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Woolford SJ, Villegas J, Resnicow K. Motivational Interviewing for the Prevention and Treatment of Pediatric Obesity: A Primer. Pediatr Clin North Am 2024; 71:927-941. [PMID: 39343502 DOI: 10.1016/j.pcl.2024.06.006] [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: 10/01/2024]
Abstract
Motivational interviewing (MI), which is recommended for prevention and treatment of pediatric obesity, is a patient-centered counseling style used to modify behaviors. When using MI, pediatric providers generally avoid direct attempts to convince or persuade. Instead, they help patients or parents think about and verbalize their reasons for and against change and how their behavior aligns with their values and goals. MI relies on specific techniques, including reflective listening, to strategically balance the need to "comfort the afflicted" and "afflict the comfortable"; to balance the expression of empathy with the need to build discrepancy for change, thereby encouraging "change talk".
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Affiliation(s)
- Susan J Woolford
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, NCRC Building 16, 2800 Plymouth Road Room G20, Ann Arbor, MI 48109-2800, USA.
| | - Juliet Villegas
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, NCRC Building 16, 2800 Plymouth Road Room G20, Ann Arbor, MI 48109-2800, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI 48109-2029, USA
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Bezrati I, Hammami R, Ceylan Hİ, Govindasamy K, Fradj MKB, Feki M, Mansour AB, Parpa K. Poor Eating Habits and Low Physical Activity Contribute to Weight Excess and Increase Cardiometabolic Risk in Adolescents Practicing Soccer as a Recreational Sport. CHILDREN (BASEL, SWITZERLAND) 2024; 11:857. [PMID: 39062306 PMCID: PMC11275476 DOI: 10.3390/children11070857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Monitoring anthropometry, dietary intake, and physical activity (PA) is essential to prevent/counteract childhood obesity. This study examined dietary intake, PA, and anthropometric characteristics in young boys practicing soccer as a recreational sport. METHODS A cross-sectional study included 226 boys aged 8 to 13 years participating in soccer as a recreational activity in football academies located in Tunis, Tunisia. Anthropometric measures allowed the calculation of body mass index, fat mass, and peak height velocity as markers of biological maturity. A three-day food record and a food frequency questionnaire estimated nutrient intake and eating habits. The International Physical Activity Questionnaire (IPAQ) was used to estimate the PA level of the participants. RESULTS It was found that a high percentage of the children had excess weight (54%) and excess fat mass (47%). The total energy, carbohydrate, and saturated fat intake of the children exceeded the recommended levels by approximately 10%, 15%, and 30%, respectively. However, the intake of unsaturated fat was below the estimated requirements, particularly in obese children. In addition to the unbalanced macronutrient intake, the children also showed an insufficient intake of many essential micronutrients. Around 60% to 70% of the children in all three groups had a low intake of magnesium, n-3 polyunsaturated fatty acids (PUFA), and vitamins B9, B12, and D. Moreover, 20% to 35% of the children in the three groups had an insufficient intake of vitamins A and C. Insufficient vitamin E intake was found in 63% of obese children and 35% of non-obese children. It was observed that the PA level was lower in the overweight/obese group compared to the normal-weight group (p < 0.005). More than three-quarters of overweight/obese children had low PA levels, about 20% were moderately active, and only 1 to 2% were highly active. Conversely, normal-weight children showed moderate to high PA levels. CONCLUSIONS Poor eating behavior, an unbalanced diet, and a low PA level are prevalent in Tunisian boys practicing recreational sports. Such a combination is responsible for a disparity between energy intake and expenditure, contributing to weight excess and increased cardiometabolic risk. The study findings provide meaningful information for practitioners and authorities on applying a balanced diet and adequate PA to prevent and fight against obesity and improve cardiometabolic health in youth.
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Affiliation(s)
- Ikram Bezrati
- Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, LR99ES11, Tunis 1007, Tunisia; (I.B.); (M.K.B.F.); (M.F.); (A.B.M.)
- Tunisian Research Laboratory ‘Sports Performance Optimization’, National Center of Medicine and Science in Sports (CNMSS-LR09SEP01), Tunis 1003, Tunisia;
| | - Raouf Hammami
- Tunisian Research Laboratory ‘Sports Performance Optimization’, National Center of Medicine and Science in Sports (CNMSS-LR09SEP01), Tunis 1003, Tunisia;
- Higher Institute of Sport and Physical Education of Ksar-Said, Manouba University, Tunis 2010, Tunisia
| | - Halil İbrahim Ceylan
- Department of Physical Education of Sports Teaching, Faculty of Sports Sciences, Atatürk University, Erzurum 25100, Türkiye
| | - Karuppasamy Govindasamy
- Department of Physical Education and Sports Sciences, Faculty of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India;
| | - Mohamed K. Ben Fradj
- Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, LR99ES11, Tunis 1007, Tunisia; (I.B.); (M.K.B.F.); (M.F.); (A.B.M.)
| | - Moncef Feki
- Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, LR99ES11, Tunis 1007, Tunisia; (I.B.); (M.K.B.F.); (M.F.); (A.B.M.)
| | - Abderraouf Ben Mansour
- Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, LR99ES11, Tunis 1007, Tunisia; (I.B.); (M.K.B.F.); (M.F.); (A.B.M.)
| | - Koulla Parpa
- Faculty of Sport and Exercise Science, UCLan University of Cyprus, Pyla 7080, Cyprus;
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Boman C, Bernhardsson S, Lundqvist S, Melin K, Lauruschkus K. Physical activity on prescription for children with obesity: a focus group study exploring experiences in paediatric healthcare. FRONTIERS IN HEALTH SERVICES 2024; 4:1306461. [PMID: 38638607 PMCID: PMC11024476 DOI: 10.3389/frhs.2024.1306461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Background Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers. Methods Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Results The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging. Conclusions PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community.
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Affiliation(s)
- Charlotte Boman
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Education Primary Health Care, Gothenburg, Sweden
| | - Stefan Lundqvist
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Education Primary Health Care, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Lauruschkus
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Habilitation, Committee on Psychiatry, Habilitation and Technical Aids, Malmö, Sweden
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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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Santiago E, Quick V, Olfert M, Byrd-Bredbenner C. Relationships of Maternal Employment and Work Impact with Weight-Related Behaviors and Home Environments of Mothers and Their School-Age Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6390. [PMID: 37510622 PMCID: PMC10379117 DOI: 10.3390/ijerph20146390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
The prevalence of obesity continues to rise. Preventing obesity, especially childhood obesity, is critically important. Parents, especially mothers, play a vital role in preventing childhood obesity. Numerous factors, such as maternal employment, may influence maternal weight-related practices and home environment characteristics that affect the risk of childhood obesity. Given the prevalence of both childhood obesity and maternal employment, this study was conducted to examine how weight-related maternal, child, and household behaviors as well as home environment characteristics differ by maternal employment hours and extends existing research by examining work impact on behaviors and home characteristics. U.S. mothers (n = 527) with at least one school-age child (6 to 11 years), who were between the ages of 25 and 54 years and the main food gatekeeper in the household completed an online survey. ANOVA comparisons of non-working, part-time employed, and full-time employed mothers revealed few differences in any of the variables studied. Cluster analysis of the 336 employed mothers based on six work impact scale scores found three unique clusters characterized as Enthusiastic Earners, Indifferent Earners, and Strained Earners. Few differences in sociodemographic and job characteristics occurred among clusters and the differences noted had small effect sizes. Clusters did not differ by maternal BMI or perceived child weight status. However, the clusters differed in numerous weight-related behaviors and home environment characteristics. Future research should aim to determine the direction of the associations of work impact with weight-related behaviors and home environments as well as identify potential strategies for overcoming the negative effects of employment on weight-related behaviors and environments and weight status as well as clarify other factors that may affect maternal work impact, such as time management, reasons for employment, and stress.
