searched the Medline, Embase, Scopus, Web of Science, and Scielo databases from their inception until March 2020, including studies examining the effect of physical activity or physical activity plus diet interventions on BMI in children and adolescents and based on data from intervention studies. The DerSimonian and Laird method was used to compute a pooled standardized mean difference for BMI in terms of effect size (ES) and respective 95% confidence intervals (CIs). Eighteen studies were included. Analyses were performed based on intervention (four studies were included for physical activity only and four studies were included for physical activity plus diet). In the analysis of physical activity only versus control, there was no effect on BMI (ES = 0.00; 95% CI −0.17–0.17, I2 = 0.0%; p = 0.443). In the analysis of physical activity plus diet versus control, there was a decrease in BMI in favour of the intervention group (ES = −0.28; 95% CI −0.42–−0.14, I2 = 74.5%; p = 0.001). When ES was estimated considering only the effect in intervention groups, there was no evidence of a decrease in BMI (ES = −0.17; 95% CI −0.44–0.11, I2 = 84.5%; p < 0.001) for physical activity only (eight studies). However, there was a statistically significant decrease in BMI (ES = −0.30; 95% CI −0.50–0.11, I2 = 95.8%; p < 0.001) for physical activity plus diet (ten studies). Some limitations of this review could compromise our results, but the main limitation that should be stated is the quality of the studies (mainly medium/moderate), especially as physical activity and diet interventions cannot be blinded, compromising the quality of these studies. In summary, this meta-analysis offers evidence that physical activity plus diet interventions produced a reduction in BMI in Latin American children and adolescents, but physical activity only interventions did not.
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Thompson K, Leadbeater B, Ames M, Merrin GJ. Associations Between Marijuana Use Trajectories and Educational and Occupational Success in Young Adulthood. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:257-269. [PMID: 29704147 PMCID: PMC6414467 DOI: 10.1007/s11121-018-0904-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adolescence and young adulthood is a critical stage when the economic foundations for life-long health are established. To date, there is little consensus as to whether marijuana use is associated with poor educational and occupational success in adulthood. We investigated associations between trajectories of marijuana use from ages 15 to 28 and multiple indicators of economic well-being in young adulthood including achievement levels (i.e., educational attainment and occupational prestige), work characteristics (i.e., full vs part-time employment, hours worked, annual income), financial strain (i.e., debt, trouble paying for necessities, delaying medical attention), and perceived workplace stress. Data were from the Victoria Healthy Youth Survey, a 10-year prospective study of a randomly recruited community sample of 662 youth (48% male; Mage = 15.5), followed biennially for six assessments. Models adjusted for baseline age, sex, SES, high school grades, heavy drinking, smoking, and internalizing and oppositional defiant disorder symptoms. Chronic users (our highest risk class) reported lower levels of educational attainment, lower occupational prestige, lower income, greater debt, and more difficulty paying for medical necessities in young adulthood compared to abstainers. Similarly, increasers also reported lower educational attainment, occupational prestige, and income. Decreasers, who had high early use but quit over time, showed resilience in economic well-being, performing similar to abstainers. Groups did not differ on employment status or perceived workplace stress. The findings indicate that early onset and persistent high or increasingly frequent use of marijuana in the transition from adolescent to young adulthood is associated with risks for achieving educational and occupational success, and subsequently health, in young adulthood.
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Affiliation(s)
- Kara Thompson
- Department of Psychology, St. Francis Xavier University, 2323 Notre Dame Ave., Antigonish, NS, B2G 2W5, Canada.
| | | | - Megan Ames
- University of Victoria, Victoria, BC, V8P 5C2, Canada
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McMaster CM, Gow ML, Neal R, Alexander S, Baur LA, Cohen J. Acceptability of Hospital-Based Pediatric Weight Management Services among Patients and Families: A Narrative Synthesis. Child Obes 2020; 16:129-140. [PMID: 31621388 DOI: 10.1089/chi.2019.0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
High rates of attrition from pediatric weight management services are well documented in the literature; however, studies reporting on acceptability of "real-world" services have not previously been reviewed. This narrative synthesis aimed to summarize quantitative and qualitative research reporting on satisfaction of families who attended a secondary or tertiary pediatric weight management service. Electronic databases were searched for studies of family and/or patient satisfaction with hospital-based pediatric weight management services. Included articles were scored on their methodological quality. Searches returned 4509 articles of which 17 were eligible. Education, practical strategies to assist behavior change and the approach of staff were reported as the most valued service aspects. Practical, organizational, and service content issues were reported as the primary reasons for poor engagement or discontinuation of treatment. The majority of recommendations for service improvement related to service content, with the following subthemes: program content, delivery of the weight management intervention, individualized treatment, and treatment expectations. Potential strategies for reducing attrition and improving consumer satisfaction include assessment of families' readiness to change at the outset of treatment and implementation of treatment non-negotiables. Development of a standardized measure of patient satisfaction for use in pediatric weight management service development, evaluation, and comparison is recommended.
