1
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Nicholson WK, Silverstein M, Wong JB, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Krousel-Wood M, Lee S, Li L, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wiehe S. Interventions for High Body Mass Index in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 332:226-232. [PMID: 38888912 DOI: 10.1001/jama.2024.11146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Importance Approximately 19.7% of children and adolescents aged 2 to 19 years in the US have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention growth charts from 2000. The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents and children from lower-income families. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on interventions (behavioral counseling and pharmacotherapy) for weight loss or weight management in children and adolescents that can be provided in or referred from a primary care setting. Population Children and adolescents 6 years or older. Evidence Assessment The USPSTF concludes with moderate certainty that providing or referring children and adolescents 6 years or older with a high BMI to comprehensive, intensive behavioral interventions has a moderate net benefit. Recommendation The USPSTF recommends that clinicians provide or refer children and adolescents 6 years or older with a high BMI (≥95th percentile for age and sex) to comprehensive, intensive behavioral interventions. (B recommendation).
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Affiliation(s)
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | | | - Sei Lee
- University of California, San Francisco
| | - Li Li
- University of Virginia, Charlottesville
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
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2
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Gülşen M, Yalçın SS. Fostering Tomorrow: Uniting Artificial Intelligence and Social Pediatrics for Comprehensive Child Well-being. Turk Arch Pediatr 2024; 59:345-352. [PMID: 39110287 DOI: 10.5152/turkarchpediatr.2024.24076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
This comprehensive review explores the integration of artificial intelligence (AI) in the field of social pediatrics, emphasizing its potential to revolutionize child healthcare. Social pediatrics, a specialized branch within the discipline, focuses on the significant influence of societal, environmental, and economic factors on children's health and development. This field adopts a holistic approach, integrating medical, psychological, and environmental considerations. This review aims to explore the potential of AI in revolutionizing child healthcare from social pediatrics perspective. To achieve that, we explored AI applications in preventive care, growth monitoring, nutritional guidance, environmental risk factor prediction, and early detection of child abuse. The findings highlight AI's significant contributions in various areas of social pediatrics. Artificial intelligence's proficiency in handling large datasets is shown to enhance diagnostic processes, personalize treatments, and improve overall healthcare management. Notable advancements are observed in preventive care, growth monitoring, nutritional counseling, predicting environmental risks, and early child abuse detection. We find that integrating AI into social pediatric healthcare aims to enhance the effectiveness, accessibility, and equity of pediatric health services. This integration ensures high-quality care for every child, regardless of their social background. The study elucidates AI's multifaceted applications in social pediatrics, including natural language processing, machine learning algorithms for health outcome predictions, and AI-driven tools for health and environmental monitoring, collectively fostering a more efficient, informed, and responsive pediatric healthcare system.
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Affiliation(s)
- Murat Gülşen
- Department of Autism, Special Mental Needs and Rare Diseases, Turkish Ministry of Health, Ankara, Türkiye
- Division of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Sıddıka Songül Yalçın
- Division of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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3
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Gaskin CJ, Cooper K, Stephens LD, Peeters A, Salmon J, Porter J. Clinical practice guidelines for the management of overweight and obesity published internationally: A scoping review. Obes Rev 2024; 25:e13700. [PMID: 38296655 DOI: 10.1111/obr.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/17/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
With the increasing prevalence of obesity placing additional demands on healthcare systems, many jurisdictions and professional bodies have developed clinical practice guidelines to support practitioners in the management of people with overweight and obesity. This scoping review aimed to identify key features of contemporary guidelines for the clinical management of overweight and obesity. Searches of MEDLINE, Guidelines International Network's international guidelines library, and other grey literature sources identified 38 guidelines of 18 countries and one region published since 2010. Guidelines were developed by committees (n = 36, 95%) that comprised knowledgeable experts (n = 36, 95%) and were multidisciplinary (n = 33, 87%), with limited consumer representation (n = 11, 29%). Guideline documentation incorporated review questions (n = 23, 61%), systematic reviews (n = 25, 66%), evidence grading systems (n = 33, 87%), processes for reaching consensus (n = 19, 50%), and guideline review details (n = 28, 74%). Treatment approaches included in most guidelines were nutrition and physical activity (n = 38, 100%), psychology (n = 37, 97%), pharmacotherapy (n = 32, 84%), and bariatric surgery (n = 31, 82%). Most guidelines targeted populations based on age (n = 30, 79%). Guidelines contained recommendations for pregnancy (n = 12, 32%), older adults (n = 9, 24%), and people with eating disorders (n = 8, 21%). Future guidelines would benefit from involvement of consumers including groups known to be at increased risk of overweight and obesity, targeted guidance for at risk groups, and consideration of weight bias and stigma.
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Affiliation(s)
- Cadeyrn J Gaskin
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Kelly Cooper
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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4
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Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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5
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Blaxall M, Richardson R, Schoonees A, Metzendorf MI, Durão S, Naude C, Bero L, Farquhar C. Obesity intervention evidence synthesis: Where are the gaps and which should we address first? Obes Rev 2024; 25:e13685. [PMID: 38151751 DOI: 10.1111/obr.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 12/29/2023]
Abstract
Health professionals and policymakers rely on evidence synthesized from high quality research studies. Yet, there remain unanswered questions about how to prevent and treat obesity. In this research project, international practice guidelines and Cochrane systematic reviews were examined in order to identify gaps in the synthesized obesity intervention evidence base. One hundred and forty-two partial or complete gaps were found. Systematic review questions to address these gaps were formulated and subjected to a prioritization consultation process with 36 international obesity expert stakeholders. Forty-three review questions were priority-assessed. The top 10 ranked review questions received support from at least 75.0% of stakeholders. The leading questions focused on preventive and community-based approaches, including those delivered through primary-care. Children within the context of their families were a highly-prioritized target group, as were persons with diabetes or disabilities. Experts also prioritized reviews to determine which elements of programs are the most effective, and by which mode they are best delivered. Experts recommended that negative, psycho-social, and longer-term outcomes be captured in reviews. We request reviewers and funders to strongly consider addressing the top 10 leading prioritized review questions presented here.
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Affiliation(s)
- Michelle Blaxall
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Anel Schoonees
- Centre for Evidence-based Healthcare, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Solange Durão
- South African Medical Research Council, Capetown, South Africa
| | - Celeste Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lisa Bero
- School of Medicine and Public Health, Center for Bioethics and Humanities, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Cindy Farquhar
- School of Medicine, University of Auckland; National Women's Health Services, Auckland Hospital, Auckland, New Zealand
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6
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Lee-Baggley D, Fils-Aimé N, Audet I, Barakat M. Improving implementation of best practices in obesity management: Physician experiences in obesity care. Clin Obes 2024; 14:e12624. [PMID: 37846529 DOI: 10.1111/cob.12624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/20/2023] [Accepted: 06/23/2023] [Indexed: 10/18/2023]
Abstract
In this study, we sought to analyse experiences in weight management among physicians working in the area of obesity and contrast these experiences with best practices. By understanding experiences of physicians working in obesity management, we can better support implementation of best practices in their day-to-day practice. An online survey of Canadian primary care physicians, internists and endocrinologists recruited from a nationwide market research database was conducted. The survey captured demographic characteristics and perceptions about weight loss and its management. One hundred and ninety-two physicians (140 primary care, 22 internists and 30 endocrinologists) were recruited and completed the survey. Challenges identified by the physicians in helping patients lose weight included patients' poor compliance and lack of time and resources to address the issue. Most physicians reported considering obesity to be a chronic disease, but most did not incorporate a multi-dimensional, chronic disease model of obesity treatment (i.e., combination of lifestyle interventions with psychological, medical and/or surgical interventions). Endocrinologists reported management practices consistent with a chronic disease model more frequently than primary care physicians. These data highlight the need for improvement in obesity management, particularly in primary care. Despite proliferation of guidelines on best practices, implementation of these practices into daily practice remains low.
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Affiliation(s)
- Dayna Lee-Baggley
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychology Department, Saint Mary's University, Halifax, Nova Scotia, Canada
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7
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Yudkin JS, Koym K, Hamad Y, Malthaner LQ, Burgess RM, Ortiz LN, Dhurjati N, Mitha S, Calvi G, Hill K, Brownell M, Wei E, Swartz K, Atem FD, Galeener CA, Messiah SE, Barlow SE, Allicock MA. Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework. Transl Behav Med 2024; 14:34-44. [PMID: 37632769 DOI: 10.1093/tbm/ibad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023] Open
Abstract
Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.