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Affiliation(s)
- Elena Santiago
- Maryland SNAP-Ed Department, Family and Consumer Sciences, University of Maryland, Columbia, MD 21044, USA
| | - Virginia Quick
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08901-8520, USA
| | - Melissa Olfert
- Department of Animal and Nutritional Sciences, University of West Virginia, Morgantown, WV 26506-3740, USA
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ 08901-8520, USA
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Lewis KH, Hsu FC, Block JP, Skelton JA, Schwartz MB, Krieger J, Hindel LR, Ospino Sanchez B, Zoellner J. A Technology-Driven, Healthcare-Based Intervention to Improve Family Beverage Choices: Results from a Pilot Randomized Trial in the United States. Nutrients 2023; 15:2141. [PMID: 37432293 DOI: 10.3390/nu15092141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 07/12/2023] Open
Abstract
Background: Healthcare-based interventions to address sugary beverage intake could achieve broad reach, but intensive in-person interventions are unsustainable in clinical settings. Technology-based interventions may provide an alternative, scalable approach. Methods: Within an academic health system in the United States that already performs electronic health record-based sugary drink screening, we conducted a pilot randomized trial of a technology-driven family beverage choice intervention. The goal of the intervention was to reduce sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption in 60 parent-child dyads, in which children were 1-8 years old. The pediatrician-initiated intervention consisted of a water promotion toolkit, a video, a mobile phone application, and 14 interactive voice-response phone calls to parents over 6 months. The study was conducted between June 2021 and May 2022. The aim of the pilot study was to assess the potential feasibility and efficacy of the newly developed intervention. Results: Intervention fidelity was excellent, and acceptability was high for all intervention components. Children in both the intervention and the control groups substantially decreased their consumption of SSB and FJ over follow-up (mean combined baseline 2.5 servings/day vs. 1.4/day at 6 months) and increased water consumption, but constrained linear mixed-effects models showed no differences between groups on these measures. Compared to parents in the control group, intervention parents had larger decreases in SSB intake at 3 months (-0.80 (95% CI: -1.54, -0.06, p = 0.03) servings daily), but these differences were not sustained at 6 months. Conclusion: These findings suggest that, though practical to implement in a clinical care setting and acceptable to a diverse participant group, our multicomponent intervention may not be universally necessary to achieve meaningful behavior changes around family beverage choice. A lower-intensity intervention, such as EHR-based clinical screening alone, might be a less resource-intense way for health systems to achieve similar behavioral outcomes. Future studies might therefore explore whether, instead of applying a full intervention to all families whose children overconsume SSB or FJ, a stepped approach, starting with clinical screening and brief counseling, could be a better use of health system resources.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph A Skelton
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT 06103, USA
| | - James Krieger
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
- Healthy Food America, Seattle, WA 98122, USA
| | - Leah Rose Hindel
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Beatriz Ospino Sanchez
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
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Gorecki MC, Piotrowski ME, Brown CM, Teli RR, Percy Z, Lane L, Bolling CF, Siegel RM, Copeland KA. STEP IN: Supporting Together Exercise and Play and Improving Nutrition; a Feasibility Study of Parent-Led Group Sessions and Fitness Trackers to Improve Family Healthy Lifestyle Behaviors in a Low-Income, Predominantly Black Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5686. [PMID: 37174204 PMCID: PMC10178511 DOI: 10.3390/ijerph20095686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Pediatric obesity is prevalent and challenging to treat. Although family-centered behavioral management is the gold standard, many families face structural inequities to its access and efficacy. Identifying ways to manage pediatric obesity within primary care is needed. METHODS This feasibility study included three sequential trials of peer-led group sessions occurring biweekly or monthly between 3/2016 and 2/2017. Parent-child dyads were recruited from a large academic primary care clinic via mailed invitations, prioritizing patients living in local zip codes of historical disinvestment. Eligible patients were 6 to 12 years with a body mass index ≥85th percentile, with parent and child interest in making healthy lifestyle changes, and English speaking. RESULTS 27 dyads participated, 77% were non-Hispanic Black. Retention and attendance rates were highest in the initial four-session biweekly pilot (100%, 0 dropouts), high in the full six-session biweekly cohort (83%, 1 dropout), and moderate in the monthly cohort (62.7%, 4 dropouts). Families reported high satisfaction with the sessions (4.75/5). Qualitative comments suggested social connections had motivated behavior change in some families. CONCLUSION Parent-led group sessions for pediatric weight management show promise in engaging families. A future large trial is needed to assess behavior change and anthropometric outcomes.
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Affiliation(s)
- Michelle C. Gorecki
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Megan E. Piotrowski
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Courtney M. Brown
- Department of Pediatrics, Division of Primary Care Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Radhika R. Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zana Percy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Laura Lane
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Christopher F. Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Robert M. Siegel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kristen A. Copeland
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Kral TVE, O’Malley L, Johnson K, Benvenuti T, Chittams J, Quinn RJ, Thomas JG, Pinto-Martin JA, Levy SE, Kuschner ES. Effects of a mobile health nutrition intervention on dietary intake in children who have autism spectrum disorder. Front Pediatr 2023; 11:1100436. [PMID: 36873654 PMCID: PMC9975727 DOI: 10.3389/fped.2023.1100436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Background Children who have Autism Spectrum Disorder (ASD) show preferences for processed foods, such as salty and sugary snacks (SSS) and sugar-sweetened beverages (SSB), while healthier foods, such as fruits and vegetables (FV), are consumed less. Innovative tools are needed that can efficiently disseminate evidence-based interventions and engage autistic children to improve their diet. Aim The aim of this 3-month randomized trial was to test the initial efficacy of a mobile health (mHealth) nutrition intervention on changing consumption of targeted healthy (FV) and less healthy foods/beverages (SSS, SSB) in children who have ASD, ages 6-10, who were picky eaters. Methods Thirty-eight parent-child dyads were randomly assigned to either an intervention (technology) group or a wait list control (education) group. The intervention included behavioral skills training, a high level of personalization for dietary goals, and involved parents as "agents of change." Parents in the education group received general nutrition education and the dietary goals but did not receive skills training. Children's intake was assessed at baseline and at 3 months using 24-hour dietary recalls. Results While there were no significant group-by-time interactions (P > 0.25) for any of the primary outcomes, we found a significant main effect of time for FV intake (P = 0.04) indicating that both groups consumed more FV at 3 months (2.58 ± 0.30 servings/day) than at baseline (2.17 ± 0.28 servings/day; P = 0.03). Children in the intervention group who consumed few FV at baseline and showed high engagement with the technology increased their FV intake by 1.5 servings/day (P < 0.01). Children's taste/smell sensitivity significantly predicted their FV intake (P = 0.0446); for each unit of lower taste/smell sensitivity (indicating greater sensory processing abnormalities), FV intake increased by 0.13 ± 0.1 servings/day. Discussion This mHealth intervention did not yield significant between-group differences for changing consumption of targeted foods/beverages. Only children who consumed few FV at baseline and highly engaged with the technology increased their FV intake at 3 months. Future research should test additional strategies to expand the intervention's impact on a wider range of foods while also reaching a broader group of children who have ASD. This trial was registered at clinicaltrials.gov as NCT03424811.Clinical Trial Registration: This study was registered at clinicaltrials.gov as NCT03424811.
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Affiliation(s)
- Tanja V. E. Kral
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lauren O’Malley
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kelsey Johnson
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | | | - Jesse Chittams
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Ryan J. Quinn
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - J. Graham Thomas
- Weight Control and Diabetes Research Center, Brown University School of Medicine and The Miriam Hospital, Providence, RI, United States
| | - Jennifer A. Pinto-Martin
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan E. Levy
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Emily S. Kuschner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Departments of Psychiatry and Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Rosal MC, Lemon SC, Borg A, Lopez-Cepero A, Sreedhara M, Silfee V, Pbert L, Kane K, Li W. The Healthy Kids & Families study: Outcomes of a 24-month childhood obesity prevention intervention. Prev Med Rep 2023; 31:102086. [PMID: 36820371 PMCID: PMC9938323 DOI: 10.1016/j.pmedr.2022.102086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were child-parent/guardian (Kindergarten to 6th grade at baseline) dyads (n = 247) recruited through schools located in socioeconomically disadvantaged neighborhoods in Worcester, MA, USA. Using a quasi-experimental design, the study tested the impact of Healthy Kids & Families, a theory-based, low-intensity, parent-focused, CHW-delivered intervention to improve children's weight, healthy eating and physical activity. The attention-control comparison condition was a positive parenting intervention. The primary outcome was change in child body mass index (BMI) z-score at 24 months. Secondary outcomes included number of positive child and parent changes in selected diet and physical activity behaviors targeted by the intervention and change in parent BMI. Outcomes were assessed following the intent-to-treat principle and using multivariable generalized linear mixed models. Compared to the attention-control comparison condition, the Healthy Kids & Families intervention led to a greater reduction in children's BMI z-score (β = -0.17, 95 %CI: -1.92 to -0.36; p = 0.057) and a greater number of positive behavior changes among children (β = 0.57, 95 %CI: 0.08-1.06; p = 0.02) at 24 months. There was no significant change in parent outcomes. The Healthy Kids & Families intervention shows promise for obesity prevention among children in socioeconomically disadvantaged communities.
