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Chen C, Eichen D, Kang Sim DE, Strong D, Boutelle KN, Rhee KE. Change in Weight Status Among Children Who Do and Do Not Participate in Intensive Health Behavior and Lifestyle Treatment for Obesity. Child Obes 2024. [PMID: 38265804 DOI: 10.1089/chi.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background: Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial. Methods: Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group. Results: Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment. Conclusions: While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.
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Affiliation(s)
- Cathy Chen
- Northern California Kaiser Permanente Medical Group, Sacramento, CA, USA
| | - Dawn Eichen
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - D Eastern Kang Sim
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - David Strong
- Department of Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Kerri N Boutelle
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Kyung E Rhee
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
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Russell SJ, Mytton OT, Viner RM. Estimating the effects of preventive and weight-management interventions on the prevalence of childhood obesity in England: a modelling study. Lancet Public Health 2023; 8:e878-e888. [PMID: 37898520 DOI: 10.1016/s2468-2667(23)00216-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The effects of the systematic delivery of treatments for obesity are unknown. We aimed to estimate the potential effects on the prevalence of childhood obesity of systematically offering preventive and treatment interventions to eligible children in England, based on weight or health status. METHODS For this modelling study, we developed a cross-sectional simulation model of the child and young adult population in England using data from multiple years of the Health Survey of England conducted between Jan 1, 2010, and Dec 31, 2019. Individuals were assessed for eligibility via age, BMI, and medical complications. Weight status was defined based on clinical criteria used by the UK National Institute of Health and Care Excellence. Published systematic reviews were used to estimate effect sizes for treatments, uptake, and completion for each weight-management tier. We used all available evidence, including evidence from studies that showed an unfavourable effect. We estimated the effects of two systematic approaches: a staged approach, in which children and young people were simultaneously given the most intensive treatment for which they were eligible, and a stepped approach, in which each management tier was applied sequentially, with additive effects. The primary outcomes were estimated prevalence of clinical obesity, defined as a BMI ≥98th centile on the UK90 growth chart, and difference in comparison with the estimated baseline prevalence. FINDINGS 18 080 children and young people were included in the analytical sample. Baseline prevalence of clinical obesity was estimated to be 11·2% (95% CI 10·5 to 11·8) for children and young people aged 2-18 years. In modelling, we estimated absolute decreases in the prevalence of obesity of 0·9% (95% CI 0·1 to 1·8) for universal, preventive interventions; 0·2% (0·1 to 0·4) for interventions within a primary-care setting; 1·0% (0·1 to 2·1) for community and lifestyle interventions; 0·2% (0·0 to 0·4) for pharmaceutical interventions; and 0·4% (0·1 to 0·7) for surgical interventions. Staged care was estimated to result in an absolute decrease in the prevalence of obesity of 1·3% (-0·3 to 2·4) and stepped care was estimated to lead to an absolute decrease of 2·4% (0·1 to 4·8). INTERPRETATION Although individual effect sizes for prevention and treatment interventions were small, when delivered at scale across England, these interventions have the potential to meaningfully contribute to reducing the prevalence of childhood obesity. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Simon J Russell
- Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Oliver T Mytton
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Russell M Viner
- Great Ormond Street Institute of Child Health, University College London, London, UK
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3
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Åsberg M, Derwig M, Castor C. Parents' recalled experiences of the child centred health dialogue in children with overweight: a qualitative study. BMC Health Serv Res 2023; 23:289. [PMID: 36973799 PMCID: PMC10045090 DOI: 10.1186/s12913-023-09308-8] [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: 09/27/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Because overweight and obesity are still increasing and prevention of childhood obesity is more likely to be effective when initiated in preschool children, the Child Health Service in the south of Sweden developed a structured child-centred health dialogue model targeting all 4-year-old children and their families. The aim of this study was to describe parents' recalled experiences of this health dialogue in children with overweight. METHODS A qualitative inductive approach with purposeful sampling was used. Thirteen individual interviews with parents (including 11 mothers and 3 fathers) were conducted and analysed with qualitative content analysis. RESULTS The analysis resulted in two categories: 'A valuable visit with a subtle individual impact' that described parents' recalled experiences of the health dialogue and 'There is a complex interaction between weight and lifestyle' that reflected the parents' perceptions of the relationship between their children's weight and lifestyle. CONCLUSIONS Parents recalled the child-centred health dialogue as important and described discussing a healthy lifestyle as one of the obligations of the Child Health Service. Parents wanted confirmation that their family lifestyle was healthy; however, they did not want to discuss the relationship between their family lifestyle and their children's weight. Parents expressed that when their child followed the child's growth curve, then this indicated healthy growth. This study supports using the child-centred health dialogue as a model to provide structure for discussing a healthy lifestyle and growth but highlights the difficulties of discussing body mass index and overweight, especially in the presence of children.