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Affiliation(s)
- Caitlin M McMaster
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia.,Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - Megan L Gow
- University of Sydney Children's Hospital Westmead Clinical School, Westmead, Australia
| | - Renee Neal
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Shirley Alexander
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia
| | - Louise A Baur
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia.,University of Sydney Children's Hospital Westmead Clinical School, Westmead, Australia
| | - Jennifer Cohen
- Weight Management Services, The Children's Hospital at Westmead, Westmead, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia
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Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong IC. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundFive linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.Objectives(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).MethodsFive substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.ResultsStudy A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.Future work and limitationsWork is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.Trial registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Sanjay Kinra
- Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J Cole
- Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK
| | - Silvia Costa
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Helen Croker
- The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK
| | - Tam Fry
- Child Growth Foundation, Edgware, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lee Hudson
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anthony S Kessel
- Director of Global Public Health, Public Health England, London, UK
| | - Steve Morris
- Centre of Applied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Science, University College London, London, UK
| | - Dasha Nicholls
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Faculty of Medicine, Imperial College London, London, UK
| | - Barry Taylor
- Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Billy White
- Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK
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Scudiero O, Pero R, Ranieri A, Terracciano D, Fimiani F, Cesaro A, Gentile L, Leggiero E, Laneri S, Moscarella E, Mazzaccara C, Frisso G, D'Alicandro G, Limongelli G, Pastore L, Calabrò P, Lombardo B. Childhood obesity: an overview of laboratory medicine, exercise and microbiome. Clin Chem Lab Med 2019; 58:1385-1406. [PMID: 31821163 DOI: 10.1515/cclm-2019-0789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
In the last few years, a significant increase of childhood obesity incidence unequally distributed within countries and population groups has been observed, thus representing an important public health problem associated with several health and social consequences. Obese children have more than a 50% probability of becoming obese adults, and to develop pathologies typical of obese adults, that include type 2-diabetes, dyslipidemia and hypertension. Also environmental factors, such as reduced physical activity and increased sedentary activities, may also result in increased caloric intake and/or decreased caloric expenditure. In the present review, we aimed to identify and describe a specific panel of parameters in order to evaluate and characterize the childhood obesity status useful in setting up a preventive diagnostic approach directed at improving health-related behaviors and identifying predisposing risk factors. An early identification of risk factors for childhood obesity could definitely help in setting up adequate and specific clinical treatments.
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Affiliation(s)
- Olga Scudiero
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Raffaela Pero
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy
| | - Annaluisa Ranieri
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Daniela Terracciano
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Naples "Federico II", Napoli, Italy
| | - Fabio Fimiani
- Divisione di Cardiologia, Dipartimento di Scienze Cardiotoraciche e Respiratorie, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Arturo Cesaro
- Divisione di Cardiologia, Dipartimento di Scienze Cardiotoraciche e Respiratorie, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Sonia Laneri
- Dipartimento di Farmacia, Università degli Studi di Naples "Federico II", Napoli, Italy
| | - Elisabetta Moscarella
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", Caserta, Italy.,Unità di Cardiologia, Ospedale "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Cristina Mazzaccara
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Giovanni D'Alicandro
- Centro di Medicina dello Sport e delle Disabilità, Dipartimento di Neuroscienze e Riabilitazione, AORN, Santobono-Pausillipon, Naples, Italy
| | - Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Lucio Pastore
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Paolo Calabrò
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", Caserta, Italy.,Unità di Cardiologia, Ospedale "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Barbara Lombardo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Naples "Federico II", Napoli, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
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Yeager LJ, Karp SM, Leming-Lee T'S. Barriers to the Implementation of Pediatric Overweight and Obesity Guidelines in a School-Based Health Center. Nurs Clin North Am 2019; 54:159-168. [PMID: 30712542 DOI: 10.1016/j.cnur.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This project applied a quality improvement design to assess perceived barriers to pediatric overweight and obesity guideline implementation in school-based health centers. An electronic survey was administered to nurse practitioners and licensed practical nurses working in school-based health centers in New York. The most commonly cited primary care-based barriers were lack of patient compliance, family lifestyle, and the poor dietary practices and sedentary behaviors common in America. The most commonly cited school-based barriers were that children have little control over the groceries purchased and foods cooked at home and the lack of parent presence during appointments.