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Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kelsey Koym
- Texas Medical Center Library, Houston, TX, USA
| | - Yasmin Hamad
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Lauren Q Malthaner
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Rebecca Meredith Burgess
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Nalini Dhurjati
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sharmin Mitha
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Gabriela Calvi
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kristina Hill
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Elena Wei
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kyle Swartz
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
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8
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Minghetti A, Faude O, Donath L, Hanssen H. Effects of a cluster-randomized exercise intervention on cardiovascular health in preschoolers. J Child Health Care 2023; 27:424-434. [PMID: 35229675 DOI: 10.1177/13674935221078368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary health prevention in at-risk children is receiving increased attention while less information is available on cardiovascular profile and response to exercise in healthy children. Our study examined the effects of a gross motor skill-based exercise intervention on micro- and macro-vascular health in preschoolers. This is a sub-study of a five-armed clinical trial with six kindergartens and 68 children. Four kindergartens were assigned to the intervention group (INT) and two to control groups (CON). We performed gross motor skill assessment (TGMD-2), static retinal vessel analysis, and measurements of central hemodynamics before and after the intervention. INT received one weekly exercise session for 25 weeks, while CON received no intervention. We calculated linear regressions correcting for age, sex, BMI-percentile, and baseline. We observed favorable effects in TGMD-2 for INT over CON (Cohen's d = 0.52 95% CI [0.15; 0.90]). Trivial between-group differences were observed in retinal vessel diameters (0.08 < d ≤ 0.29) and trivial to moderate differences in all other arterial stiffness parameters (-0.55 < d ≤ 0.31). Motor-skill based interventions are sensible measures to incorporate physical activity in pre-schools and improve gross motor proficiency at a very young age. The potential of motor skill-based interventions as primordial prevention strategy in healthy preschoolers needs to be further investigated.
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Affiliation(s)
- Alice Minghetti
- Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Switzerland
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9
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Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T, Summerbell C, Wabitsch M. Child and adolescent obesity. Nat Rev Dis Primers 2023; 9:24. [PMID: 37202378 DOI: 10.1038/s41572-023-00435-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andrew J Hill
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Claude Marcus
- Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany
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10
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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: 15] [Impact Index Per Article: 15.0] [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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11
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Anderson LN, Yoshida-Montezuma Y, Jambon M, Smith BT, Carsley S, Gonzalez A. Income precarity and child and parent weight change during the COVID-19 pandemic: a cross-sectional analysis of the Ontario Parent Survey. BMJ Open 2022; 12:e063653. [PMID: 36600386 PMCID: PMC9742846 DOI: 10.1136/bmjopen-2022-063653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To describe child and parent weight change during the pandemic, overall and by income precarity. DESIGN A cross-sectional online survey was conducted. SETTING Caregivers of children 0-17 years of age living in Ontario, Canada, during the COVID-19 pandemic from May 2021 to July 2021. PARTICIPANTS A convenience sample of parents (n=9099) with children (n=9667) living in Ontario were identified through crowdsourcing. PRIMARY OUTCOME MEASURE Parents recalled, for themselves and their child, whether they lost weight, gained weight or remained the same over the past year. OR and 95% CI were estimated using multinomial logistic regression for the association between income precarity variables and weight loss or gain, adjusted for age, gender and ethnicity. RESULTS Overall, 5.5% of children lost weight and 20.2% gained weight. Among adolescents, 11.1% lost weight and 27.1% gained weight. For parents, 17.1% reported weight loss and 57.7% reported weight gain. Parent weight change was strongly associated with child weight change. Income precarity measures, including job loss by both parents (OR=7.81, 95% CI 5.16 to 11.83) and disruption to household food supply (OR=6.05, 95% CI 4.77 to 7.68), were strongly associated with child weight loss. Similarly, job loss by both parents (OR=2.03, 95% CI 1.37 to 3.03) and disruption to household food supply (OR=2.99, 95% CI 2.52 to 3.54) were associated with child weight gain. CONCLUSIONS Weight changes during the COVID-19 pandemic were widespread and income precarity was strongly associated with weight loss and weight gain in children and parents. Further research is needed to investigate the health outcomes related to weight change during the pandemic, especially for youth, and the impacts of income precarity.
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Affiliation(s)
- Laura N Anderson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | | | - Marc Jambon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention Program, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Carsley
- Health Promotion, Chronic Disease and Injury Prevention Program, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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12
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Lim CYS, Foo YW, Tok CLX, Lim YY, Loke KY, Lee YS, Ng NBH. Screening for metabolic complications of childhood and adolescent obesity: A scoping review of national and international guidelines. Obes Rev 2022; 23:e13513. [PMID: 36286080 DOI: 10.1111/obr.13513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
The rise in prevalence of childhood obesity is paralleled by an increase in obesity-related metabolic complications, which add significantly to the population burden of cardiovascular morbidity in the long term. Early detection of obesity-related metabolic complications through appropriate screening strategies forms a crucial aspect of obesity management. We performed a scoping review of international and national guidelines on the management of pediatric obesity to evaluate the recommendations on screening for metabolic complications, namely, hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease. Thirty guidelines were included, 23 (76.7%) of which had some guidance on screening for metabolic complications. However, there were significant variations in the extent and details of recommendations for screening for these metabolic complications. There has been no consensus on the body mass index (BMI) thresholds, age of onset, frequency, and screening tests recommended for detecting hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease between guidelines. These variations did not appear to be polarized based on geographical location or population ethnicity. We provide our recommendations on metabolic screening based on the strength of evidence in the guidelines, also incorporating recommendations from key childhood hypertension, diabetes, and lipid guidelines. Appropriate implementation of screening strategies is crucial to improve detection of metabolic complications, to allow for earlier or more intensified interventions for affected children with obesity.
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Affiliation(s)
- Carey Yun Shan Lim
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yu Wah Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chanel Li Xuan Tok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yvonne Yijuan Lim
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Tully L, Arthurs N, Wyse C, Browne S, Case L, McCrea L, O’Connell JM, O’Gorman CS, Smith SM, Walsh A, Ward F, O’Malley G. Guidelines for treating child and adolescent obesity: A systematic review. Front Nutr 2022; 9:902865. [PMID: 36313105 PMCID: PMC9597370 DOI: 10.3389/fnut.2022.902865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.
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Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh Arthurs
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Cathy Wyse
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Lois McCrea
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Jean M. O’Connell
- St. Columcille’s Hospital Weight Management Service, St.Vincent’s University Hospital, Dublin, Ireland
| | - Clodagh S. O’Gorman
- School of Medicine, University of Limerick, Limerick, Ireland,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| | - Susan M. Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Ward
- Department of Clinical Nutrition and Dietetics, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Grace O’Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland,*Correspondence: Grace O’Malley,
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14
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Gooey M, Skouteris H, Betts J, Hatzikiriakidis K, Sturgiss E, Bergmeier H, Bragge P. Clinical practice guidelines for the prevention of childhood obesity: A systematic review of quality and content. Obes Rev 2022; 23:e13492. [PMID: 35818135 PMCID: PMC9539478 DOI: 10.1111/obr.13492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Obesity in childhood is a significant global issue, and prevention is key to reducing prevalence. Healthcare providers can play an important role in the prevention of obesity. The aim of this systematic review was to identify and evaluate clinical practice guidelines (CPGs) for preventing childhood obesity with a focus on the role of medical doctors. Peer-reviewed literature and gray literature sources were searched for CPGs published from 2010 to 2021. Eleven CPGs were identified. Quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Collaboration (AGREE II) instrument; seven CPGs were higher quality and four lower quality. Recommendations within the CPGs covered three main areas: growth monitoring, maintaining a healthy weight, and managing overweight. The importance of involving the whole family and healthy lifestyle behaviors was emphasized. The majority of the CPGs rated poorly in guideline applicability highlighting the need for practical implementation tools. Although our review identified a number of CPGs relevant to the prevention of obesity for doctors working with children and their families, more research is needed to produce high-quality meaningful and applicable CPGs to maximize uptake, implementation, and ultimately, benefit to children and their families.