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Affiliation(s)
- Malin Åsberg
- Vårdcentralen Staffanstorp, Södergatan 2, Staffanstorp, 245 31, Sweden
| | - Mariette Derwig
- Faculty of Medicine, Department of Health Sciences, Lund University, BOX 157, Lund, 222 40, Sweden
| | - Charlotte Castor
- Faculty of Medicine, Department of Health Sciences, Lund University, BOX 157, Lund, 222 40, Sweden.
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4
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Beets MW, Weaver RG, Ioannidis JPA, Pfledderer CD, Jones A, von Klinggraeff L, Armstrong B. Influence of pilot and small trials in meta-analyses of behavioral interventions: a meta-epidemiological study. Syst Rev 2023; 12:21. [PMID: 36803891 PMCID: PMC9938611 DOI: 10.1186/s13643-023-02184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status. METHODS Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study (N ≤ 100, N > 100, and N > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N ≤ 100 studies on the estimated summary ES. RESULTS A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N ≤ 100 studies comprised 22% (0-58%) and 21% (0-83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N ≤ 100) or mostly large (N > 370). Concordance was low when removing both pilot/feasibility and N ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies (N > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES. CONCLUSIONS When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.
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Affiliation(s)
- Michael W. Beets
- Arnold School of Public Health, University of South Carolina, SC Columbia, USA
| | - R. Glenn Weaver
- Arnold School of Public Health, University of South Carolina, SC Columbia, USA
| | - John P. A. Ioannidis
- Department of Medicine, Stanford University, Stanford, CA USA
- Department of Health Research and Policy, Stanford University, Stanford, CA USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA USA
- Department of Statistics, Stanford University, Stanford, CA USA
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA USA
| | | | - Alexis Jones
- Arnold School of Public Health, University of South Carolina, SC Columbia, USA
| | | | - Bridget Armstrong
- Arnold School of Public Health, University of South Carolina, SC Columbia, USA
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5
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Ebbeling CB, Ludwig DS. Treatment for childhood obesity: Using a biological model to inform dietary targets. J Pediatr 2022; 255:22-29. [PMID: 36509158 DOI: 10.1016/j.jpeds.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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6
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Rodriguez LA, Gopalan A, Darbinian JA, Chandra M, Greenspan LC, Howell A, Lo JC. Identifying modifiable obesogenic behaviors among Latino adolescents in primary pediatric care. Prev Med Rep 2022; 29:101939. [PMID: 35942298 PMCID: PMC9356151 DOI: 10.1016/j.pmedr.2022.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Latino adolescents engage in more obesogenic behaviors, including sedentary behaviors and sugary drink consumption, than White adolescents. However, it is unclear whether engagement in obesogenic behaviors differs within the Latino population. Cross-sectional data were examined from Latino adolescents ages 13–17 with a well-child visit (2016–2019) in an integrated healthcare system. Adolescents self-reported on four daily obesogenic behaviors: 1) consuming < 5 servings of fruits/vegetables; 2) drinking > 1 juice/soda; 3) exercising/playing sports < 60 min; and 4) > 2 h screen time. A composite variable of ≥ 3 self-reported behaviors was constructed. Multivariable logistic regression was used to examine associations between obesogenic behaviors with age category (13–15 or 16–17 years), sex, household language preference (English/Spanish), neighborhood deprivation index (NDI quartiles), and body mass index (BMI). Among 77,514 Latino adolescents (mean age 14.7 ± 1.4; 50 % female), 23 % lived in Spanish-speaking households, 43 % resided in census tracts with the highest (most deprived) NDI quartile, and 45 % had an overweight or obese BMI. Older (vs younger) adolescents had higher odds of insufficient fruit/vegetable intake (OR 1.20; CI 1.17–1.24), greater sedentary behavior (OR 1.51; 1.46–1.56), and reporting > 2 h screen time (OR 1.07; 1.03–1.11). Adolescents in the 4th (vs 1st) NDI quartile (OR 1.34; 1.26–1.42) and those with obesity (vs healthy weight) (OR 1.55; 1.42–1.70 for class 3 obesity) had higher odds of ≥ 3 obesogenic behaviors. In conclusion, among Latino adolescents, older age, obesity, and living in more deprived neighborhoods were associated with greater obesogenic behaviors. Identifying adolescents more likely to engage in obesogenic behaviors can inform targeted lifestyle interventions.