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Affiliation(s)
- Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Stephenie C. Lemon
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Amy Borg
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Andrea Lopez-Cepero
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Meera Sreedhara
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Valerie Silfee
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Weight Watchers International, NY, USA
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kevin Kane
- Health Statistics and Geography Lab, Center for Health Statistics and Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Wenjun Li
- Health Statistics and Geography Lab, Center for Health Statistics and Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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11
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Ben Othman R, Talbi E, Mizouri R, Ben Amor N, Gamoudi A, Lahmer I, Berriche O, Mahjoub F, Jamoussi H. Evaluation of anthropometric profile in obese children: risk factors & eating disorder. ALEXANDRIA JOURNAL OF MEDICINE 2022. [DOI: 10.1080/20905068.2022.2103884] [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: 10/15/2022] Open
Affiliation(s)
- rym Ben Othman
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - emna Talbi
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - ramla Mizouri
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - nadia Ben Amor
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - amel Gamoudi
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - ines Lahmer
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - olfa Berriche
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - faten Mahjoub
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - henda Jamoussi
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
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Hsueh WY, Kang KT, Yao CCJ, Chen YJ, Weng WC, Lee PL, Chang CW, Hsu WC. Measurements of craniofacial morphology using photogrammetry in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2022; 162:111287. [PMID: 36029654 DOI: 10.1016/j.ijporl.2022.111287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/20/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the craniofacial morphology in children with sleep-disordered breathing (SDB) using nonradiation and readily accessible photogrammetry technique. METHODS Included children aged 3-18 years with SDB-related symptoms from April 2019 to February 2020 in a tertiary center. All participants underwent craniofacial photogrammetry and overnight polysomnography (PSG). Participants were stratified into 2 groups (obstructive sleep apnea [OSA] group: apnea-hypopnea index [AHI] ≥ 1 and non-OSA group: AHI <1). Craniofacial photogrammetry was performed to derive variables of craniofacial features in standardized frontal and profile views. The 2 groups were propensity score matched based on age, sex, and body mass index (BMI) percentiles. Associations between craniofacial feature variables and OSA (AHI ≥1) likelihood were examined using logistic regression test. intraclass correlation coefficient (ICC) was used to evaluate the intrarater and interrater reliability. RESULTS In total, 58 children were enrolled for the analysis after matching. All 3 variables representing the mandibular plane angle in the profile view were increased in the OSA group (mego-tn: 34.85 ± 5.99 vs 31.65 ± 5.96°, odds ratio [OR]: 1.10, 95% CI:1.02 to 1.18, P = .01; tn-gogn: 28.65 ± 6.38 vs 25.91 ± 5.38°, OR: 1.08, 95% CI:1.02 to 1.15, P = .012; and gome-tsup: 26.71 ± 6.13 vs 22.20 ± 5.89°, OR: 1.13, 95% CI:1.04 to 1.23, P = .003). CONCLUSIONS Craniofacial photogrammetry revealed increased mandibular inclination in children with OSA. A steep mandibular plane with craniofacial photogrammetry is considered a potential predictor of pediatric OSA. Further investigation with a large sample size is required to clarify the validity of photogrammetry in evaluating pediatric OSA.
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Affiliation(s)
- Wan-Yi Hsueh
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Wei Chang
- Division of Endodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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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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Browne NT, Cuda SE. Nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS 2022; 2:100012. [PMID: 37990712 PMCID: PMC10661897 DOI: 10.1016/j.obpill.2022.100012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details nutritional and activity recommendations for the child with normal weight, overweight, and obesity (Appendix A) with consideration of food insecurity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices in the normal range and body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement details nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity. In addition, this CPS addresses nutritional recommendations for complications related to the disease of obesity as well as providing guidance on food insecurity as it impacts children with obesity and their families. Conclusions This OMA Clinical Practice Statement on nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
| | - Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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15
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Van Fossen C, Kiser H, Lambert Brown C, Skelton J, Pratt KJ. Parents' Reports of Children's Physical and Sedentary Behavior Engagement among Parents in Weight Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3773. [PMID: 35409456 PMCID: PMC8997835 DOI: 10.3390/ijerph19073773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023]
Abstract
Background: The purpose of this study was to explore the associations between demographics, family exercise participation, family discouragement of exercise, and the children’s physical and sedentary behaviors to identify specific areas of physical activity intervention for children with parents engaged in medical weight management (MWM). Methods: Parents (n = 294) of children aged 2−18 years old were recruited from two university MWM programs to complete a one-time survey. Bivariate analyses tested associations. Results: Parents reported that sedentary activity was higher for children who identified as racial minorities (t(141) = −2.05, p < 0.05). Mobile phone and tablet use was higher for adolescents compared to school age and young children (H(2) = 10.96, p < 01) Exercise game use was higher for racial minority children compared to white children (U = 9440.5, z = 2.47, p ≤ 0.03). Male children (t(284) = 1.83, p < 0.07), children perceived to have a healthy weight status (t(120) = 4.68, p < 0.00), and younger children (t(289) = 1.79, p < 0.08) all engaged in more strenuous physical activity. Family exercise participation (t(162) = −2.93, p < 0.01) and family discouragement of exercise (U = 7813.50, z = −2.06, p ≤ 0.04) were significantly higher for children in racial minority families. Conclusions: Future work should determine methods to engage children and their parents participating in MWM in physical activities together to ensure that the changes the parents are making with MWM are sustainable.
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Affiliation(s)
- Catherine Van Fossen
- Department of Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, PA 19207, USA
| | - Haley Kiser
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (H.K.); (K.J.P.)
| | - Callie Lambert Brown
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA; (C.L.B.); (J.S.)
- Department of Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA
| | - Joseph Skelton
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA; (C.L.B.); (J.S.)
- Department of Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA
| | - Keeley Jean Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (H.K.); (K.J.P.)
- Department of Surgery, College of Medicine, The Ohio State University; Columbus, OH 43210, USA
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16
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Assessment of Potential Benefits of Functional Food Characteristics of Beetroot Energy Drink and Flavored Milk. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1971018. [PMID: 35342761 PMCID: PMC8947884 DOI: 10.1155/2022/1971018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/01/2022] [Indexed: 12/03/2022]
Abstract
Objective This study was designed to determine the antioxidant activity of the extracts of beetroot by using beetroot energy drink and flavored milk (products). Material & Methods. This experimental trial was conducted at Jinnah University for Women, Pakistan, under the approval of local institutional review board number JUW/DFST/RCB010/2020. All the materials such as beetroot, carrot, cucumber, and lemon were obtained commercially from which two products were formulated: beetroot energy drink (sample1) and flavored milk (sample 2). These formulated products were evaluated for quality analysis (pH and brix), phytochemical screening using the Keller-Kiliani test, Salkowski's test, Alkaline reagent test, lead acetate test, ferric chloride test, protein test, quantitative test of phenol, antioxidant activity, sensory analysis, and shelf life study. The paired t-test was applied to detect significant differences between two samples. Results The phytochemical analysis revealed that cardiac glycosides, phytosterol, flavonoids, and terpenoids were found in both energy booster drink (EBD) and flavored milk (FM) except phenolic compounds that were found only in EBD. The antioxidant capacity of beetroot juice was far greater than FM. The statistical sensorial analysis of FM and EBD reported a significant mean difference between most of the groups with p < 0.0001. Conclusion This study concludes that energy drinks having beetroot indicated higher antioxidant capacity than flavored milk. The nutraceutical products (energy booster drink and flavored milk) containing beetroot are enriched with optimum quantities of proteins and fats and low carbohydrates at a stable pH with an adequate total energy content.
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Seum T, Meyrose AK, Rabel M, Schienkiewitz A, Ravens-Sieberer U. Pathways of Parental Education on Children's and Adolescent's Body Mass Index: The Mediating Roles of Behavioral and Psychological Factors. Front Public Health 2022; 10:763789. [PMID: 35321198 PMCID: PMC8936576 DOI: 10.3389/fpubh.2022.763789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/31/2022] [Indexed: 12/20/2022] Open
Abstract
Aim The increasing body mass index (BMI) often followed by overweight and obesity is a global health problem of the 21st century. Children and adolescents with lower socioeconomic status are more affected than their counterparts. The mechanisms behind these differences must be well understood to develop effective prevention strategies. This analysis aims at examining the association of parental education as an indicator of the socioeconomic status on children's and adolescent's body mass index and the role of behavioral and psychological risk factors for a higher BMI longitudinally. Methods The analysis was based on a nationwide sample of N = 460 children and adolescents, aged 11 to 17 at baseline (2009-2012), who took part in the representative BELLA study, the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). A follow-up was conducted 5 years later. Using mediation analyses, the mediating effects of breakfast consumption, consumption of sugar-sweetened beverages, screen time, physical activity, mental health problems (Strengths and Difficulties Questionnaire), and health-related quality of life (KIDSCREEN-10) on the association of parent's years of education on their children's BMI were investigated. Results A lower level of parental education was significantly associated with a higher BMI in children and adolescents 5 years later. The association was partially mediated by breakfast consumption and total screen time, with breakfast consumption mediating 16.7% and total screen time 27.8% of the association. After controlling for age, gender, and migration status, only breakfast consumption remained a partial mediator (8.5%). Other included variables had no mediating effects. Conclusions Preventive measures should be mainly targeted at children and adolescents of parents with lower educational levels. Tailored strategies to prevent the development of overweight and obesity in this population among children and adolescents should promote daily breakfast consumption at home and reducing screen time.