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Affiliation(s)
- Michelle Gooey
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Warwick Business School, University of Warwick, Coventry, UK
| | - Juliana Betts
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
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15
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Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol 2022; 10:351-365. [PMID: 35248172 PMCID: PMC9831747 DOI: 10.1016/s2213-8587(22)00047-x] [Citation(s) in RCA: 238] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
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Affiliation(s)
- Hiba Jebeile
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Louise A Baur
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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16
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Ball GDC, Eaton A, Rathwell S, Peng C, Maximova K, Kokkvoll A, Zehnder E, Ho J, Perez A. Re-referring Children for Multidisciplinary Obesity Management. J Pediatr 2022; 244:101-106.e2. [PMID: 35074309 DOI: 10.1016/j.jpeds.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To examine characteristics of children referred for obesity management based on referral frequency, child- and referrer-related variables associated with re-referral, and determine whether re-referral increased treatment initiation. STUDY DESIGN This population-level, retrospective analysis included all 2- to 17-year-olds referred for obesity management to 1 of 3 multidisciplinary clinics in Alberta, Canada between April 2013 and December 2017. Children were dichotomized based on referral frequency, specifically once only or more than once (re-referred). Data were retrieved from standardized referral forms and patient registries. Analyses included logistic regression and generalized estimating equations models. RESULT We analyzed data from 2745 children (47.2% female; mean age: 11.4 years; mean body mass index z score: 3.03) and 2705 physicians (60.2% female; 65.6% pediatricians). Overall, 300 (10.2%) children were re-referred with most (n = 276; 92.0%) being referred twice. Children were less likely to be re-referred if they were referred by a family physician (vs pediatrician) (aOR 0.62; 95% CI 0.46-0.84; P = .0018) or scheduled a clinic appointment following their index referral (aOR: 0.29; 95% CI 0.21-0.4; P < .001). Treatment initiation was higher in children who were referred once only (42.1%) vs their re-referred peers (18.0%; P < .0001); however, for children who were re-referred, they were more likely to initiate treatment following their second referral (aOR 2.3; 95% CI 1.22-4.31; P = .01). This improvement was not sustained on subsequent referrals (aOR 0.44; 95% CI 0.17-1.12; P = .08). CONCLUSIONS Few children were re-referred for pediatric obesity management; however, for those children who were re-referred, being re-referred once only increased the likelihood of treatment initiation.
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Andrea Eaton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Rathwell
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Chenhui Peng
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ane Kokkvoll
- Department of Pediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Emily Zehnder
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Josephine Ho
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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17
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Krueger H, Robinson S, Hancock T, Birtwhistle R, Buxton JA, Henry B, Scarr J, Spinelli JJ. Priorities among effective clinical preventive services in British Columbia, Canada. BMC Health Serv Res 2022; 22:564. [PMID: 35473549 PMCID: PMC9044882 DOI: 10.1186/s12913-022-07871-0] [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: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing. Methods We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained. Results Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services. Conclusions These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
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Affiliation(s)
- Hans Krueger
- H. Krueger & Associates Inc., Delta, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard Birtwhistle
- Department of Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada.,Canadian Task Force on Preventive Health Care, Ottawa, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Center for Disease Control, Vancouver, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Ministry of Health, Victoria, Canada
| | - Jennifer Scarr
- Child Health BC, Provincial Health Services Authority, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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18
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Johnston BC, Merdad R, Sherifali D, Kebbe M, Birken CS, Buchholz A, Ge L, Gehring ND, Hadjiyannakis S, Hamilton J, Hatanaka D, Henderson M, Lebel T, Moore SA, Morrison KM, Salas XR, Sebastianski M, Zenlea IS, Ball GDC. Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol. CMAJ Open 2022; 10:E155-E164. [PMID: 35232814 PMCID: PMC8896489 DOI: 10.9778/cmajo.20200289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity. METHODS This guideline will update the pediatric components of the 2007 Canadian clinical practice guideline for the management of obesity. In partnership with Obesity Canada, we began preliminary work in 2019; activities are scheduled for completion in 2022. The guideline will follow standards developed by the National Academy of Medicine and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Guideline development will be informed by 5 complementary literature reviews: a scoping review that focuses on clinical assessment in pediatric obesity management and 4 systematic reviews to synthesize evidence regarding families' values and preferences as well as the safety and effectiveness of interventions (psychological and behavioural; pharmacotherapeutic; and surgical). We will use standard systematic review methodology, including summarizing and assessing the certainty of evidence and determining the strength of recommendations. Competing interests will be managed proactively according to recommendations from the Guidelines International Network. Diverse stakeholders, including families and clinicians, will be engaged throughout guideline development. INTERPRETATION The guideline will support Canadian families and clinicians to make informed, value-sensitive and evidence-based clinical decisions related to managing pediatric obesity. The guideline and accompanying resources for end-users will be published in English and French, and we will partner with Obesity Canada to optimize dissemination using integrated and end-of-project knowledge translation.
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Affiliation(s)
- Bradley C Johnston
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Roah Merdad
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Diana Sherifali
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Maryam Kebbe
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Catherine S Birken
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Annick Buchholz
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Long Ge
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Nicole D Gehring
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Stasia Hadjiyannakis
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Jill Hamilton
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Dawn Hatanaka
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Mélanie Henderson
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Tracy Lebel
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Sarah A Moore
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Katherine M Morrison
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Ximena Ramos Salas
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Meghan Sebastianski
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Ian S Zenlea
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont
| | - Geoff D C Ball
- Departments of Nutrition and of Epidemiology and Biostatistics (Johnston), Texas A&M University, College Station, Tex.; Department of Community Health and Epidemiology (Johnston, Merdad), Dalhousie University, Halifax, NS; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Pennington Biomedical Research Center (Kebbe), Louisiana State University, Baton Rouge, La.; Department of Paediatrics (Birken, Hamilton), University of Toronto, Toronto, Ont.; Children's Hospital of Eastern Ontario Research Institute (Buchholz), Ottawa, Ont.; Department of Psychology (Buchholz), Carleton University, Ottawa, Ont.; Evidence-based Social Science Research Centre (Ge), School of Public Health, Lanzhou University, Lanzhou, China; School of Public Health (Gehring), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Hadjiyannakis), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Obesity Canada (Hatanaka, Ramos Salas), Edmonton, Alta.; Department of Pediatrics (Henderson), Université de Montréal, Montréal, Que.; Centre de recherche du Centre hospitalier universitaire Sainte-Justine (Henderson), Montréal, Que.; Department of Social and Preventive Medicine (Henderson), School of Public Health, Université de Montréal, Montréal, Que.; patient and family partner (Lebel), Edmonton, Alta.; School of Health & Human Performance (Moore), Faculty of Health, Dalhousie University, Halifax, NS; Department of Pediatrics (Morrison), McMaster University, Hamilton, Ont.; Department of Pediatrics (Sebastianski, Ball), University of Alberta, Edmonton, Alta.; Institute for Better Health (Zenlea), Trillium Health Partners, Mississauga, Ont.
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Lamb M, Buchholz A, Gunnell KE, Valois DD, Obeid N, Henderson K, Flament M, Goldfield GS. Examining the Bidirectional Association Between Body Esteem and Body Mass Index During Adolescence. J Dev Behav Pediatr 2021; 42:631-636. [PMID: 33908378 DOI: 10.1097/dbp.0000000000000945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Research on body esteem (weight and appearance esteem) and weight suggests that having a positive body esteem may be associated with more stable weight trajectories during adolescence, and adolescents with higher weight report lower levels of body esteem. However, bidirectional relationships between body esteem and weight have not yet been examined. This 3-year longitudinal study examined (1) bidirectional relationships between body esteem and body mass index (BMI) and (2) how BMI and body esteem changed together throughout adolescence. METHODS Participants (N = 1163 adolescents, at time 1 [T1] baseline; 60.3% female) from a school-based community sample completed surveys approximately annually for 3 years. RESULTS Latent growth modeling revealed that (a) among boys and girls, appearance and weight esteem scores decreased over time, (b) higher initial BMI scores were associated with slower decreases in appearance esteem over time. However, evidence for bidirectionality was not found, in which baseline appearance and weight esteem did not predict changes in BMI over time and vice versa. CONCLUSION Results suggest that changes in BMI and body esteem are co-occurring (rather than predictive) throughout adolescence. The decreasing trajectory of body esteem over time suggests the need for prevention efforts to improve body esteem throughout adolescence.