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Affiliation(s)
- Luis A. Rodriguez
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- Corresponding author at: Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
| | - Anjali Gopalan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- The Permanente Medical Group, Oakland, CA, United States
| | - Jeanne A. Darbinian
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Malini Chandra
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Louise C. Greenspan
- The Permanente Medical Group, Oakland, CA, United States
- Kaiser Permanente San Francisco, Department of Pediatrics, San Francisco, CA, United States
| | - Amanda Howell
- Health Engagement Consulting Services, The Permanente Medical Group, Oakland, CA, United States
| | - Joan C. Lo
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
- The Permanente Medical Group, Oakland, CA, United States
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7
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Else V, Chen Q, Cortez AB, Koebnick C. Sustainability of weight loss from a family-centered pediatric weight management program integrated in primary care. BMC Health Serv Res 2022; 22:12. [PMID: 34974835 PMCID: PMC8720465 DOI: 10.1186/s12913-021-07361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity. METHODS In a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error. RESULTS The baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI - 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI - 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG). CONCLUSIONS The initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.
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Affiliation(s)
- Veronica Else
- Southern California Permanente Medical Group, Kaiser Permanente Yorba Linda Medical Offices, 22550 Savi Ranch Parkway, Yorba Linda, CA, 92887, USA.
| | - Qiaoling Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Alan B Cortez
- Southern California Permanente Medical Group, Kaiser Permanente Tustin Ranch, Tustin, California, USA
| | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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8
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Schick MR, Kirk-Provencher KT, Goldstein SC, Nalven T, Spillane NS. A Framework for the Adaptation of Positive Psychological Interventions to North American Indigenous Populations. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:913-922. [PMID: 34296375 PMCID: PMC8501455 DOI: 10.1007/s11121-021-01282-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Positive psychology research has led to the development of brief interventions designed to promote positive emotions: positive psychological interventions (PPIs). Randomized controlled trials examining PPIs have found them to be effective in increasing well-being and decreasing depressive symptoms. PPIs have been studied in samples consisting primarily of White Americans; however, PPIs may be useful for members of North American Indigenous groups. PPIs align well with Indigenous views on health, which tend to be strengths-based, holistic, and encompassing the whole body (including the medicine wheel's four dimensions of spirit, mind, heart, and body). This paper provides a framework for the adaptation of PPIs for Indigenous communities and a review of preliminary data on the relationships between positive psychological characteristics and health outcomes including substance use. Implications include the potential widespread impact of culturally adapted PPIs given their alignment with Indigenous thoughts on health and relative ease of administration.