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Affiliation(s)
- Lydia J Yeager
- School Based Health Program, Ryan Health, 110 W. 97th Street, New York, NY 10025, USA.
| | - Sharon M Karp
- Vanderbilt University School of Nursing, 366 Frist Hall, 461 21st Avenue South, Nashville, TN 37240, USA
| | - Treasa 'Susie' Leming-Lee
- Vanderbilt University School of Nursing, 461 21st Avenue South, 216 Godchaux Hall, Nashville, TN 37240, USA
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Kelley GA, Kelley KS, Pate RR. Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials. BMJ Open 2019; 9:e031220. [PMID: 31719081 PMCID: PMC6858189 DOI: 10.1136/bmjopen-2019-031220] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents. DESIGN Network meta-analysis of randomised exercise intervention trials. SETTING Any setting where a randomised trial could be conducted. PARTICIPANTS Overweight and obese male and/or female children and adolescents 2-18 years of age. INTERVENTIONS Randomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training. PRIMARY OUTCOMES Changes in BMI in kg/m2, fat mass and per cent body fat. RESULTS Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI. CONCLUSIONS Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents. PROSPERO REGISTRATION NUMBER CRD42017073103.
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Affiliation(s)
- George A Kelley
- Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Kristi S Kelley
- Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Russell R Pate
- Exercise Science, University of South Carolina, Columbia, South Carolina, USA
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Kozioł-Kozakowska A, Wójcik M, Furtak A, Januś D, Starzyk JB. A Comparison of the Impact of Two Methods of Nutrition-Behavioral Intervention on Selected Auxological and Biochemical Parameters in Obese Prepubertal Children-Crossover Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2841. [PMID: 31398932 PMCID: PMC6718985 DOI: 10.3390/ijerph16162841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023]
Abstract
Obese children are exposed to short and long-term health consequences, such as dyslipidemia, hypertension and diabetes mellitus. For these reasons, the prevention and treatment of obesity in the pediatric population is a challenge for health care professionals. The aim of this study was to evaluate whether an intensive intervention based on diet and physical activity has a better impact on the auxological and biochemical parameters than standard care (intervention). The study included 20 children (six boys, 14 girls), of the mean age 8.9 (SD 1.4) before puberty. The participants were randomly assigned to two groups: Group I (starting treatment with intensive intervention), and II (starting treatment with standard intervention). After three months, the groups were switched. The comparison of the two interventions in the study group indicates a better effectiveness of intensive intervention in the improvement of anthropometric parameters and majority of biochemical ones (except for insulin concentration, HOMA IR index and LDL cholesterol). As the result of intensive intervention, the mean % of weight-to-height excess and hip circumference decreased significantly (p < 0.005). Our results confirm that complex intervention based on systematic control visits, including personalized dietitian counselling and physician care, during the weight reduction process is more effective than a one-off standard visit.
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Affiliation(s)
- Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
- Children's University Hospital in Krakow, 30-663 Krakow, Poland
| | - Małgorzata Wójcik
- Children's University Hospital in Krakow, 30-663 Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, 30-663 Krakow, Poland.
| | - Aleksandra Furtak
- Children's University Hospital in Krakow, 30-663 Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, 30-663 Krakow, Poland
| | - Dominika Januś
- Children's University Hospital in Krakow, 30-663 Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, 30-663 Krakow, Poland
| | - Jerzy B Starzyk
- Children's University Hospital in Krakow, 30-663 Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University, Medical College, 30-663 Krakow, Poland
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Psaltopoulou T, Tzanninis S, Ntanasis-Stathopoulos I, Panotopoulos G, Kostopoulou M, Tzanninis IG, Tsagianni A, Sergentanis TN. Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses. World J Pediatr 2019; 15:350-381. [PMID: 31313240 DOI: 10.1007/s12519-019-00266-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity. METHODS An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included. RESULTS Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity. CONCLUSIONS Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.