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Affiliation(s)
- Megan Lamb
- Carleton University Department of Psychology, Ottawa, ON, Canada
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Annick Buchholz
- Carleton University Department of Psychology, Ottawa, ON, Canada
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Katie E Gunnell
- Carleton University Department of Psychology, Ottawa, ON, Canada
| | - Darcie D Valois
- Carleton University Department of Psychology, Ottawa, ON, Canada
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nicole Obeid
- Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | - Gary S Goldfield
- Carleton University Department of Psychology, Ottawa, ON, Canada
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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20
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Gehring ND, Kebbe M, Rathwell S, Perez A, Peng C, Zendher E, Ho J, Ball GDC. Physician-related predictors of referral for multidisciplinary paediatric obesity management: a population-based study. Fam Pract 2021; 38:576-581. [PMID: 33755099 DOI: 10.1093/fampra/cmab019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health. OBJECTIVE To determine predictors of referral to multidisciplinary paediatric obesity management. METHODS This retrospective, population-level study included physicians who could refer 2-17 years old with a body mass index ≥85th percentile to one of three multidisciplinary paediatric obesity management clinics in Alberta, Canada. Physician demographic and procedural data were obtained from Practitioner Claims and Provider Registry maintained by Alberta Health from January 2014 to December 2017. Physician characteristics were compared based on whether they did or did not refer children for obesity management. Univariable and multivariable logistic regression models analysed associations between physician characteristics and referral making. RESULTS Of the 3863 physicians (3468 family physicians, 395 paediatricians; 56% male; 49.3 ± 12.2 years old; 22.3 ± 12.6 years since graduation) practicing during the study period, 1358 (35.2%) referred at least one child for multidisciplinary paediatric obesity management. Multivariable regression revealed that female physicians (versus males) [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.46-1.93; P < 0.0001], paediatricians (versus family physicians) (OR: 4.89, 95% CI: 3.85-6.21; P < 0.0001) and urban-based physicians (versus non-urban-based physicians) (OR: 2.17, 95% CI: 1.79-2.65; P < 0.0001) were more likely to refer children for multidisciplinary paediatric obesity management. CONCLUSIONS Approximately one-third of family physicians and paediatricians referred children for multidisciplinary paediatric obesity management. Strategies are needed to improve referral practices for managing paediatric obesity, especially among male physicians, family physicians and non-urban-based physicians as they were less likely to refer children.
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Affiliation(s)
- Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Sarah Rathwell
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chenhui Peng
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Emily Zendher
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Josephine Ho
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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21
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Zahn K, Ibrahim Q, Ball GDC, Buchholz A, Hamilton J, Ho J, Laberge AM, Legault L, Tremblay MS, Zenlea I, Thabane L, Chanoine JP, Morrison KM. Variability in How Canadian Pediatric Weight Management Clinics Deliver Care: Evidence from the CANadian Pediatric Weight Management Registry. Child Obes 2021; 17:420-426. [PMID: 33978453 DOI: 10.1089/chi.2021.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Clinical practice guidelines for pediatric weight management highlight the importance of family-based behavioral strategies to enhance health behaviors. Little is known, however, of how clinics implement these programs. The study objectives were to (1) describe how Canadian pediatric weight management clinics deliver care and (2) evaluate change in services over time. Methods: The CANadian Pediatric Weight management Registry (CANPWR) is a multisite prospective cohort study of participants enrolled in a Canadian pediatric weight management clinic. Clinical program characteristics (e.g., referral process, inclusion criteria, funding, program characteristics, patient interaction methods, and follow-up) were collected at the start and end of the CANPWR recruitment period (2015-2019). Results: Entrance into the nine clinics varied with limiting criteria based on geographic proximity, age, weight status, and presence of health conditions. The clinics varied in size (50-220 new patients/year). The planned length of intervention varied widely, from 10 weeks to open-ended (median 2 years). Behavior modification strategies were delivered with a mix of individual and group-based sessions and most were delivered in person, complemented by use of virtual care. Over time, more clinics saw patients under the age of 5 years and all clinics defined a program length. Conclusion: Although all clinics offered family-based behavioral weight management services, these varied considerably, especially in program entrance criteria, size of clinic, and the length of intervention. The influence of the variability in delivery of services on health outcomes will be addressed in future studies.
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Affiliation(s)
- Kristen Zahn
- Department of Pediatrics, Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Quazi Ibrahim
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jill Hamilton
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Laberge
- Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners and Department of Pediatrics, University of Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Pediatrics, Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jean-Pierre Chanoine
- Pediatric Endocrinology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
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22
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Hale I, Jackson E. Evaluating routine pediatric growth measurement as a screening tool for overweight and obese status. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:161-165. [PMID: 33727374 DOI: 10.46747/cfp.6703161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Hale
- Family physician and Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia.
| | - Emma Jackson
- Family medicine resident at the University of British Columbia
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23
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Tsiros MD, Vincent HK, Getchell N, Shultz SP. Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review. Curr Sports Med Rep 2021; 20:374-383. [PMID: 34234093 DOI: 10.1249/jsr.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.
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Affiliation(s)
- Margarita D Tsiros
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, Adelaide, SA, AUSTRALIA
| | - Heather K Vincent
- Department of Orthopaedics and Rehabilitation, Division of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
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24
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Vanderloo LM, Vanderhout SM, Tavares E, Maguire J, Straus S, Birken CS. Parent engagement in co-design of clinical trials: the PARENT trial. Trials 2021; 22:347. [PMID: 34001229 PMCID: PMC8130403 DOI: 10.1186/s13063-021-05305-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
Evidence generated from partnering with parents to design and conduct research together may be used to refine, adjust, and modify future research approaches. This study aimed to describe the initial approaches to parent engagement in the design of the PARENT trial as well as understand parent perspectives on the acceptability and relevance of the PARENT trial and potential barriers and facilitators to participation.Parents participating in the TARGet Kids! cohort were invited to participate in a focus group, called the PARENT panel, to co-design the PARENT trial. This focus group was conducted to capture diverse individual and collective parents' experiences. Overall methodological approaches for the PARENT panel were informed by the CIHR Strategy for Patient Oriented Research (SPOR) guiding principles (mutual respect, co-building, inclusiveness, and support) for patient engagement in research, and facilitated through the Knowledge Translation Program in the Li Ka Shing Knowledge Institute at Unity Health Toronto. Using a Nominal Group Technique, the PARENT panel provided feedback on the feasibility, relevance, and acceptability of the proposed intervention. Findings from this work will be used to further refine, adjust, and modify the next iteration of the PARENT trial, which will also serve as an opportunity to discuss the efforts made by researchers to incorporate parent suggestions and what additional steps are required for improved patient engagement.
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Affiliation(s)
- Leigh M Vanderloo
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
- School of Occupational Therapy, Health & Rehabilitation Sciences, Western University, London, Canada.
| | - Shelley M Vanderhout
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Erika Tavares
- Genetics and Genome Biology, The Hospital for Sick Children Research Institute [Parent representative], Toronto, Canada
| | - Jonathon Maguire
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Straus
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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25
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Hale I, Jackson E. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:166-170. [PMID: 33727375 PMCID: PMC7963017 DOI: 10.46747/cfp.6703166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ilona Hale
- Médecin de famille et professeure adjointe de clinique au Département de la pratique familiale de l'Université de la Colombie-Britannique.
| | - Emma Jackson
- Résidente en médecine familiale à l'Université de la Colombie-Britannique
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26
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Alman KL, Lister NB, Garnett SP, Gow ML, Aldwell K, Jebeile H. Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines. Obes Rev 2021; 22:e13132. [PMID: 32896058 DOI: 10.1111/obr.13132] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first-line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low-energy diet (n = 4), protein-sparing modified fast (n = 2), and very low-carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.
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Affiliation(s)
- Kim L Alman
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Camperdown, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie B Lister
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Hiba Jebeile
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
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27
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Doucet E, Hall K, Miller A, Taylor VH, Ricupero M, Haines J, Brauer P, Gudzune KA, House JD, Dhaliwal R. Emerging insights in weight management and prevention: implications for practice and research. Appl Physiol Nutr Metab 2020; 46:288-293. [PMID: 33086027 DOI: 10.1139/apnm-2020-0585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent advances in foundational research on energy balance and weight loss shed new light on earlier findings. Emerging evidence and insights around mental illness and client-centred, weight-inclusive approaches have implications for practitioners. This paper provides an overview of opinions from invited experts who presented at the Canadian Nutrition Society Thematic Conference in January 2019. Novelty: Weight loss involves an interplay of multiple factors, not diet alone. There is no "best diet" or treatment approach for weight loss. Future research should involve minimizing weight loss countermeasures and new health system-based approaches aimed at improving health.