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Affiliation(s)
- Teresa Seum
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Katrin Meyrose
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany
| | - Matthias Rabel
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cuda SE, Censani M. Assessment, differential diagnosis, and initial clinical evaluation of the pediatric patient with obesity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 1:100010. [PMID: 37990703 PMCID: PMC10662031 DOI: 10.1016/j.obpill.2022.100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 12/26/2021] [Accepted: 01/02/2022] [Indexed: 11/23/2023]
Abstract
Background The Obesity Medical Association (OMA) Clinical Practice Statement (CPS) on the assessment, differential diagnosis, and initial clinical evaluation of pediatric patients with obesity is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indexes greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement on assessment, differential diagnosis, and initial clinical evaluation of pediatric patients with obesity provides clinical information regarding classification of children and adolescents with overweight or obesity, differential diagnoses to consider, and a roadmap for the initial clinical evaluation. Conclusions This OMA Clinical Practice Statement on assessment, differential diagnosis, and initial clinical evaluation of pediatric patients with obesity is an overview of current recommendations. Assessment of pediatric patients with obesity is the first step in determining treatments leading to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
- Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Marisa Censani
- New York Presbyterian Hospital, Weill Cornell Medicine, Department of Pediatrics, Division of Pediatric Endocrinology; New York, NY, USA
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Matthan NR, Barger K, Wylie-Rosett J, Xue X, Groisman-Perelstein AE, Diamantis PM, Ginsberg M, Mossavar-Rahmani Y, Lichtenstein AH. Spillover Effects of a Family-Based Childhood Weight-Management Intervention on Parental Nutrient Biomarkers and Cardiometabolic Risk Factors. Curr Dev Nutr 2022; 6:nzab152. [PMID: 35155982 PMCID: PMC8826936 DOI: 10.1093/cdn/nzab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Parental involvement has been shown to favorably affect childhood weight-management interventions, but whether these interventions influence parental diet and cardiometabolic health outcomes is unclear. OBJECTIVES The aim was to evaluate whether a 1-y family-based childhood weight-management intervention altered parental nutrient biomarker concentrations and cardiometabolic risk factors (CMRFs). METHODS Secondary analysis from a randomized-controlled, parallel-arm clinical trial (NCT00851201). Families were recruited from a largely Hispanic population and assigned to either standard care (SC; American Academy of Pediatrics overweight/obesity recommendations) or SC + enhanced program (SC+EP; targeted diet/physical activity strategies, skill building, and monthly support sessions). Nutrient biomarkers (plasma carotenoids and fat-soluble vitamins, RBC fatty acid profiles) and CMRFs (BMI, blood pressure, glucose, insulin, lipid profile, inflammatory and endothelial dysfunction markers, adipokines) were measured in archived samples collected from parents of participating children at baseline and end of the 1-y intervention. RESULTS Parents in both groups (SC = 106 and SC+EP = 99) had significant reductions in trans fatty acid (-14%) and increases in MUFA (2%), PUFA n-6 (ɷ-6) (2%), PUFA n-3 (7%), and β-carotene (20%) concentrations, indicative of lower partially hydrogenated fat and higher vegetable oil, fish, and fruit/vegetable intake, respectively. Significant reductions in high-sensitivity C-reactive protein (hsCRP; -21%) TNF-α (-19%), IL-6 (-19%), and triglycerides (-6%) were also observed in both groups. An additional significant improvement in serum insulin concentrations (-6%) was observed in the SC+EP parents. However, no major reductions in BMI or blood pressure and significant unfavorable trajectories in LDL-cholesterol and endothelial dysfunction markers [P-selectin, soluble intercellular adhesion molecule (sICAM), thrombomodulin] were observed. Higher carotenoid, MUFA, and PUFA (n-6 and n-3) and lower SFA and trans fatty acid concentrations were associated with improvements in circulating glucose and lipid measures, inflammatory markers, and adipokines. CONCLUSIONS The benefits of a family-based childhood weight-management intervention can spill over to parents, resulting in apparent healthier dietary shifts that are associated with modest improvements in some CMRFs.
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Affiliation(s)
- Nirupa R Matthan
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Kathryn Barger
- Biostatistics and Data Management Core Unit, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Pamela M Diamantis
- Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Mindy Ginsberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Wang X, Liu J, Gao D, Li Y, Ma Q, Chen L, Chen M, Ma T, Ma Y, Zhang Y, Yang J, Dong Y, Song Y, Ma J. Effectiveness of national multicentric school-based health lifestyles intervention among chinese children and adolescents on knowledge, belief, and practice toward obesity at individual, family and schools' levels. Front Pediatr 2022; 10:917376. [PMID: 36061391 PMCID: PMC9433560 DOI: 10.3389/fped.2022.917376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to evaluate the effectiveness of the trial of national multicentric school-based health lifestyles intervention toward childhood obesity on the KBP at individual, family and schools' levels. METHODS The national trial was a multi-centered, cluster-controlled trial, which was conducted in seven provinces from September 2013 to February 2014, aiming at preventing childhood overweight and obesity. Integrated intervention strategies focused on changing specific practice related to energy intake and expenditure, such as decreasing the consumption of sweetened fizzy drinks, increasing the consumption of vegetables, ensuring proper protein intake, reducing sedentary practice including screen time, and maintaining at least 1 h of moderate to vigorous physical activity. A total of 27,477 children and adolescents in the control group and 30,997 in the intervention group were recruited with a mean follow-up period of 6.7 months. The binomial response mixed-effects model was used for assessing the effects of the national school-based health lifestyles intervention on obesity-related KBP at students individual, parents' and schools' levels. RESULTS Children and adolescents in the intervention group mastered better obesity-related knowledge, and they had higher correct response rates to all questions about obesity-related knowledge compared to the control group (P < 0.05). In terms of obesity-related belief, individuals in the intervention group was more motivated than the control group, participants in the intervention group had higher correctness of 71.18, 52.94, and 56.60% than the control group of 68.61, 49.86, and 54.43%, (P < 0.05). In addition, healthier habits of eating breakfast and drinking milk every day were observed in the intervention group. For the beliefs toward obesity, parents of the intervention group had higher correctness than the control group. At the same time except for the fruit consumption, other obesity-related practice in the intervention group were healthier than the control group (P < 0.05). Except for some beliefs and practice, the intervention effect at the parent level was not significant in other aspects. CONCLUSION The obesity-related knowledge and beliefs of children and adolescents got improved significantly. However, the effects on the knowledge, beliefs and certain practices of their parents and school administrators failed to reach significance.
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Affiliation(s)
- Xinxin Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Jieyu Liu
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Di Gao
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yanhui Li
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Qi Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Li Chen
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Manman Chen
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Tao Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Ying Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yi Zhang
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jianjun Yang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Yanhui Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yi Song
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jun Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Beijing, China
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21
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The Effect of Incorporating an Exergame Application in a Multidisciplinary Weight Management Program on Physical Activity and Fitness Indices in Children with Overweight and Obesity. CHILDREN 2021; 9:children9010018. [PMID: 35053643 PMCID: PMC8774446 DOI: 10.3390/children9010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
Children with overweight/obese (OW/OB) have low physical activity (PA) levels and excessive daily screen times. Although access to personal smartphones may complicate restricting sedentary screen time, these devices may be used to promote PA and improve fitness. Therefore, we aim to examine the impact of incorporating an exergame application (APP) into an existing weight management program on BMI, physical activity, fitness levels, and attitude toward PA among OW/OB children. Seventy-nine children (51% girls), median age 10 years, completed an established 5-month weight management program. The intervention included structured PA sessions (2/week), nutritional, and behavioral counseling. An exergame app was installed on the smartphones of the intervention group (APP, n = 32). BMI, physical fitness, PA level, and attitudes toward PA were assessed before and after the intervention. BMI decreased (p < 0.0001) in both groups by 0.67 kg/m2 (Q1, Q3: −1.36–0.12). There were improvements in more fitness components in the APP group than controls, with significantly greater improvements in aerobic fitness (p = 0.038), speed and agility (p = 0.01), and leg strength endurance (p = 0.05) compared to controls. PA levels increased similarly in both groups during the intervention period. The incorporation of an exergame application leads to more significant improvements in fitness components. These findings support the use of exergame apps to improve fitness in OW/OB children.
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22
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Confroy K, Miles C, Kaplan S, Skelton JA. Pediatric Obesity and Sports Medicine: A Narrative Review and Clinical Recommendations. Clin J Sport Med 2021; 31:e484-e498. [PMID: 32852300 DOI: 10.1097/jsm.0000000000000839] [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: 10/11/2019] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review what is known about sports medicine and pediatric obesity, with a focus on injuries and MSK concerns. DATA SOURCES Systematically searched MEDLINE (PubMed) for all years, using search combinations to best identify potential publications. Manuscripts were reviewed, summarized, and discussed in detail. Experienced clinicians in sports medicine and pediatric obesity reviewed the final searches for substantive content. Inclusion criteria include English language publications, children ≤18 years old, related to the practice of sports medicine and pediatric obesity. Publications excluded that dealt with non-sports medicine aspects of pediatric obesity, such as increasing physical activity or exercise, or the prevention or treatment of obesity. MAIN RESULTS Twenty-eight publications were included for review. Papers fell into 5 groupings: (1) MSK-increased incidence of MSK injury in children with obesity, hypothesized to be a result of changes in biomechanics; (2) weight management-gradual loss while maintaining proper hydration and nutrition for sports performance; (3) fitness/conditioning-children with overweight/obese showed decreased fitness measures and cardiopulmonary conditioning; (4) exertional heat illness-a concern for adolescent athletes with obesity, specifically in football; and (5) differential diagnoses-3 key differential diagnoses were identified for increased awareness: slipped capital femoral epiphysis, Blount's disease, and pes planus. Clinical topics pertinent to sports medicine and pediatric obesity were discussed. CONCLUSIONS Sports medicine clinicians should be aware of the common MSK and sports-related conditions in children with obesity. Few studies have focused investigations on issues related to children with obesity participating in sports and other physical activities.