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Affiliation(s)
- Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str, 115 27, Athens, Greece.
| | - Stamatios Tzanninis
- Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Panotopoulos
- Hellenic Association for the Study of Obesity, Metabolism and Eating Disorders (HASOMED), Athens, Greece
| | - Myrto Kostopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str, 115 27, Athens, Greece
| | | | - Anastasia Tsagianni
- Division of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str, 115 27, Athens, Greece
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Bahia L, Schaan CW, Sparrenberger K, Abreu GDA, Barufaldi LA, Coutinho W, Schaan BD. Overview of meta-analysis on prevention and treatment of childhood obesity. J Pediatr (Rio J) 2019; 95:385-400. [PMID: 30121174 DOI: 10.1016/j.jped.2018.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.
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Affiliation(s)
- Luciana Bahia
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Medicina Interna, Rio de Janeiro, RJ, Brazil; Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil
| | - Camila Wohlgemuth Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Karen Sparrenberger
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil.
| | - Gabriela de Azevedo Abreu
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Laura Augusta Barufaldi
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Brasília, DF, Brazil
| | - Walmir Coutinho
- Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Instituto Estadual de Diabetes e Endocrinologia (IEDE), Rio de Janeiro, RJ, Brazil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Medicina Interna, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Bahia L, Schaan CW, Sparrenberger K, Abreu GDA, Barufaldi LA, Coutinho W, Schaan BD. Overview of meta‐analysis on prevention and treatment of childhood obesity. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Jordan N, Graham AK, Berkel C, Smith JD. Costs of Preparing to Implement a Family-Based Intervention to Prevent Pediatric Obesity in Primary Care: a Budget Impact Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:655-664. [PMID: 30613852 PMCID: PMC6542705 DOI: 10.1007/s11121-018-0970-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The costs associated with implementing evidence-based programs for pediatric obesity contribute to a lack of widespread adoption. This study examined the costs of preparing to implement the Family Check-Up 4 Health (FCU4Health), a family-centered behavioral program for the prevention of pediatric obesity and excess weight gain in primary care. Budget impact analysis was used to estimate the cost of preparing to implement FCU4Health (i.e., the activities to prepare for, but prior to, offering the service to families). Electronic cost capture methods were used to prospectively track personnel time associated with implementation preparation activities. We also estimated the cost of replicating these preparatory activities to inform future decisions to adopt the program and associated budgetary planning. The total cost of FCU4Health implementation preparation in three clinics and developing delivery materials and infrastructure was $181,768, for an average of $60,589 per clinic. Over two thirds of the total cost were personnel related, the largest of which was associated with the time spent developing automated fidelity coding for monitoring (20%), developing and tailoring clinical materials (16%), and training FCU4Health coordinators (15%). Due to these development costs associated with an initial implementation, that we anticipate would not be repeated in full, we estimated the cost to prepare FCU4Health for implementation in a future initiative will range from $15,195 to $17,912 per clinic. This study is a critical step towards equipping decision-makers with comprehensive short-term information about expected costs that are incurred immediately after choosing to adopt an evidence-based program.
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Affiliation(s)
- Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Cady Berkel
- REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA.
| | - Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Zoellner JM, You W, Hill JL, Brock DJP, Yuhas M, Alexander RC, Price B, Estabrooks PA. A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods. Contemp Clin Trials 2019; 84:105801. [PMID: 31260792 DOI: 10.1016/j.cct.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022]
Abstract
While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice - particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IDENTIFIERS: Clincialtrials.gov: NCT03245775.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 304 Hutcheson Hall, 24060, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
| | - Donna-Jean P Brock
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Maryam Yuhas
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Ramine C Alexander
- Department of Family and Consumer Sciences, North Carolina A&T State University, Benbow 202-A, Greensboro, NC 27411, USA
| | - Bryan Price
- UVA Cancer Center, Community Outreach and Education, Main Street, Unit 102, Danville, VA 24541, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
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Hingle MD, Turner T, Going S, Ussery C, Roe DJ, Saboda K, Kutob R, Stump C. Feasibility of a family-focused YMCA-based diabetes prevention program in youth: The E.P.I.C. Kids (Encourage, Practice, and Inspire Change) Study. Prev Med Rep 2019; 14:100840. [PMID: 30911460 PMCID: PMC6416652 DOI: 10.1016/j.pmedr.2019.100840] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 01/08/2023] Open
Abstract
Efficacious lifestyle modification programs for children at risk of type 2 diabetes (T2D) have not been well established outside of clinical settings. In this study, the feasibility of a family-focused, YMCA-based prevention program for children at risk of T2D was evaluated between September 2015 and July 2016 in Tucson, Arizona. A 12-week YMCA-led lifestyle intervention was adapted for 9-12-year-old children and their families to encourage healthy eating, physical activity, and supportive home environments. Two YMCA locations were randomized to offer either a face-to-face lifestyle coach-led intervention or an alternating face-to-face and digitally-delivered intervention. Program feasibility and preliminary effects on child anthropometric and behavioral outcomes were assessed at baseline and post-intervention. Changes were assessed using linear regression combining delivery formats, with adjustment for clustering of participants within site/format. Forty-eight children (10.9 ± 1.2 years old; 45% female; 40% Hispanic; 43% White; 87% obese) and their parents enrolled, and 36 (75%) completed 12-week measures. Weekly program attendance averaged 61%. Participants and coaches highly rated program content and engagement strategies. Statistically significant changes in child BMI-z score (-0.05, p = 0.03) and family food and physical activity environment (+5.5% family nutrition and physical activity score, p = 0.01) were observed. A YMCA-led family-focused T2D intervention was feasible for the YMCA and participants and effects on child weight, behavior, and the home environment warranted further investigation.