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Affiliation(s)
- Eric Doucet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrea Miller
- Nutrition & Dietetics, Private Practice, 74 Kearney Drive, Ajax, ON L1T 2T7, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, Foothills Hospital, University of Calgary, AB T2N 2T9, Canada
| | - Maria Ricupero
- Nutrition & Dietetics, Private Practice, 136 Geoffrey St., Toronto ON M6R 1P5, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - James D House
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Rupinder Dhaliwal
- Metabolic Syndrome Canada, 1164 Trailhead Place, Kingston, ON K7M 9H3, Canada
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28
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Kosowan L, Page J, Protudjer J, Williamson T, Queenan J, Singer A. Characteristics associated with pediatric growth measurement collection in electronic medical records: a retrospective observational study. BMC FAMILY PRACTICE 2020; 21:191. [PMID: 32933471 PMCID: PMC7490864 DOI: 10.1186/s12875-020-01259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022]
Abstract
Background Complete growth measurements are an essential part of pediatric care providing a proxy for a child’s overall health. This study describes the frequency of well-child visits, documented growth measurements, and clinic and provider factors associated with measurement. Methods Retrospective cross-sectional study utilizing electronic medical records (EMRs) from primary care clinics between 2015 and 2017 in Manitoba, Canada. This study assessed the presence of recorded height, weight and head circumference among children (0–24 months) who visited one of 212 providers participating in the Manitoba Primary Care Research Network. Descriptive and multivariable logistic regression analyses assessed clinic, provider, and patient factors associated with children having complete growth measurements. Results Our sample included 4369 children. The most frequent growth measure recorded was weight (79.2% n = 3460) followed by height (70.8% n = 3093) and head circumference (51.4% n = 2246). 67.5% of children (n = 2947) had at least one complete growth measurement recorded (i.e. weight, height and head circumference) and 13.7% (n = 599) had complete growth measurements at all well-child intervals attended. Pediatricians had 2.7 higher odds of documenting complete growth measures within well-child intervals compared to family physicians (95% CI 1.8–3.8). Additionally, urban located clinics (OR 1.7, 95% CI 1.2–2.5), Canadian trained providers (OR 2.3, 95% CI 1.4–3.7), small practice size (OR 1.6, 95% CI 1.2–2.2) and salaried providers (OR 3.4, 95% CI 2.2–5.2) had higher odds of documented growth measures. Conclusions Growth measurements are recorded in EMRs but documentation is variable based on clinic and provider factors. Pediatric growth measures at primary care appointments can improve primary prevention and surveillance of child health outcomes.
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Affiliation(s)
- Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Page
- The Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Jennifer Protudjer
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tyler Williamson
- Departments of Biostatistics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - John Queenan
- Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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29
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Khoury M, Kavey REW, St Pierre J, McCrindle BW. Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology. Can J Cardiol 2020; 36:1417-1428. [PMID: 32679170 PMCID: PMC7358764 DOI: 10.1016/j.cjca.2020.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.
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Affiliation(s)
- Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Rae-Ellen W. Kavey
- Preventive Cardiology–Lipid Clinic, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Julie St Pierre
- Department of Pediatrics, McGill University, Clinique 180, Montréal, Québec, Canada
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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30
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Gates A, Elliott SA, Shulhan-Kilroy J, Ball GDC, Hartling L. Effectiveness and safety of interventions to manage childhood overweight and obesity: An Overview of Cochrane systematic reviews. Paediatr Child Health 2020; 26:310-316. [PMID: 34336060 DOI: 10.1093/pch/pxaa085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Childhood overweight and obesity are associated with adverse physical, social, and psychological outcomes. Objectives We conducted an overview of Cochrane systematic reviews on the effectiveness and risks of interventions to treat overweight and obesity in children and adolescents. Methods In June 2019, we searched the Cochrane Database of Systematic Reviews for eligible reviews. The primary outcomes were change in adiposity (body mass and body mass index [BMI] z-score) and adverse events. Two reviewers screened studies and one reviewer extracted and another verified data. Two reviewers assessed methodological quality and reached consensus. Data were synthesized narratively. Results We included seven Cochrane reviews published between 2011 and 2017 containing evidence from 167 randomized controlled trials with 21,050 participants. Lifestyle and behavioural interventions more effectively reduced weight compared with no intervention, usual care, or another behavioural treatment (three reviews, low-to-moderate certainty). Parent-child lifestyle and behavioural interventions more effectively reduced BMI z-score compared with no intervention (one review, low certainty). Decision support tools for healthcare providers more effectively limited increases in BMI z-score compared with usual care (one review, moderate certainty). Pharmacologic treatments combined with behavioural modification more effectively reduced adiposity compared with placebo or usual care (one review, low certainty), but the risk of adverse events was greater than non-pharmacologic therapy. Surgical interventions (e.g., LAP-BAND) combined with behavioural modification more effectively reduced adiposity compared with behavioural modification alone (one review, low certainty). Those who underwent surgery reported a higher number of adverse events compared with those treated with lifestyle modification. Conclusions There is low-certainty evidence that lifestyle and behavioural interventions, pharmacologic interventions, and surgical interventions are effective in weight management for children with overweight and obesity. Safety data remain lacking across all intervention modalities. Future research should focus on implementation strategies. Further, a focus on overall well-being may be more beneficial than weight management specifically.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Sarah A Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta.,Cochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Jocelyn Shulhan-Kilroy
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta.,Cochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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31
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Rombeek M, De Jesus S, Prapavessis H, Dempsey AA, Fraser D, Welisch E, Altamirano-Diaz L, Norozi K. Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study. PATIENT EDUCATION AND COUNSELING 2020; 103:1326-1334. [PMID: 32089389 DOI: 10.1016/j.pec.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children. METHODS Thirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified. RESULTS There was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change. CONCLUSIONS The study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children. PRACTICE IMPLICATIONS Remote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.
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Affiliation(s)
- Meghan Rombeek
- Department of Paediatrics, Western University, London, Canada
| | - Stefanie De Jesus
- Department of Paediatrics, Western University, London, Canada; School of Kinesiology, Western University, London, Canada
| | | | - Adam A Dempsey
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada
| | - Douglas Fraser
- Department of Paediatrics, Western University, London, Canada; Children's Health Research Institute, London, Canada; Translational Research Centre, London, Canada; Lawson Health Research Institute, London, Canada
| | - Eva Welisch
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada
| | - Luis Altamirano-Diaz
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, Canada; Paediatric Cardiopulmonary Research Laboratory, London Health Science Centre, London, Canada; Children's Health Research Institute, London, Canada; Lawson Health Research Institute, London, Canada; Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany.
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32
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Bonder R, Provvidenza CF, Hubley D, McPherson AC. Putting positive weight-related conversations into practice: The pilot implementation of a Knowledge Translation Casebook. Child Care Health Dev 2020; 46:360-368. [PMID: 32083751 DOI: 10.1111/cch.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healthcare professionals (HCPs) play an important role in discussing weight with children and their parents but report barriers such as lack of training and supports. These barriers are especially prevalent within specialized populations such as children with autism spectrum disorder (ASD). To address this, a Knowledge Translation Casebook on positive weight-related conversations was developed by a research team at a Canadian paediatric hospital. The purpose of the current pre-implementation pilot study was to explore initial acceptability and adoption of the Casebook into clinical settings. METHODS An interactive, multimodal education workshop was created to provide HCPs with knowledge and training on how to have positive weight-related conversations with children and parents. Two workshops were conducted using the same curriculum but delivered either in-person or online. Participants were drawn from a team of clinicians at a teaching hospital whose care focuses on medication management for clients with ASD and clinicians participating in a distance learning programme on best practice care for clients with ASD. Participants completed a demographic questionnaire, workshop evaluation, and a pre-workshop and post-workshop questionnaire. Descriptive statistics were used to summarize demographic, questionnaire, and survey data. Answers to open-ended questions were analysed using content analysis. RESULTS Participants agreed that the workshop gave them a clear understanding of the Casebook's content and helped them easily navigate the Casebook. Based on raw scores, self-efficacy in having weight-related conversations seemed to increase from pre-to post-workshop, but reported weight-management clinical practice scores did not change over time. However, the small sample precluded in-depth statistical analysis. CONCLUSIONS The Casebook was acceptable and appeared to increase self-efficacy about having weight-related conversations with children with ASD and parents. More robust implementation strategies are needed to foster the uptake of best practices in weight-related conversations into clinical practice.