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Affiliation(s)
- Kristen Confroy
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Sebastian Kaplan
- Departments of Family and Community Medicine
- Psychiatry and Behavioral Medicine; and
| | - Joseph A Skelton
- Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
- Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina
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23
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Moffat LF, Ritchie LD, Gosliner W, Plank KR, Au LE. Perceived Produce Availability and Child Fruit and Vegetable Intake: The Healthy Communities Study. Nutrients 2021; 13:3681. [PMID: 34835936 PMCID: PMC8619213 DOI: 10.3390/nu13113681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Children eat more fruits and vegetables when more are available at home, but less is known about how the neighborhood food environment relates to children's diet and weight outcomes. The goal of this study was to determine whether parental perception of the food environment (neighborhood and home) is associated with children's fruit and vegetable (F&V) intake and weight outcomes, and to assess differences by household food security status and household income. Cross-sectional data from the 2013-2015 U.S. Healthy Communities Study included 5138 children, aged 4 to 15 years old, from 130 U.S. communities. Neighborhood and home food environments were assessed with parent-reported, perceived F&V availability scores. Associations were tested with multi-level linear regression models. Parents' perception of produce availability was associated with household F&V availability ratings (β = 0.09 points, p < 0.001). Household F&V availability was associated with child F&V intake (β = 0.32 cups/day or 25.6 g/day, p < 0.001). A higher child F&V intake was associated with a lower child BMI z-score (β = -0.05, p = 0.002). Weaker relationships were seen for children living in food insecure or low-income households. Optimizing neighborhood and home access to F&V may help children improve diet quality, but may not be as effective for children living in food insecure or low-income households.
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Affiliation(s)
- Laurel F. Moffat
- Youth and Families Unit, Extension, Washington State University, Spokane, WA 99202, USA;
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA; (L.D.R.); (W.G.); (K.R.P.)
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA; (L.D.R.); (W.G.); (K.R.P.)
| | - Kaela R. Plank
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA; (L.D.R.); (W.G.); (K.R.P.)
| | - Lauren E. Au
- Department of Nutrition, University of California, Davis, CA 95616, USA
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24
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A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research. BMC Public Health 2021; 21:1867. [PMID: 34654393 PMCID: PMC8520198 DOI: 10.1186/s12889-021-11936-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships. METHODS We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos. RESULTS Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred. CONCLUSIONS Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.
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Auckburally S, Davies E, Logue J. The Use of Effective Language and Communication in the Management of Obesity: the Challenge for Healthcare Professionals. Curr Obes Rep 2021; 10:274-281. [PMID: 34003446 PMCID: PMC8408082 DOI: 10.1007/s13679-021-00441-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Initial conversations about weight with patients are important to set the tone for future dialogue and management of obesity. There is often reluctance in raising the topic of overweight or obesity in consultations. We aimed to evaluate literature to discover the perceived barriers to optimal discussion about weight status and preferred weight-based terminology for adults, adolescents and parents of younger children. RECENT FINDINGS Fear of offending patients, insufficient training and lack of knowledge of referral pathways were identified as factors hindering healthcare professionals' ability to discuss weight with patients. Neutral terms, such as 'weight', were preferred by patients, with 'fat' and 'obese' viewed as undesirable and stigmatising words. There is a need for greater support and provision of specific training, including education on communicating weight status, for those involved in the management of obesity. More research is necessary to assess the impact of interventions to improve initial discussions with patients about weight.
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Affiliation(s)
- Sameera Auckburally
- Faculty of Health and Medicine, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK.
- Department of Paediatrics, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool, FY3 8NR, UK.
| | - Elena Davies
- Faculty of Health and Medicine, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
| | - Jennifer Logue
- Faculty of Health and Medicine, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
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26
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Kranjac AW, Kranjac D. Child obesity moderates the association between poverty and academic achievement. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Dinko Kranjac
- Department of Psychology University of La Verne La Verne California USA
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27
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El Mikati HK, Boateng AO, McKinney BM, Haberlin-Pittz K, Pike J, Perry P, Hannon TS, Yazel-Smith L. Forever-Fit Summer Camp: The Impact of a 6-Week Summer Healthy Lifestyle Day Camp on Anthropometric, Cardiovascular, and Physical Fitness Measures in Youth With Obesity. J Prim Care Community Health 2021; 11:2150132720903888. [PMID: 31994432 PMCID: PMC6990606 DOI: 10.1177/2150132720903888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pediatric obesity is a public health concern with lifestyle intervention as the first-line treatment. Forever-Fit Summer Camp (FFSC) is a 6-week summer day program offering physical activity, nutrition education, and well-balanced meals to youth at low cost. The aim of the study was to assess the efficacy of this program that does not emphasize weight loss rather emphasizes healthy behaviors on body mass index, cardiovascular and physical fitness. Methods: The inclusion criteria were adolescents between 8 and 12 years and body mass index (BMI) ≥85th percentile. The data were collected at baseline and week 6 (wk-6) and was analyzed for 2013-2018 using paired-sample t tests. Results: The participants’ (N = 179) average age was 10.6 ± 1.6 years with a majority of females (71%) and black race/ethnicity (70%). At wk-6, BMI and waist circumference decreased by 0.8 ± 0.7 kg/m2 and 1.0 ± 1.3 in, respectively. Resting heart rate, diastolic and systolic blood pressure decreased by 8.5 ± 11.0 bpm, 6.3 ± 8.8 mmHg, and 6.4 ± 10.1 mmHg, respectively. The number of pushups, curl-ups, and chair squats were higher by 5.8 ± 7.5, 6.7 ± 9.1, and 7.7 ± 8.5, respectively. Conclusion: The FFSC is efficacious for improving BMI, cardiovascular, and physical fitness in the short term. The effect of similar episodic efforts that implement healthy lifestyle modifications throughout the school year should be investigated.
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Affiliation(s)
| | | | | | | | - Julie Pike
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick Perry
- American Foundation for Preventive Medicine, Indianapolis, IN, USA
| | - Tamara S Hannon
- Indiana University School of Medicine, Indianapolis, IN, USA
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Gance-Cleveland B, Ozkaynak M. Multidisciplinary Teams are Essential for Developing Clinical Decision Support to Improve Pediatric Health Outcomes: An Exemplar. J Pediatr Nurs 2021; 58:104-106. [PMID: 32855005 DOI: 10.1016/j.pedn.2020.08.012] [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: 03/29/2020] [Accepted: 08/12/2020] [Indexed: 01/16/2023]
Abstract
Clinical decision support with individualized patient education information can facilitate the translation of evidence-based guidelines into practice to improve pediatric patient outcomes. Interdisciplinary teams are required to develop and implement this technology support into practice. Engineering expertise with attention to three components is required: backend (e.g., data science, predictions), front end (e.g., user interface), and integration (e.g., workflow) must be addressed to achieve useful technology that will be adopted. An engineering framework, Technology Acceptance Model, can be used to guide the development of clinical decision support with patient education materials and includes a partnership with end users, both clinicians and patients.
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Affiliation(s)
- Bonnie Gance-Cleveland
- Lorreta C Ford Professor, University of Colorado Anschutz Medical Center, United States.
| | - Mustafa Ozkaynak
- Lorreta C Ford Professor, University of Colorado Anschutz Medical Center, United States
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Family Social Capital: Links to Weight-Related and Parenting Behaviors of Mothers with Young Children. Nutrients 2021; 13:nu13051428. [PMID: 33922656 PMCID: PMC8145036 DOI: 10.3390/nu13051428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/10/2023] Open
Abstract
Family social capital includes the social relationships, values, and norms shared by a family and is positively linked with children’s mental and physical health status. This cross-sectional study addresses a gap in the literature related to family social capital vis-à-vis weight-related behaviors and home environments of 557 mothers and their young children (ages 2 to 9 years). Mothers completed an online survey comprised of valid, reliable questionnaires assessing family relationships and weight-related behavioral and home environment measures. The measures that determined family social capital (i.e., supportive, engaged parenting behaviors; family cohesion; family conflict; and family meal frequency) yielded distinct tertile groups that differed significantly (p < 0.001) on every family social capital measure with large effect sizes. Analysis of variance with Tukey post-hoc test revealed greater family social capital was linked to significantly better maternal health, dietary intake, physical activity, and sleep behavior. Additionally, maternal modeling of healthy eating and physical activity, child feeding practices, and home environments was higher in groups with greater family social capital. Child mental and physical health, physical activity, and sleep quality were better in families with greater family social capital. Findings suggest greater family social capital is linked to healthier weight-related behaviors and home environments. Future intervention studies should incorporate strategies to build family social capital and compare longitudinal outcomes to traditional interventions to determine the relative value of family social capital on health behaviors.