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Affiliation(s)
- Melanie D. Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA
- The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Tami Turner
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA
- The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Scott Going
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA
- The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Chris Ussery
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, USA
- The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Denise J. Roe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Randa Kutob
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
- The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
| | - Craig Stump
- Diabetes Program, College of Medicine, University of Arizona, Tucson, AZ, USA
- The Collaboratory for Metabolic Disease Prevention and Treatment, University of Arizona, Tucson, AZ, USA
- Southern Arizona VA Health Care System, Tucson, AZ, USA
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Girona A, Iragola V, Alcaire F, Curutchet MR, Pereira P, Magnani D, Barreto P, Petingi S, Allegue G, Conzalo G, Mosteiro C, Ares G. Factors underlying compliance with a healthy snacking initiative in the school environment: accounts of school principals in Montevideo (Uruguay). Public Health Nutr 2019; 22:726-737. [PMID: 30587269 PMCID: PMC10260554 DOI: 10.1017/s1368980018003488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/12/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals. DESIGN A mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools. SETTING Primary and secondary schools in Montevideo (the capital city of Uruguay). PARTICIPANTS School principals. RESULTS The great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for non-compliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising. CONCLUSIONS Results showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.
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Affiliation(s)
- Alejandra Girona
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Valentina Iragola
- Espacio Interdisciplinario, Universidad de la República, Montevideo, Uruguay
| | - Florencia Alcaire
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Canelones, Uruguay
| | - María Rosa Curutchet
- Observatorio de Seguridad Alimentaria, Instituto Nacional de Alimentación, Montevideo, Uruguay
| | - Pablo Pereira
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Daiana Magnani
- Observatorio de Seguridad Alimentaria, Instituto Nacional de Alimentación, Montevideo, Uruguay
| | - Patricia Barreto
- Observatorio de Seguridad Alimentaria, Instituto Nacional de Alimentación, Montevideo, Uruguay
| | - Sofía Petingi
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Gimena Allegue
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Gonzalo Conzalo
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Camila Mosteiro
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Gastón Ares
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Canelones, Uruguay
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Ryder JR, Kaizer AM, Jenkins TM, Kelly AS, Inge TH, Shaibi GQ. Heterogeneity in Response to Treatment of Adolescents with Severe Obesity: The Need for Precision Obesity Medicine. Obesity (Silver Spring) 2019; 27:288-294. [PMID: 30677258 PMCID: PMC6352902 DOI: 10.1002/oby.22369] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/29/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Treating pediatric severe obesity is challenging because of the complex biological, behavioral, and environmental factors that underpin the disease. The multifactorial etiology of obesity combined with the physiologic complexity of the energy regulatory system contributes to treatment variability. The goal of this secondary analysis of pooled data was to describe the degree of individual variation in response to various interventions among adolescents with severe obesity. METHODS Data from three centers across the United States conducting either lifestyle (n = 53), pharmacotherapy (n = 40), or metabolic and bariatric surgery (n = 78) interventions were pooled. Inclusion criteria were severe obesity at baseline and at least one follow-up visit > 30 days after treatment start. RESULTS Change in BMI following intervention ranged from -50.2% to +12.9%, with each intervention (lifestyle [range: -25.4% to 5.0%], pharmacotherapy [range: -10.8% to 12.9%], and metabolic and bariatric surgery [range: -50.2% to -13.3%]) exhibiting wide individual variation in response. Changes in cardiometabolic risk factors demonstrated similarly high variability. CONCLUSIONS Adolescents with severe obesity demonstrated a high degree of heterogeneity in terms of BMI reduction and cardiometabolic risk factor response across treatment modalities. Reporting individual response data in trials and identifying factors driving variability in response will be vital for advancing precision medicine approaches to address obesity.