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Affiliation(s)
- Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Darlene Hubley
- Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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33
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Mansoor Y, Hale I. Parent perceptions of routine growth monitoring: A scoping review. Paediatr Child Health 2020; 26:154-158. [PMID: 33936334 DOI: 10.1093/pch/pxaa041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Despite being a well-accepted part of paediatric care, little is known about the benefits or potential harms of routine growth monitoring (RGM) from a parent's perspective. Objective To explore parental experiences with RGM. Methods Literature searches were performed on Google Scholar, psycINFO, CINAHL, and PubMed. Included studies were published after 2000 and described parental comprehension, preferences, attitudes toward, and/or behaviour change related to RGM. Results Of 24 reviewed studies, four themes were identified: reliance on growth monitoring, understanding, influence on feeding and behaviour, and response to obesity-related classification. RGM was familiar but not strongly preferred to identify a child's weight status. Parental understanding of RGM was poor, particularly among parents with low socioeconomic status. A common belief was that heavier babies were healthier, while smaller babies should prompt concern. Parents may be anxious and change behaviour in response to RGM, such as by halting breastfeeding, supplementing, or restricting their child's diet. Parents frequently discounted RGM information when their child was identified as overweight, and expressed concerns about self-esteem and eating disorders. Conclusion This scoping review identifies that although RGM is familiar and sometimes reassuring to parents, increased consideration should be given to potential harms from parental perspectives when conducting growth monitoring.
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Affiliation(s)
- Yasmeen Mansoor
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Ilona Hale
- Department of Family Practice, University of British Columbia, Kimberley, British Columbia
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Birken CS, Omand JA, Nurse KM, Borkhoff CM, Koroshegyi C, Lebovic G, Maguire JL, Mamdani M, Parkin PC, Randall Simpson J, Tremblay MS, Duku E, Reid-Westoby C, Janus M. Fit for School Study protocol: early child growth, health behaviours, nutrition, cardiometabolic risk and developmental determinants of a child's school readiness, a prospective cohort. BMJ Open 2019; 9:e030709. [PMID: 31748293 PMCID: PMC6886995 DOI: 10.1136/bmjopen-2019-030709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION School readiness is a multidimensional construct that includes cognitive, behavioural and emotional aspects of a child's development. School readiness is strongly associated with a child's future school success and well-being. The Early Development Instrument (EDI) is a reliable and valid teacher-completed tool for assessing school readiness in children at kindergarten age. A substantial knowledge gap exists in understanding how early child growth, health behaviours, nutrition, cardiometabolic risk and development impact school readiness. The primary objective was to determine if growth patterns, measured by body mass index trajectories in healthy children aged 0-5 years, are associated with school readiness at ages 4-6 years (kindergarten age). Secondary objectives were to determine if other health trajectories, including health behaviours, nutrition, cardiometabolic risk and development, are associated with school readiness at ages 4-6 years. This paper presents the Fit for School Study protocol. METHODS AND ANALYSIS This is an ongoing prospective cohort study. Parents of children enrolled in the The Applied Health Research Group for Kids (TARGet Kids!) practice-based research network are invited to participate in the Fit for School Study. Child growth, health behaviours, nutrition, cardiometabolic risk and development data are collected annually at health supervision visits and linked to EDI data collected by schools. The primary and secondary analyses will use a two-stage process: (1) latent class growth models will be used to first determine trajectory groups, and (2) generalised linear mixed models will be used to examine the relationship between exposures and EDI results. ETHICS AND DISSEMINATION The research ethics boards at The Hospital for Sick Children, Unity Health Toronto and McMaster University approved this study, and research ethics approval was obtained from each school board with a student participating in the study. The findings will be presented locally, nationally and internationally and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT01869530.
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Affiliation(s)
- Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, Universtiy of Toronto, Toronto, Ontario, Canada
| | - Jessica A Omand
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Kim M Nurse
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christine Koroshegyi
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, Universtiy of Toronto, Toronto, Ontario, Canada
- The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janis Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research, Children's Hospital of Eastern Ontario Research Institute, Healthy Active Living and Obesity Research, Ottawa, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eric Duku
- The Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Caroline Reid-Westoby
- The Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Magdalena Janus
- The Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Wolfenden L, Ezzati M, Larijani B, Dietz W. The challenge for global health systems in preventing and managing obesity. Obes Rev 2019; 20 Suppl 2:185-193. [PMID: 31317659 DOI: 10.1111/obr.12872] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Few health crises have been as predictable as the unfolding obesity pandemic. Clinical and public health services remain the front line of efforts to reduce the burden of obesity. While a range of clinical practice guidelines exist, the need for clinical interventions exceeds the capacity of health systems to provide care for those affected with obesity, and routine clinical practices fall far short of guidelines recommendations even in high-income countries. In this manuscript, we discuss current recommendations regarding obesity interventions and key challenges facing global health systems in managing the health needs of people with obesity. Improving the provision of obesity-related health care is a considerable challenge and will require changing existing perceptions of obesity as a matter of personal failure to its recognition as a disease, innovative approaches to health system reform, clinician capacity building and implementation support, a focus on prevention, and wise resource allocation. Leadership from governments, the medical profession, and patient and community groups to address the issues raised in this manuscript is urgently needed to address the growing health concern.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District, Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Bagher Larijani
- Diabetes Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - William Dietz
- Redstone Global Centre for Prevention and Wellness, George Washington University, Washington, DC, US
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Koch S, Lasinsky AM, Puterman E. Leveraging Omics Profiling to Advance the Treatment of Pediatric Obesity. JAMA Pediatr 2019; 173:910-911. [PMID: 31449286 DOI: 10.1001/jamapediatrics.2019.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah Koch
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne M Lasinsky
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eli Puterman
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Buchholz A, Howard AL, Baldwin K, Hammond NG, Mohipp C, Rutherford J, Kazoun F, Clark L, Adamo K, Goldfield G, Hadjiyannakis S. Health trajectories of children with severe obesity attending a weight management program. Paediatr Child Health 2019; 25:439-446. [PMID: 33173555 DOI: 10.1093/pch/pxz088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/27/2019] [Indexed: 11/14/2022] Open
Abstract
Purpose The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health. Methods This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels. Results The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%. Conclusions This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.
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Affiliation(s)
- Annick Buchholz
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Department of Psychology, Carleton University, Ottawa, Ontario
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, Ontario
| | - Katherine Baldwin
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Nicole G Hammond
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Charmaine Mohipp
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Jane Rutherford
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Fatima Kazoun
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Laurie Clark
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Kristi Adamo
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Gary Goldfield
- Department of Psychology, Carleton University, Ottawa, Ontario.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Stasia Hadjiyannakis
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario
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Tsiros MD, Shultz SP. Take 10! Action Points for Physical Therapists to Consider When It Comes to Childhood Obesity. Phys Ther 2019; 99:490-493. [PMID: 30834434 DOI: 10.1093/ptj/pzz016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/21/2018] [Indexed: 02/09/2023]
Affiliation(s)
- Margarita D Tsiros
- Alliance for Research in Exercise, Nutrition, and Activity, School of Health Sciences, University of South Australia, PO Box 2471, Adelaide, South Australia 5001
| | - Sarah P Shultz
- School of Sport, Exercise, and Nutrition, Massey University, Wellington, New Zealand
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Gibb S, Shackleton N, Audas R, Taylor B, Swinburn B, Zhu T, Taylor R, Derraik JG, Cutfield W, Milne B. Child obesity prevalence across communities in New Zealand: 2010–2016. Aust N Z J Public Health 2019; 43:176-181. [DOI: 10.1111/1753-6405.12881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/01/2018] [Accepted: 01/01/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sheree Gibb
- Department of Public HealthUniversity of Otago Wellington New Zealand
- A Better Start National Science Challenge Dunedin New Zealand
| | - Nichola Shackleton
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| | - Rick Audas
- A Better Start National Science Challenge Dunedin New Zealand
- Department of Women’s and Children’s HealthUniversity of Otago Dunedin New Zealand
| | - Barry Taylor
- A Better Start National Science Challenge Dunedin New Zealand
- Department of Women’s and Children’s HealthUniversity of Otago Dunedin New Zealand
| | - Boyd Swinburn
- Population Nutrition and Global HealthUniversity of Auckland New Zealand
| | - Tong Zhu
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| | - Rachael Taylor
- A Better Start National Science Challenge Dunedin New Zealand
- Department of MedicineUniversity of Otago Dunedin New Zealand
| | - José G.B. Derraik
- A Better Start National Science Challenge Dunedin New Zealand
- Liggins InstituteUniversity of Auckland New Zealand
| | - Wayne Cutfield
- A Better Start National Science Challenge Dunedin New Zealand
- Liggins InstituteUniversity of Auckland New Zealand
| | - Barry Milne
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
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Hill SG, Phan TLT, Datto GA, Hossain J, Werk LN, Abatemarco D. Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States. J Child Health Care 2019; 23:63-78. [PMID: 29792063 PMCID: PMC6105559 DOI: 10.1177/1367493518777308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.