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Affiliation(s)
- Melissa R Schick
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA.
| | - Katelyn T Kirk-Provencher
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Silvi C Goldstein
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Tessa Nalven
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Nichea S Spillane
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
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9
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Loth KA, Lebow J, Uy MJA, Ngaw SM, Neumark-Sztainer D, Berge JM. First, Do No Harm: Understanding Primary Care Providers' Perception of Risks Associated With Discussing Weight With Pediatric Patients. Glob Pediatr Health 2021; 8:2333794X211040979. [PMID: 34514059 PMCID: PMC8427925 DOI: 10.1177/2333794x211040979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.
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Affiliation(s)
- Katie A. Loth
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | | | | | - Jerica M. Berge
- University of Minnesota Medical School, Minneapolis, MN, USA
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10
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Hale I, Jackson E. Evaluating routine pediatric growth measurement as a screening tool for overweight and obese status. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:161-165. [PMID: 33727374 DOI: 10.46747/cfp.6703161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Hale
- Family physician and Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia.
| | - Emma Jackson
- Family medicine resident at the University of British Columbia
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11
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Kaufman TK, Lynch BA, Wilkinson JM. Childhood Obesity: An Evidence-Based Approach to Family-Centered Advice and Support. J Prim Care Community Health 2021; 11:2150132720926279. [PMID: 32501125 PMCID: PMC7278289 DOI: 10.1177/2150132720926279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The prevalence of childhood obesity continues to rise despite decades of clinical and public health efforts. Early identification of children at risk of developing obesity is essential using newer electronic health systems, which move beyond traditional growth charts to provide a wealth of information about body mass index and other relevant parameters such as social determinants of health and comorbid conditions. For children who already have obesity, there are several evidence-based strategies health care providers can use as they work with patients and families to mitigate the effects. First and foremost, providers should address the issue; unfortunately, weight is often not discussed in clinical practice. In addressing the issue, providers should support families through effective, positive relationships. Providers must be aware of their biases; their language should be appropriate and nonstigmatizing. Helpful interventions should focus on behavior, not weight, health, or appearance. Motivational interviewing may be used to promote healthful behaviors: supportive parenting, regular exercise, healthful food choices, minimal screen time, and optimal sleep. There is limited evidence for the efficacy of specific weight loss diets. Both medication and bariatric surgery are indicated for select adolescents who have severe disease unresponsive to behavioral management.
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Affiliation(s)
- Tara K. Kaufman
- Mayo Clinic, Rochester, MN, USA
- Tara K. Kaufman, Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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12
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Sease KK, Rolke LJ, Forrester JE, Griffin SF. Feedback Following a Family-Focused Pediatric Weight Management Intervention: Experiences From the New Impact Program. J Patient Exp 2021; 8:23743735211008309. [PMID: 34179436 PMCID: PMC8205377 DOI: 10.1177/23743735211008309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Weight management interventions have the potential to reduce body mass index and help families adopt healthier behaviors. This study examined feedback from families to identify central aspects of various intervention strategies based on self-determination theory constructs that have the strongest influence on patient success, with the aim of understanding how best to approach weight management in a clinical pediatric setting. Telephone interviews were conducted with 22 individuals (20 parents/guardians and 2 teenagers) who participated in a multidisciplinary weight management program and data was analyzed using inductive and deductive thematic analysis processes. Participants identified motivational interviewing strategies that were most influential to their success. Parents and patient's identified barriers and facilitators to success included patient readiness to change, personal logistics, family engagement, and establishing long- and short-term goals. Successful pediatric obesity management requires consideration to both the patient and family's readiness, structured implementation adaptations to address barriers, intentional efforts to move from external reward to internal motivation, and strategies to ensure families develop self-efficacy toward achievable healthy behaviors.