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30
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Motevalli M, Drenowatz C, Tanous DR, Khan NA, Wirnitzer K. Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies. Nutrients 2021; 13:1200. [PMID: 33917383 PMCID: PMC8067342 DOI: 10.3390/nu13041200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023] Open
Abstract
As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.
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Affiliation(s)
- Mohamad Motevalli
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University College of Teacher Education Upper Austria, A-4020 Linz, Austria;
| | - Derrick R. Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
| | - Naim Akhtar Khan
- Nutritional Physiology & Toxicology Division, INSERM UMR 1231, Université de Bourgogne, F-21000 Dijon, France;
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
- Department of Subject Didactics and Educational Research & Development, University College of Teacher Education Tyrol, A-6020 Innsbruck, Austria
- Life and Health Science Cluster Tirol, Subcluster Health/Medicine/Psychology, A-6020 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria
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31
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Management of Childhood Obesity—Time to Shift from Generalized to Personalized Intervention Strategies. Nutrients 2021. [DOI: 10.3390/nu13041200
expr 902416715 + 844236509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.
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32
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Motevalli M, Drenowatz C, Tanous DR, Khan NA, Wirnitzer K. Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies. Nutrients 2021; 13:1200. [PMID: 33917383 PMCID: PMC8067342 DOI: 10.3390/nu13041200&set/a 931824908+802380262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.
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Affiliation(s)
- Mohamad Motevalli
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
- Correspondence:
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University College of Teacher Education Upper Austria, A-4020 Linz, Austria;
| | - Derrick R. Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
| | - Naim Akhtar Khan
- Nutritional Physiology & Toxicology Division, INSERM UMR 1231, Université de Bourgogne, F-21000 Dijon, France;
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
- Department of Subject Didactics and Educational Research & Development, University College of Teacher Education Tyrol, A-6020 Innsbruck, Austria
- Life and Health Science Cluster Tirol, Subcluster Health/Medicine/Psychology, A-6020 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria
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Cardel MI, Newsome FA, Skelton JA. Time Equivalency and Child Adiposity: The Biggest Bang for the Buck. Pediatrics 2021; 147:e2020042168. [PMID: 33771916 PMCID: PMC8225557 DOI: 10.1542/peds.2020-042168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Michelle I Cardel
- Departments of Health Outcomes and Biomedical Informatics and
- Pediatrics, College of Medicine and
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida
| | - Faith A Newsome
- Departments of Health Outcomes and Biomedical Informatics and
| | - Joseph A Skelton
- Departments of Pediatrics and
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
- Brenner Families in Training, Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Pbert L, Trivedi M, Druker S, Bram J, Olendzki B, Crawford S, Frisard C, Andersen V, Waring ME, Clements K, Schneider K, Geller AC. Supporting families of children with overweight and obesity to live healthy lifestyles: Design and rationale for the Fitline cluster randomized controlled pediatric practice-based trial. Contemp Clin Trials 2021; 104:106348. [PMID: 33706002 DOI: 10.1016/j.cct.2021.106348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Over a third of preadolescent children with overweight or obesity. The American Academy of Pediatrics (AAP) recommends pediatric providers help families make changes in eating and activity to improve body mass index (BMI). However, implementation is challenging given limited time and referral sources, and family burden to access in-person weight management programs. PURPOSE To describe the design of a National Heart Blood and Lung Institute sponsored cluster randomized controlled pediatric-based trial evaluating the effectiveness of the Fitline pediatric practice-based referral program to reduce BMI and improve diet and physical activity in children with overweight or obesity. Comparison will be made between brief provider intervention plus referral to (1) eight weekly nutritionist-delivered coaching calls with workbook to help families make AAP-recommended lifestyle changes (Fitline-Coaching), vs. (2) the same workbook in eight mailings without coaching (Fitline-Workbook). METHODS Twenty practices are pair-matched and randomized to one of the two conditions; 494 parents and their children ages 8-12 with a BMI of ≥85th percentile are being recruited. The primary outcome is child BMI; secondary outcomes are child's diet and physical activity at baseline and 6- and 12-months post-baseline. Cost-effectiveness of the two interventions also will be examined. CONCLUSION This is the first randomized controlled trial to examine use of a centrally located telephonic coaching service to support families of children with overweight and obesity in making AAP-recommended lifestyle changes. If effective, the Fitline program will provide an innovative model for widespread dissemination, setting new standards for weight management care in pediatric practice. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03143660.
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Affiliation(s)
- Lori Pbert
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Michelle Trivedi
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Susan Druker
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jennifer Bram
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Barbara Olendzki
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sybil Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, United States
| | - Christine Frisard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Victoria Andersen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Karen Clements
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kristin Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
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Jacob CM, Hardy-Johnson PL, Inskip HM, Morris T, Parsons CM, Barrett M, Hanson M, Woods-Townsend K, Baird J. A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. Int J Behav Nutr Phys Act 2021; 18:1. [PMID: 33397403 PMCID: PMC7784329 DOI: 10.1186/s12966-020-01065-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. METHODS A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. RESULTS Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. CONCLUSIONS Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.
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Affiliation(s)
- Chandni Maria Jacob
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.
- Institute of Developmental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Mail point 887, Tremona Road, Southampton, SO16 6YD, UK.
| | - Polly Louise Hardy-Johnson
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK.
| | - Hazel M Inskip
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Taylor Morris
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Camille M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Millie Barrett
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
| | - Mark Hanson
- Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- Institute of Developmental Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Mail point 887, Tremona Road, Southampton, SO16 6YD, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Janis Baird
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Level two, room 306, Tremona Road, Southampton, SO16 6YD, UK
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36
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Wolfe WS, Dollahite J. Evaluation of the Choose Health: Food, Fun, and Fitness 3rd- to 6th-Grade Curriculum: Changes in Obesity-Related Behaviors. THE JOURNAL OF SCHOOL HEALTH 2021; 91:9-18. [PMID: 33152803 DOI: 10.1111/josh.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 03/20/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Choose Health: Food, Fun, and Fitness (CHFFF) is aimed at 3rd to 6th graders, and uses experiential learning, food preparation, active games, goal setting, and a family newsletter to target behaviors shown to decrease childhood obesity and chronic disease risk. This study aimed to evaluate CHFFF as intended in low-income settings. METHODS A quasi-experimental design with delayed intervention was used. CHFFF participants in 27 after-school and 28 in-school groups in 5 New York counties in 2014 to 2015 completed a self-report survey at initial enrollment, after a no-intervention control period, and after receiving CHFFF. Statistical analyses were based on 561 3rd to 6th graders who completed all 3 surveys and participated in at least 4 of the 6 lessons. RESULTS Compared to their control period, after receiving CHFFF, youth significantly improved in the following multi-item dietary scores: overall dietary intake (p < .001), vegetable intake (p < .001), fruit intake (p < .01), soda/fast food intake (p < .05) and intent to consume soda/fast food (p < .001). Youth also reported reading Nutrition Facts labels and sharing about healthy eating with their family more often (both p < .001), and greater likelihood of having tried a new food (p < .001). CONCLUSIONS Results provide evidence for the effectiveness of this curriculum in improving self-reported child diet and related behaviors.
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Affiliation(s)
- Wendy S Wolfe
- Research Associate, , Division of Nutritional Sciences, Cornell University, B11 Savage Hall, Ithaca NY 14853
| | - Jamie Dollahite
- Professor Emerita, , Division of Nutritional Sciences, Cornell University, 408 Savage Hall, Ithaca NY 14853
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37
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Wang L, Jansen W, van Grieken A, Vlasblom E, Boere-Boonekamp MM, L'Hoir MP, Raat H. Identifying patterns of lifestyle behaviours among children of 3 years old. Eur J Public Health 2020; 30:1115-1121. [PMID: 32653911 PMCID: PMC7733046 DOI: 10.1093/eurpub/ckaa109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To identify the patterns of lifestyle behaviours in children aged 3 years, to investigate the parental and child characteristics associated with the lifestyle patterns, and to examine whether the identified lifestyle patterns are associated with child BMI and weight status. METHODS Cross-sectional data of 2090 children 3 years old participating in the Dutch BeeBOFT study were used. Child dietary intakes, screen times and physical activity were assessed by parental questionnaire, and child weight and height were measured by trained professionals according to a standardized protocol. Latent class analysis was applied to identify patterns of lifestyle behaviours among children. RESULTS Three subgroups of children with distinct patterns of lifestyle behaviours were identified: the 'unhealthy lifestyle' pattern (36%), the 'low snacking and low screen time' pattern (48%) and the 'active, high fruit and vegetable, high snacking and high screen time' pattern (16%). Children with low maternal educational level, those raised with permissive parenting style (compared those with authoritative parents), and boys were more likely be allocated to the 'unhealthy lifestyle' pattern and the 'active, high fruit and vegetable, high snacking and high screen time' pattern (P < 0.05). No association was found between the identified lifestyle patterns and child BMI z-score at age 3 years. CONCLUSIONS Three different lifestyle patterns were observed among children aged 3 years. Low maternal educational level, permissive parenting style and male gender of the child were associated with having unhealthy lifestyle patterns for the child.