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Affiliation(s)
- Samareh G Hill
- Department of Pediatric Weight Management, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Thao-Ly T Phan
- Division of Weight Management, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - George A Datto
- Division of Weight Management, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Jobayer Hossain
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Lloyd N Werk
- Division of General Academic Pediatrics, Nemours Children’s Hospital, Orlando, FL, USA
| | - Diane Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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Li P, Rourke L, Leduc D, Arulthas S, Rezk K, Rourke J. Relevé postnatal Rourke 2017. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e99-e109. [PMID: 30867189 PMCID: PMC6515956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectif Décrire le processus et les données probantes ayant servi à mettre à jour les recommandations en matière de soins préventifs du RPR 2017 afin d’aider les professionnels de soins de première ligne à prendre les décisions sur les manœuvres à prioriser et à mettre en application dans la pratique. Qualité des données Nous avons effectué une recherche des publications médicales entre juin 2013 et juin 2016 en ayant recours à la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation) pour évaluer rigoureusement les principales études de recherche, et en présence d’un appui substantiel dans les nouvelles publications, nous avons modifié les recommandations. Message principal Les changements importants des recommandations en matière de soins préventifs pour les enfants de 5 ans et moins sont l’ajout de la surveillance de l’indice de masse corporelle à compter de 2 ans; des données probantes plus robustes étayant l’introduction d’aliments allergènes sans délai (changement de la qualité de la recommandation de passable à bonne); la recommandation de poser aux parents des questions validées sur les effets de la pauvreté, des données probantes montrant qu’il n’existe aucun niveau sécuritaire d’exposition des enfants au plomb; une recommandation en matière de durée quotidienne du sommeil; la qualité de la recommandation est passée de passable à bonne pour les éléments liés à la prévention et au dépistage des expériences défavorables durant l’enfance, y compris l’évaluation des ecchymoses chez les bébés de moins de 9 mois; et la surveillance de la tension artérielle exclusivement chez les enfants à risque. Conclusion Les expositions et les habitudes durant la petite enfance ont des conséquences sur la santé à court et à long terme. Le RPR continue de publier des mises à jour pour veiller à ce que les professionnels de la santé soient équipés pour favoriser la santé et le bien-être tout au long de la vie par l’entremise de soins éclairés par des données probantes aux jeunes enfants.
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Affiliation(s)
- Patricia Li
- Professeure adjointe de pédiatrie à la Faculté de médecine du Centre universitaire de santé McGill à Montréal, Québec
| | - Leslie Rourke
- Professeure émérite à la Faculté de médecine de l'Université Memorial de Terre-Neuve à St. John's.
| | - Denis Leduc
- Professeur adjoint de pédiatrie à la Faculté de médecine du Centre universitaire de santé McGill
| | - Stephani Arulthas
- Était adjointe de recherche au Département de pédiatrie du Centre universitaire de santé McGill
| | - Karen Rezk
- Était adjointe de recherche au Département de pédiatrie du Centre universitaire de santé McGill
| | - James Rourke
- Professeur de médecine familiale et ancien doyen de médecine de l'Université Memorial de Terre-Neuve
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Li P, Rourke L, Leduc D, Arulthas S, Rezk K, Rourke J. Rourke Baby Record 2017: Clinical update for preventive care of children up to 5 years of age. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:183-191. [PMID: 30867174 PMCID: PMC6515953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe the process and evidence used to update preventive care recommendations in the 2017 Rourke Baby Record to assist primary care providers' decisions around which maneuvers to prioritize and implement in practice. QUALITY OF EVIDENCE A search of the literature from June 2013 to June 2016 was conducted, using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to critically appraise primary research studies, and recommendations were changed where there was substantial support from the new literature. MAIN MESSAGE The important changes in preventive care recommendations for children up to 5 years of age include the addition of body mass index monitoring as of 2 years of age; stronger evidence to support the introduction of allergenic foods without delay (strength of recommendation change from fair to good); the recommendation to ask validated questions regarding the effects of poverty; evidence showing no safe level of lead exposure in children; the recommendation of a daily sleep duration; the upgrade of recommendation strength from fair to good of items related to the prevention and detection of adverse childhood experiences, including assessment of bruising in babies younger than 9 months; and blood pressure monitoring only for children at risk. CONCLUSION Early childhood exposures and habits have short- and long-term health consequences. The Rourke Baby Record will continue to publish updates to ensure that primary care providers are equipped to promote lifelong health and well-being through evidence-informed care in young children.
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Affiliation(s)
- Patricia Li
- Assistant Professor of Pediatrics in the Faculty of Medicine at the McGill University Health Centre in Montreal, Que
| | - Leslie Rourke
- Professor Emerita in the Faculty of Medicine at Memorial University of Newfoundland in St John's.
| | - Denis Leduc
- Associate Professor of Pediatrics in the Faculty of Medicine at the McGill University Health Centre
| | - Stephani Arulthas
- Was research assistant in the Department of Pediatrics at the McGill University Health Centre
| | - Karen Rezk
- Was research assistant in the Department of Pediatrics at the McGill University Health Centre
| | - James Rourke
- Professor of Family Medicine and former Dean of Medicine at Memorial University of Newfoundland
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Rahman S, Maximova K, Carson V, Jhangri GS, Veugelers PJ. Stay in or play out? The influence of weather conditions on physical activity of grade 5 children in Canada. Canadian Journal of Public Health 2019; 110:169-177. [PMID: 30710245 DOI: 10.17269/s41997-019-00176-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/07/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Regular physical activity (PA) in children is essential for their development and prevention of overweight and obesity. Little is known about the effect of day-to-day variations in weather conditions on PA levels in school-aged children, particularly with regard to school compared to non-school days and girls compared to boys. METHODS Daily step count (7:00 a.m.-9:00 p.m.) from 972 grade 5 students aged 10-11 years from 60 schools across Alberta, Canada, was collected using time-stamped pedometers (minimum wear time of two school and one non-school days) during March-June 2013. Time-matched weather conditions (actual and feels-like temperature, cloud coverage, and precipitation amount) were obtained from local weather stations in Alberta during the same period. Multilevel mixed-effect regression models were used to estimate the effect of each weather condition on daily step count. RESULTS A 1 °C increase in feels-like temperature was associated with 26 more steps/day (p < 0.05), while 1-unit increase in cloud coverage was associated with 61 fewer steps/day (p < 0.01). Compared to no precipitation, heavy precipitation (> 5 mm/day) was associated with 1022 fewer steps/day (p < 0.01). Students' PA levels were associated with weather conditions more on non-school vs. school days and more among girls vs. boys. CONCLUSION Results suggest that daily weather conditions can affect PA in school children, particularly outside school hours, and should be considered when evaluating PA levels or designing interventions to promote PA in children. Findings provide support for increased investment toward creating weather-appropriate physical activity opportunities for wet and colder days to prevent PA decline in children during inclement weather conditions.
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Affiliation(s)
- Sholeh Rahman
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Gian S Jhangri
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Bailey K, Easterbrook B, Blinder H, Hoogenes J, Morrison K. Understanding paediatric patients' attitudes toward obesity and expectations prior to entering a weight management program. Paediatr Child Health 2019; 24:e26-e32. [PMID: 30792606 PMCID: PMC6376291 DOI: 10.1093/pch/pxy068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This qualitative study explored attitudes toward weight management and knowledge of healthy, active living among paediatric patients referred to a weight management program. The objective of this study was to determine the emotional state and attitudes of patients entering into a paediatric weight management program. METHODS Study participants (aged 7 to 17 years old) were recruited during clinic orientation. Semistructured interviews were conducted, audiotaped and transcribed verbatim. Qualitative content analysis generated a thematic coding scheme, identifying concepts and linkages in the data. Study rigour was achieved collaboratively through an audit trail, and data triangulation. RESULTS Fifteen patients (median age 11 years) consented to interviews. Three recurring themes emerged: emotions, motivation and learning. A total of nine subthemes were identified. Four key spheres of influence (family, peers, school and health care providers) affected the patient's outlook on obesity positively by providing support or negatively by adversely influencing their emotions and motivation. The level of individual motivation to engage in the weight management program varied. A positive outlook toward learning about obesity from school officials and health care providers emerged. CONCLUSIONS This study provided insight regarding paediatric attitudes related to entering a weight management program. The negative emotional state and sometimes fear of the program expressed should be considered by the referring physician and by clinicians in weight management programs engaging in their care.