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Affiliation(s)
- Kerry K Sease
- Department of Pediatrics, Prisma Health Children's Hospital - Upstate, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Laura J Rolke
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Jacqueline E Forrester
- Bradshaw Institute for Community Child Health & Advocacy, Prisma Health, Greenville, SC, USA
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Illescas-Zárate D, Batis C, Ramírez-Silva I, Torres-Álvarez R, Rivera JA, Barrientos-Gutiérrez T. Potential Impact of the Nonessential Energy-Dense Foods Tax on the Prevalence of Overweight and Obesity in Children: A Modeling Study. Front Public Health 2021; 8:591696. [PMID: 33634061 PMCID: PMC7902009 DOI: 10.3389/fpubh.2020.591696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Consumption of foods high in energy, sugar, fat, and salt contributes to the increase in body mass index and the prevalence of overweight and obesity in children. Mexico implemented an 8% tax to non-essential energy-dense foods (NEDF) in 2014 as part of a national strategy to reduce obesity. Objective: We modeled the potential effect of the NEDF tax on body mass index and overweight and obesity in Mexican children (6-17 years). Materials and Methods: We used the Dynamic Childhood Growth and Obesity Model calibrated to Mexican children to simulate the potential 1-year effect of the NEDF tax on body weight. Inputs for the model included NEDF consumption, weight, and height, obtained from the 2012 Mexican National Health and Nutrition Survey. To project the potential impact of the tax, we ran a first simulation without intervention and another reducing the caloric intake from NEDF in the proportion observed in the Mexican population after the tax (-5.1%). The tax effect was defined as the absolute difference in body mass index and prevalence of overweight and obesity between both models. Results: The tax on NEDF should lead to a mean reduction of 4.1 g or 17.4 kcal/day of NEDF at the population level. One year after the tax, mean body weight and body mass index should decrease 0.40 kg and 0.19 kg/m2; this translates into -1.7 and -0.4% points in overweight and obesity, respectively. Conclusions: The use of fiscal instruments to discourage the consumption of NEDF could help to reduce the prevalence of overweight and obesity in children.
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Affiliation(s)
- Daniel Illescas-Zárate
- Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Carolina Batis
- CONACYT—Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ivonne Ramírez-Silva
- Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Rossana Torres-Álvarez
- Center for Research in Population Health, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Juan A. Rivera
- Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Research in Population Health, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
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14
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Tissot H, Pfarrwaller E, Haller DM. Primary care prevention of cardiovascular risk behaviors in adolescents: A systematic review. Prev Med 2021; 142:106346. [PMID: 33275966 DOI: 10.1016/j.ypmed.2020.106346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/15/2022]
Abstract
Adolescence is associated with behavioral changes offering opportunities for prevention of cardiovascular risk behaviors. Primary care physicians are ideally placed to deliver preventive interventions to adolescents. The objective was to systematically review the evidence about effectiveness of primary care-led interventions addressing the main cardiovascular risk behaviors in adolescents: physical activity, sedentary behaviors, diet and smoking. PubMed, Embase, PsycINFO, CINAHL, Cochrane, ClinicalTrials.gov, and ISRCTN registry were searched from January 1990 to April 2020. Randomized controlled trials of interventions in primary care contexts on at least one of the cardiovascular behaviors were included, targeting 10-19-year old adolescents, according to the World Health Organization's definition. Two authors independently assessed risk of bias. Twenty-two papers were included in the narrative synthesis, reporting on 18 different studies. Interventions targeting smoking uptake seemed more effective than interventions targeting established smoking or the three other risk behaviors. Intervention components or intensity were not clearly associated with effectiveness. Risk of bias was mostly unclear for most studies. There is little evidence for specific interventions on adolescents' cardiovascular risk behaviors in primary care, mainly due to studies' methodological limitations. Further research should investigate the effectiveness of opportunistic primary care-based interventions as compared to more complex interventions, and address the methodological shortcomings identified in this review.
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Affiliation(s)
- Hervé Tissot
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Eva Pfarrwaller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of General Practice, The University of Melbourne, Melbourne, Australia.