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Affiliation(s)
- Lu Wang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Social Development, City of Rotterdam, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Magda M Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Monique P L'Hoir
- Department of Agrotechnology and Food Sciences, Subdivision Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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38
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Wachira LJ, Muthuri S, Ochola S, Onywera V, Tremblay M. Association between dietary behaviours and weight status of school children: results from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) -Kenya. CHILD AND ADOLESCENT OBESITY 2020. [DOI: 10.1080/2574254x.2020.1842014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Lucy-Joy Wachira
- Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - Stella Muthuri
- Population Dynamics and Reproductive Health Program, African Population and Health Research Center, Nairobi, Kenya
| | - Sophie Ochola
- Department of Foods, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Vincent Onywera
- Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - Mark Tremblay
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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39
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Palakshappa D, Lenoir K, Brown CL, Skelton JA, Block JP, Taveras EM, Lewis KH. Identifying geographic differences in children's sugar-sweetened beverage and 100% fruit juice intake using health system data. Pediatr Obes 2020; 15:e12663. [PMID: 32558331 PMCID: PMC8445093 DOI: 10.1111/ijpo.12663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Identifying areas with higher sugar-sweetened beverage intake could help tailor policy and public health efforts intended to reduce sugary beverage consumption. OBJECTIVE Demonstrate the feasibility of using health system data to examine the geographic distribution of sugar-sweetened beverage intake and evaluate neighbourhood characteristics associated with intake. METHODS We extracted electronic health record data from a sugar-sweetened beverage and 100% fruit juice screener used for children ages 1 to 17 years in eight pediatric practices in North Carolina (March 2017-2018) and dichotomized intake to high (≥3 sugar-sweetened beverages/day) vs not. We geocoded address and mapped the proportion of consumers in each census tract. We combined electronic health record data with US census data and evaluated associations of census tract income and race/ethnicity with intake. We used multivariable models to evaluate the association between geographic concentrations of income and race/ethnicity and sugar-sweetened beverage intake, controlling for demographics extracted from the electronic health record and clustering by tract. RESULTS Of 19 451 patients, 4579 (23.5%) reported consuming ≥3 sugar-sweetened beverages/day. In multivariable models, children living in tracts with high concentrations of low-income (OR: 1.45, 95% CI: 1.26, 1.68) and non-white residents (OR: 1.44, 95% CI: 1.21, 1.71) were more likely to consume ≥3 sugar-sweetened beverages/day than children in tracts with a high concentration of high-income and white residents. CONCLUSION We demonstrate how health system data could be used to characterize geographic variation in sugar-sweetened beverage and 100% fruit juice consumption. This approach could help target public health efforts and monitor the effects of community-level interventions.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kristin Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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40
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Camp NL, Robert RC, Kelly KP. Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children. Clin Pediatr (Phila) 2020; 59:978-987. [PMID: 32486901 DOI: 10.1177/0009922820927030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.
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Affiliation(s)
- Nadine L Camp
- Children's National Hospital, Washington, DC, USA.,The George Washington University, Washington, DC, USA.,The Catholic University of America, Washington, DC, USA
| | | | - Katherine P Kelly
- Children's National Hospital, Washington, DC, USA.,The George Washington University, Washington, DC, USA
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Marsh S, Taylor R, Galland B, Gerritsen S, Parag V, Maddison R. Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial. PLoS One 2020; 15:e0238977. [PMID: 32941530 PMCID: PMC7498059 DOI: 10.1371/journal.pone.0238977] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children. METHODS A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap. RESULTS No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents. CONCLUSIONS AND RECOMMENDATIONS A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.
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Affiliation(s)
- Samantha Marsh
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barbara Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Sarah Gerritsen
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ralph Maddison
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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Lewis KH, Skelton J, Hsu FC, Ezouah P, Taveras EM, Block JP. Use of Electronic Health Record Data to Study the Association of Sugary Drink Consumption With Child Weight Status. Acad Pediatr 2020; 20:767-775. [PMID: 31712182 DOI: 10.1016/j.acap.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) and, to some extent, fruit juice are modifiable risk factors for childhood obesity. Data on consumption have not been previously systematically collected in the electronic health record (EHR) in a way that could facilitate observational research and population health management. METHODS In 2017 to 2018, we used data from an EHR-based SSB and fruit juice screener to study the association between consumption and weight status among children 6 months through 17 years of age. We used linear models to examine the cross-sectional association between sugary drinks and BMIz, adjusting for sex, age, race/ethnicity, clinic site, and encounter type. We also used separate mixed-effects models to examine the association of baseline consumption with ∆BMIz. RESULTS Our dataset included 22,291 children (15% <2 years; 23% 2-5 years; 34% 6-11 years; 28% 12-17 years) of diverse race/ethnicity (27% African American, 30% Hispanic). Sugary drink consumption was very common; 43% reported ≥2 per day. For children 6 to 17 years, greater consumption was associated cross sectionally with higher BMIz (eg, 6-11 years old children consuming ≥3/day had 0.27 (95% CI, 0.18, 0.36) higher BMIz vs those consuming <1/week). In longitudinal models, sugary drink consumption was related to ∆BMIz for children 2 to 5 at the highest reported levels of consumption (∆0.35 (0.04, 0.65) BMIz/year more for children consuming ≥3/day versus <1x/week). Larger increases in BMIz were seen for 6 to 17 year olds reporting consumption at or above 1x/day, versus <1x/week. No consistent cross-sectional or longitudinal associations were observed among children under 2. CONCLUSIONS In our EHR-derived data, sugary drink consumption was most associated with high BMIz in school-aged children. Early childhood may be a critical period for intervening on sugary beverage consumption in obesity prevention efforts.
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Affiliation(s)
- Kristina H Lewis
- Division of Public Health Sciences, Wake Forest School of Medicine (KH Lewis, J Skelton, F-C Hsu, and P Ezouah), Winston-Salem, NC.
| | - Joseph Skelton
- Division of Public Health Sciences, Wake Forest School of Medicine (KH Lewis, J Skelton, F-C Hsu, and P Ezouah), Winston-Salem, NC; Department of Pediatrics, Wake Forest School of Medicine (J Skelton), Winston-Salem, NC
| | - Fang-Chi Hsu
- Division of Public Health Sciences, Wake Forest School of Medicine (KH Lewis, J Skelton, F-C Hsu, and P Ezouah), Winston-Salem, NC
| | - Pascaline Ezouah
- Division of Public Health Sciences, Wake Forest School of Medicine (KH Lewis, J Skelton, F-C Hsu, and P Ezouah), Winston-Salem, NC
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital (EM Taveras), Boston, Mass
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (JP Block), Boston, Mass
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Lee DH. Physical Activity Component Should be Included when Designing National Child-Obesity Program: The Rapid Review of Multi-Component Child Obesity Intervention Programs. THE ASIAN JOURNAL OF KINESIOLOGY 2020. [DOI: 10.15758/ajk.2020.22.3.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The prevalence of child obesity is steadily increasing in Korea, thus government needs to seek for effective intervention programs to counteract current epidemics. This study sought to find proven effective child obesity programs implemented in other countries in order to provide policy recommendation. We report the results of rapid review of child obesity programs which were implemented outside of Korea.METHODS A search of multiple databases (NICE Evidence Search, Open Grey, Grey Literature Report, National Cancer institute: research-tested intervention programs) was conducted to identify relevant research articles published after January 2010.RESULTS 11 studies met the inclusion criteria after systematic screening. Most of the included studies used physical activity & diet/nutrition at the same time, while school was the most common location for the intervention. 5 studies showed improvement in obesity related outcomes. Interventions contained physical activity & diet/nutrition or physical activity & psychological coaching, and intervention implemented in school, healthcare facility, summer camp, and after-school class were shown effective.CONCLUSIONS Considering the results of current review, multi-component intervention which includes physical activity is recommended when designing child obesity program. The location of the intervention should be school to maximize its effectiveness.