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Affiliation(s)
- Karen Bailey
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario
- Department of Surgery, McMaster University, Hamilton, Ontario
| | - Bethany Easterbrook
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario
- Department of Surgery, McMaster University, Hamilton, Ontario
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario
| | - Henrietta Blinder
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario
- Department of Surgery, McMaster University, Hamilton, Ontario
| | - Jen Hoogenes
- Department of Surgery, McMaster University, Hamilton, Ontario
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario
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45
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Yang HR. What should we do to prevent and manage obesity in children and adolescents? KOREAN JOURNAL OF PEDIATRICS 2019; 62:1-2. [PMID: 30651424 PMCID: PMC6351799 DOI: 10.3345/kjp.2018.07374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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46
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Wieder-Huszla S, Jurczak A, Szkup M, Barczak K, Dołęgowska B, Schneider-Matyka D, Owsianowska J, Grochans E. Relationships between Vitamin D₃ and Metabolic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E175. [PMID: 30634516 PMCID: PMC6352038 DOI: 10.3390/ijerph16020175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/25/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023]
Abstract
The growing number of overweight and obese individuals is an alarming global problem; these conditions are risk factors for the development of health problems such as metabolic syndrome (MetS), type-2 diabetes, atherosclerosis, and cardiovascular disease. Numerous studies have suggested that vitamin D₃ deficiency plays a role in the pathogenesis of MetS. The aim of this study was to analyze the relationship between MetS and vitamin D₃ levels in women. Laboratory analysis demonstrated that only 26.89% of the participants had vitamin D₃ levels close to normal, and waist-to-hip ratio (WHR) measurements revealed android obesity in 75.63% of the women. The menstruating women more often suffered from vitamin D₃ deficiency, and less often had elevated vitamin D₃ levels. The conclusions are as follows: (1) There were no statistically significant relationships between vitamin D₃ levels and MetS parameters, namely the level of triglycerides, the levels of low- and high-density lipoproteins (LDL and HDL), the level of total cholesterol, and systolic and diastolic blood pressure (SBP and DBP). Vitamin D deficiency was only observed in the women with abdominal obesity. (2) Low vitamin D₃ levels were typical of perimenopausal women. Age was a variable correlating with vitamin D. (3) The presence of menstrual cycles was an important contributor to vitamin D levels. Vitamin D deficiency was significantly more common in the menstruating women.
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Affiliation(s)
- Sylwia Wieder-Huszla
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Anna Jurczak
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Małgorzata Szkup
- Department of Nursing, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Katarzyna Barczak
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Barbara Dołęgowska
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Daria Schneider-Matyka
- Department of Nursing, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Joanna Owsianowska
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland.
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47
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Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, Kang KS, Hong J, Shim JO, Lee Y, Kang B, Lee YJ, Kim MJ, Moon JS, Koh H, You J, Kwak YS, Lim H, Yang HR. Clinical Practice Guideline for the Diagnosis and Treatment of Pediatric Obesity: Recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. Pediatr Gastroenterol Hepatol Nutr 2019; 22:1-27. [PMID: 30671370 PMCID: PMC6333581 DOI: 10.5223/pghn.2019.22.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University, College of Medicine, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Chungju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea.,Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - JeongAe You
- Department of Physical Education, College of Education, Chung-Ang University, Seoul, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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48
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Sutaria S, Devakumar D, Yasuda SS, Das S, Saxena S. Is obesity associated with depression in children? Systematic review and meta-analysis. Arch Dis Child 2019; 104:64-74. [PMID: 29959128 DOI: 10.1136/archdischild-2017-314608] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare the odds of depression in obese and overweight children with that in normal-weight children in the community. DESIGN Systematic review and random-effect meta-analysis of observational studies. DATA SOURCES EMBASE, PubMed and PsychINFO electronic databases, published between January 2000 and January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Cross-sectional or longitudinal observational studies that recruited children (aged <18 years) drawn from the community who had their weight status classified by body mass index, using age-adjusted and sex-adjusted reference charts or the International Obesity Task Force age-sex specific cut-offs, and concurrent or prospective odds of depression were measured. RESULTS Twenty-two studies representing 143 603 children were included in the meta-analysis. Prevalence of depression among obese children was 10.4%. Compared with normal-weight children, odds of depression were 1.32 higher (95% CI 1.17 to 1.50) in obese children. Among obese female children, odds of depression were 1.44 (95% CI 1.20 to 1.72) higher compared with that of normal-weight female children. No association was found between overweight children and depression (OR 1.04, 95% CI 0.95 to 1.14) or among obese or overweight male subgroups and depression (OR 1.14, 95% CI 0.93 to 1.41% and 1.08, 95% CI 0.85 to 1.37, respectively). Subgroup analysis of cross-sectional and longitudinal studies separately revealed childhood obesity was associated with both concurrent (OR 1.26, 95% CI 1.09 to 1.45) and prospective odds (OR 1.51, 95% CI 1.21 to 1.88) of depression. CONCLUSION We found strong evidence that obese female children have a significantly higher odds of depression compared with normal-weight female children, and this risk persists into adulthood. Clinicians should consider screening obese female children for symptoms of depression. BACKGROUND Childhood mental illness is poorly recognised by healthcare providers and parents, despite half of all lifetime cases of diagnosable mental illness beginning by the age of 14 years. 1 Globally, depression is the leading cause of disease burden, as measured by disability-adjusted life years, in children aged 10-19 years. 2 Untreated, it is associated with poor school performance and social functioning, substance misuse, recurring depression in adulthood and increased suicide risk, which is the second leading cause of preventable death among young people. 3-6 The resulting cost to the National Health Service of treating depression is estimated at over £2 billion, and the wider social and economic impact of depression is likely to be considerable. 7.
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Affiliation(s)
- Shailen Sutaria
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | | | - Shikta Das
- Institute of Child Health, University College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
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49
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Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, Kang KS, Hong J, Shim JO, Lee Y, Kang B, Lee YJ, Kim MJ, Moon JS, Koh H, You J, Kwak YS, Lim H, Yang HR. Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. KOREAN JOURNAL OF PEDIATRICS 2018; 62:3-21. [PMID: 30589999 PMCID: PMC6351800 DOI: 10.3345/kjp.2018.07360] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022]
Abstract
The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Chungju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Eulji University School of Medicine, Nowon Eulji Medical Hospital, Seoul, Korea
| | - Jae Young Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea
| | - JeongAe You
- Department of Physical Education, College of Education, Chung-Ang University, Seoul, Korea
| | - Young-Sook Kwak
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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50
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Byrne JLS, O'Connor K, Peng C, Morash CL, Ball GDC. Weight up? Changes in children's anthropometry from time of referral to baseline assessment for paediatric weight management. Paediatr Child Health 2018; 23:377-382. [PMID: 30455574 DOI: 10.1093/pch/pxx191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine children's wait time to access a multidisciplinary, tertiary-level weight management clinic and assess anthropometric changes from time of referral to baseline assessment. Method A retrospective medical record review was completed of children (5 to 17 years) enrolled in a multidisciplinary, tertiary-level paediatric weight management clinic from 2006 to 2015. Children's demographic and anthropometric data from their referral to and baseline assessment at the clinic were retrieved from medical records. Based on changes in body mass index (BMI) z-score from the time of referral to baseline assessment, children were categorized as decreasers (>0.05 unit decrease), increasers (>0.05 unit increase) or stabilizers (-0.05 to 0.05 unit change). The proportion of children with a ≥0.25 unit BMI z-score reduction was calculated. Analysis of variance and chi-squared tests were performed. Results Children (n=400) were 11.7 ± 2.9 years old at the time of referral, 52.8% (n=211) female, and had an average wait time of 4.5 ± 3.9 months. By 3 and 6 months postreferral, 44.0% (n=176) and 80.8% (n=323), respectively, had attended baseline assessments. Based on BMI z-score change, children were classified as decreasers (n=183; 45.8%), increasers (n=118; 29.5%) or stabilizers (n=99; 24.8%). One-fifth of children (n=86; 21.5%) experienced a BMI z-score reduction ≥0.25 units, a subgroup that was younger, had a higher BMI z-score at referral, and had a longer wait time between referral and baseline assessment (all P<0.05). Conclusions Most children who enrolled in paediatric weight management initiated treatment within six months and experienced a modest decrease or stabilization in BMI z-score during their wait time.
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Affiliation(s)
- Jillian L S Byrne
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Kathleen O'Connor
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Chenhui Peng
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Edmonton, Alberta
| | - Cailyn L Morash
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,Pediatric Centre for Weight and Health, Stollery Children's Hospital, Edmonton, Alberta
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