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Kelly S, Melnyk BM, Hoying J. Adolescents as Agents of Parental Healthy Lifestyle Behavior Change: COPE Healthy Lifestyles TEEN Program. J Pediatr Health Care 2020; 34:575-583. [PMID: 32917424 PMCID: PMC7656994 DOI: 10.1016/j.pedhc.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Obesity is a leading health crisis around the world. An intervention strategy scarcely utilized for behavior change is that of a child as change agent. The purpose of this study was to describe the impact of teens reviewing newsletters from a healthy lifestyle intervention with their parents. METHOD Evaluation data from a randomized controlled trial, COPE Healthy Lifestyle TEEN Program, was analyzed. A descriptive study was conducted of parents' and teens' lifestyle behaviors as reported by parents. RESULTS One hundred sixty-nine parents completed evaluations. Two thirds of parents reported changing a behavior as a result of the program. Nearly three quarters of parents reported behavior changes in their teens. Over 90% reported they would recommend this or a similar program. DISCUSSION The obesity epidemic shows no signs of reversal, and hence multiple approaches to impact healthy lifestyles are urgent. Including children as a change agent is a potential target for interventions addressing obesity.
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Raynor HA, Barroso C, Propst S, Berlin K, Robson S, Khatri P. Reach of a low-intensity, multicomponent childhood overweight and obesity intervention delivered in an integrated primary care setting. Transl Behav Med 2020; 10:760-769. [PMID: 31220326 PMCID: PMC7413189 DOI: 10.1093/tbm/ibz055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Reach (i.e., proportion and representativeness of participants) of low-intensity, multicomponent childhood overweight/obesity interventions delivered in primary care settings with low-income and/or minority families is unknown. The purpose of this research is to describe the reach of a low-intensity, multicomponent childhood overweight/obesity intervention delivered in an integrated primary care setting in a federally qualified health center (FQHC). Eligibility criteria included children aged 4-10 years with a body mass index (BMI) ≥85th percentile, with a female caregiver. Using the electronic health record (EHR) and release forms, families were broadly categorized into groupings from recruitment flow, with differing proportions calculated from these groupings. Representativeness was determined using EHR data from families who were informed about the program (n = 963). Three calculated reach rates ranged from 54.9% to 3.9%. Lower reach rates were calculated using the number of families randomized (n = 73) as the numerator and the children from families who were informed about the program (n = 963) or all eligible children in the FQHC attending appointments (n = 1,864) as denominators. The first two steps in recruitment, informing families about the program and families initiating participation, were where the largest decreases in reach occurred. Children who were randomized were older, had a higher BMI, had a greater number of medical diagnoses indicating overweight or obesity, and were Hispanic. Reach of the intervention was low. Strategies that assist with reducing time for informing families of treatment and increasing families' awareness of their child's weight status should assist with enhancing reach.
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Affiliation(s)
- Hollie A Raynor
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Cristina Barroso
- Department of Public Health, University of Tennessee Knoxville, Knoxville, TN, USA
| | | | | | - Shannon Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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Chong NK, Chu Shan Elaine C, de Korne DF. Creating a Learning Televillage and Automated Digital Child Health Ecosystem. Pediatr Clin North Am 2020; 67:707-724. [PMID: 32650868 DOI: 10.1016/j.pcl.2020.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article explores the impact of digital technologies, including telehealth, teleconsultations, wireless devices, and chatbots, in pediatrics. Automated digital health with the Internet of things will allow better collection of real-world data for generation of real-world evidence to improve child health. Artificial intelligence with predictive analytics in turn will drive evidence-based decision-support systems and deliver personalized care to children. This technology creates building blocks for a learning child health and health care ecosystem.