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44
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Al-Lami N, Sear K, Dai W, Chen JL. Obesity Applications in Smartphones: Development and Use of an Evaluation Tool. J Pediatr Health Care 2020; 34:377-382. [PMID: 32414553 DOI: 10.1016/j.pedhc.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Rates of obesity amongst children and teens in the United States have tripled since the 1970s, and 18.5% are now considered obese. With smartphone use among children and teens becoming the norm, smartphone applications may be a cost-effective solution to support patients and families motivated to change lifestyle behaviors and reduce obesity. The purpose of this quality-improvement project was (1) to develop an app evaluation tool and star rating system based on scientific evidence and current clinical practice guidelines in managing childhood obesity, and (2) to determine whether an in-service training can increase provider knowledge and efficacy in the use of smartphone apps in managing childhood obesity. METHODS An app evaluation tool (Ped-WHAT) was developed that includes evidence-based behavior modification strategies (BMS) and the American Academy of Pediatrics (AAP) guidelines for healthy weight management in pediatrics. Apps were given a rating based on the number of these criteria included in the app. An educational in-service training was developed to assist health care providers in using the app evaluation tool with patients. This training was tested with providers working in a pediatric weight management clinic. Pre- and post-training surveys were administered. Results were analyzed using t tests to assess differences. RESULTS Sixteen commercially available apps were evaluated using the Ped-WHAT tool. Those that included the greatest number of BMS and AAP criteria received the highest rating on a 0-5 scale. Statistically significant improvements in provider knowledge and confidence were found after the in-service training. DISCUSSION In this current digital environment, commercially available weight management apps should undergo evaluation by health care providers to ensure that they follow the standard of care and current practice guidelines/recommendations.
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Smith JD, Fu E, Kobayashi MA. Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annu Rev Clin Psychol 2020; 16:351-378. [PMID: 32097572 PMCID: PMC7259820 DOI: 10.1146/annurev-clinpsy-100219-060201] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.
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Affiliation(s)
- Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136, USA;
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Daundasekara SS, Schuler BR, Hernandez DC. Stability and Change in Early Life Economic Hardship Trajectories and the Role of Sex in Predicting Adolescent Overweight/Obesity. J Youth Adolesc 2020; 49:1645-1662. [PMID: 32378015 DOI: 10.1007/s10964-020-01249-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
There is evidence that poverty is related to adverse child health outcomes. Yet, evidence is lacking on how economic hardship experiences during early childhood are related to adolescent obesity, how the relationship may differ by child sex, in addition to the potential child and maternal behavioral factors that link economic hardship and adolescent obesity. The purpose of the current study was to address this gap by using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 1814). The analytic sample included 50.5% girls, 20% experiencing overweight status, and 19% experiencing obesity. Majority of the adolescents were born to non-Hispanic black (49%), U.S. born (86%), married/cohabitating mothers (61%) with high school or greater level of education (75%). The economic hardship trajectory classes were determined using the latent growth mixture modeling approach and supported a 4-class trajectory model, with 5% of the adolescents in the high-increasing economic hardship trajectory class. The children in the high-increasing economic hardship class had increased odds of developing overweight/obesity in adolescence compared to those in low-stable class. This association was significantly moderated by child sex (i.e., relationship was significant for adolescent boys). Parenting stress and child snacking behaviors did not significantly mediate the association between economic hardship classes and overweight/obesity. Economic hardships that increase through early childhood need to be recognized as an obesity risk factor particularly for adolescent boys.
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Affiliation(s)
- Sajeevika S Daundasekara
- Department of Health, & Health Performance, University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX, 77204-6015, USA.
| | - Brittany R Schuler
- School of Social Work, Temple University, 1301 Cecil B. Moore Ave. Ritter Annex 549, Philadelphia, PA, 19122, USA
| | - Daphne C Hernandez
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center, 6901 Bertner Avenue, Houston, TX, 77030, USA
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Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong IC. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundFive linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.Objectives(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).MethodsFive substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.ResultsStudy A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.Future work and limitationsWork is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.Trial registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Sanjay Kinra
- Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J Cole
- Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK
| | - Silvia Costa
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Helen Croker
- The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK
| | - Tam Fry
- Child Growth Foundation, Edgware, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lee Hudson
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anthony S Kessel
- Director of Global Public Health, Public Health England, London, UK
| | - Steve Morris
- Centre of Applied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Science, University College London, London, UK
| | - Dasha Nicholls
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Faculty of Medicine, Imperial College London, London, UK
| | - Barry Taylor
- Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Billy White
- Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK
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Westfall M, Roth SE, Gill M, Chan-Golston AM, Rice LN, Crespi CM, Prelip ML. Exploring the Relationship Between MyPlate Knowledge, Perceived Diet Quality, and Healthy Eating Behaviors Among Adolescents. Am J Health Promot 2020; 34:713-721. [DOI: 10.1177/0890117120901430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: MyPlate is the current dietary guidance icon meant to communicate healthy eating patterns. The purpose of this study is to evaluate knowledge of MyPlate nutrition education messages among middle school students and its association with dietary intake and perceived diet quality. Design: Secondary analysis of cross-sectional data. Settings: Survey of eighth-grade students from 16 middle schools in California. Subjects: A total of 3521 eighth-grade students. Measures: MyPlate knowledge was assessed with 3 questions asking how much of the plate in a typical meal should be (1) fruits and vegetables, (2) grains, and (3) proteins. A brief food frequency questionnaire measured intake of fruits, vegetables, sweets, salty snacks, fast-food, and sugar-sweetened beverages (SSBs) over the past 7 days. Students self-rated their diet quality as poor, fair, good, or excellent. Analysis: Hierarchical logistic regression models controlling for gender, ethnicity, and socioeconomic status. Results: Only 11% of students answered all MyPlate questions correctly. MyPlate knowledge was associated with 65% higher odds of not consuming SSBs, but 46% lower odds of not consuming sweets. MyPlate knowledge was not associated with adolescents’ perceived diet quality or intake of salty snacks, fruits, or vegetables. Conclusion: Knowledge of nutrition education messages communicated by the MyPlate dietary guidance icon is limited among adolescents. The association between MyPlate knowledge and lower consumption of SSBs is encouraging, given the strong association between SSBs and childhood obesity.
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Affiliation(s)
- Miranda Westfall
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Sarah E. Roth
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Monique Gill
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alec M. Chan-Golston
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Lindsay N. Rice
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Catherine M. Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michael L. Prelip
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Nowak D, Gośliński M. Assessment of Antioxidant Properties of Classic Energy Drinks in Comparison with Fruit Energy Drinks. Foods 2020; 9:foods9010056. [PMID: 31935989 PMCID: PMC7023211 DOI: 10.3390/foods9010056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 01/22/2023] Open
Abstract
Energy drinks (EDs) contain sugar, caffeine, and other bioactive compounds. Recently, new types of EDs, enriched with fruit juices, natural pigments, and plant extracts, have been launched in the market. The objective of this study was to investigate the composition and antioxidant properties of the most popular classic and fruit EDs. The study was carried out including 24 of the most popular energy drinks (classic and fruit EDs). The composition of EDs, especially caffeine and sugar, and antioxidant properties (antioxidant capacity, total polyphenols, total anthocyanins, vitamin C) were analyzed. Energy drinks with added fruit juice or natural pigments had a significantly higher (p ≤ 0.05) antioxidant capacity compared to classic energy drinks. Fruit EDs had a higher concentration of polyphenols and vitamin C. In some fruit EDs, slight amounts of anthocyanins were found. Generally, EDs are not a rich source of polyphenols and are not distinguished by high antioxidant capacity. However, fruit energy drinks and/or ones with added natural pigments have much better antioxidant properties than classic EDs. Both classic and fruit EDs contain a large amount of caffeine and sugar, therefore, it would be advisable not to drink large amounts of EDs for possible related health issues.
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Denford S, Hill DM, Mackintosh KA, McNarry MA, Barker AR, Williams CA. Using photo-elicitation to explore perceptions of physical activity among young people with cystic fibrosis. BMC Pulm Med 2019; 19:220. [PMID: 31771568 PMCID: PMC6878712 DOI: 10.1186/s12890-019-0985-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is recommended in the management of cystic fibrosis (CF). The aim of this study was to explore motives, barriers and enablers to physical activity among this population. METHODS Twelve participants (12-18 years) were recruited via convenience sampling. Photo-elicitation alongside semi-structured interviews were used to explore participants' views and experiences of physical activity. RESULTS Our findings revealed motives for physical activity including health, enjoyment and autonomy. Those with families who valued physical activity tended to have positive attitudes towards physical activity, and valued and integrated it into their lives. Moreover, they were likely to be intrinsically motivated to be active. Several factors enable and act as barriers to physical activity. Whilst CF influenced physical activity, the majority of enablers and barriers raised where congruent with the general populations. CONCLUSION This study provides support that healthcare providers should encourage both young people with CF and their families to be active, and subsequently informs the development of clinical interventions to support physical activity among young people with CF and their families.
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Affiliation(s)
- S Denford
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - D M Hill
- Applied Sports Science, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Swansea, UK
| | - K A Mackintosh
- Applied Sports Science, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Swansea, UK
| | - M A McNarry
- Applied Sports Science, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Swansea, UK
| | - A R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - C A Williams
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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