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Affiliation(s)
- Justin R. Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Alexander M. Kaizer
- University of Colorado, Denver, and Children’s Hospital Colorado, Aurora, CO
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Aaron S. Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Thomas H. Inge
- University of Colorado, Denver, and Children’s Hospital Colorado, Aurora, CO
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
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Fornari E, Maffeis C. Treatment of Metabolic Syndrome in Children. Front Endocrinol (Lausanne) 2019; 10:702. [PMID: 31681173 PMCID: PMC6803446 DOI: 10.3389/fendo.2019.00702] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023] Open
Abstract
The Metabolic Syndrome may be tentatively defined as the clustering of several metabolic risk factors in the same individual. A progressively higher number of children and adolescents is affected by this syndrome worldwide, mainly as a consequence of the constant increase of the prevalence of obesity and sedentary habits. As obesity, the chance that the metabolic syndrome traks into adulthood is high. Moreover, the evidence of an association between the duration of the exposition to metabolic risk factors and morbidity and mortality justifies early treatment and prevention of the metabolic syndrome in both children and adolescents. Treatment includes behavioral interventions, adequate nutrition and physical activity, and, if necessary, pharmacological treatments aimed at reducing excessive weight, dyslipidemia, hypertension, and glucose impairments. A multidisciplinary and staged approach to treatment, which includes pediatrician, mental health practitioner, dietician, and nurses, is crucial. Usually, the reduction of fat mass promotes an overall improvement of all the components of the metabolic syndrome. Nevertheless, every single component of the metabolic syndrome should be treated as quickly as possible, by using the best current practice. Drugs may be necessary for treating hypertension, type 2 diabetes mellitus and dyslipidemia. In selected cases of gross obesity resistant to treatment, surgical therapy may be also performed.
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Şendur R, Özcabı B, Mutlu GY, Bozaykut A. Effective sociodemographic and clinical factors in weight loss in childhood obesity. Turk Arch Pediatr 2018; 53:169-176. [PMID: 30459516 DOI: 10.5152/turkpediatriars.2018.6210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/12/2018] [Indexed: 11/22/2022]
Abstract
Aim Obesity is a more common and important health problem in childhood. We aimed to determine sociodemographic and clinical factors contributing weight loss. Material and Methods Medical records of 120 obese patients (6-18 years old) applied at least twice for follow-up between 2012 (January)-2016 (September) were reviewed. Age, gender, socioeconomic status, family obesity, comorbidities, medications, operations, exercise frequency, screen time, physical examination findings and biochemical/hormone values [thyroid hormone, fasting insulin/glucose, cholesterol levels, Homeostasis model assesment insulin resistance (HOMA-IR), oral glucose tolerance test results (if applied) were recorded. Patients with a difference between the initial and last body mass index standart deviation higher than -0.2 were defined as "the good losing weight" group; the rest as "the poorly losing weight" group. The SPSS 22.0 program was used for analyzes. Results Puberty stage showed a significant difference (p=0,019); 65% of patients in the poorly losing weight group but 54% of other group were at stage 4-5. The initial body mass index standart deviation and exercise frequency were higher in the good losing weight group, the last measured body mass index standart deviation was lower (p=0). In the other group, baseline HOMA-IR was higher (p=0.037); there were more metformin-initiated patients but the difference was not significant. Conclusion We observed that exercise frequency was higher in cases with good weight loss; therefore, we consider that increasing physical activity is an important step. Other crucial outcomes are that the initial body mass index standart deviation is higher while HOMA-IR is lower in those cases and that puberty stage is higher in poorly weight losing patients.
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Affiliation(s)
- Ruba Şendur
- Clinic of Pediatrics, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Bahar Özcabı
- Division of Pediatric Endocrinology, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Gül Yeşiltepe Mutlu
- Division of Pediatric Endocrinology, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, İstanbul, Turkey.,Division of Pediatric Endocrinology, Koç Univeristy School of Medicine, İstanbul, Turkey
| | - Abdulkadir Bozaykut
- Clinic of Pediatrics, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, İstanbul, Turkey
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