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Affiliation(s)
- Ng Kee Chong
- Medical Innovation & Care Transformation, Division of Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Chew Chu Shan Elaine
- Adolescent Medicine Service, Department of Paediatrics, KK Women's & Children's Hospital, Singapore
| | - Dirk F de Korne
- Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Netherlands; SVRZ Cares in Zeeland, Middelburg, Netherlands
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18
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Reed ZE, Suderman MJ, Relton CL, Davis OSP, Hemani G. The association of DNA methylation with body mass index: distinguishing between predictors and biomarkers. Clin Epigenetics 2020; 12:50. [PMID: 32228717 PMCID: PMC7106582 DOI: 10.1186/s13148-020-00841-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/17/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND DNA methylation is associated with body mass index (BMI), but it is not clear if methylation scores are biomarkers for extant BMI or predictive of future BMI. Here, we explore the causal nature and predictive utility of DNA methylation measured in peripheral blood with BMI and cardiometabolic traits. METHODS Analyses were conducted across the life course using the ARIES cohort of mothers (n = 792) and children (n = 906), for whom DNA methylation and genetic profiles and BMI at multiple time points (3 in children at birth, in childhood and in adolescence; 2 in mothers during pregnancy and in middle age) were available. Genetic and DNA methylation scores for BMI were derived using published associations between BMI and DNA methylation and genotype. Causal relationships between methylation and BMI were assessed using Mendelian randomisation and cross-lagged models. RESULTS The DNA methylation scores in adult women explained 10% of extant BMI variance. However, less extant variance was explained by scores generated in the same women during pregnancy (2% BMI variance) and in older children (15-17 years; 3% BMI variance). Similarly, little extant variance was explained in younger children (at birth and at 7 years; 1% and 2%, respectively). These associations remained following adjustment for smoking exposure and education levels. The DNA methylation score was found to be a poor predictor of future BMI using linear and cross-lagged models, suggesting that DNA methylation variation does not cause later variation in BMI. However, there was some evidence to suggest that BMI is predictive of later DNA methylation. Mendelian randomisation analyses also support this direction of effect, although evidence is weak. Finally, we find that DNA methylation scores for BMI are associated with extant cardiometabolic traits independently of BMI and genetic score. CONCLUSION The age-specific nature of DNA methylation associations with BMI, lack of causal relationship and limited predictive ability of future BMI indicate that DNA methylation is likely influenced by BMI and might more accurately be considered a biomarker of BMI and related outcomes rather than a predictor. Future epigenome-wide association studies may benefit from further examining associations between early DNA methylation and later health outcomes.
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Affiliation(s)
- Zoe E Reed
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Matthew J Suderman
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Oliver S P Davis
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The Alan Turing Institute, British Library, 96 Euston Road, London, UK
| | - Gibran Hemani
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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St George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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20
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Islami F, Goding Sauer A, Gapstur SM, Jemal A. Proportion of Cancer Cases Attributable to Excess Body Weight by US State, 2011-2015. JAMA Oncol 2019; 5:384-392. [PMID: 30589925 DOI: 10.1001/jamaoncol.2018.5639] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Excess body weight (EBW) is an established cause of cancer. Despite variations in the prevalence of EBW among US states, there is little information on the EBW-related cancer burden by state; this information would be useful for setting priorities for cancer-control initiatives. Objective To calculate the population attributable fraction (PAF) of incident cancer cases attributable to EBW among adults 30 years or older in 2011 to 2015 in all 50 states and the District of Columbia. Design, Setting, and Participants State-level, self-reported body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) data from the Behavioral Risk Factor Surveillance System were adjusted by sex, age, race/ethnicity, and education using objectively measured BMI values from the National Health and Nutrition Examination Survey. Age- and sex-specific cancer incidence data by state were obtained from the US Cancer Statistics database. All analyses were performed between February 15, 2018, and July 17, 2018. Main Outcomes and Measures Sex-, age-, and state-specific adjusted prevalence estimates for 4 high BMI categories and corresponding relative risks from large-scale pooled analyses or meta-analyses were used to compute the PAFs for each US state for esophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colorectum, liver, gallbladder, pancreas, female breast, corpus uteri, ovary, kidney and renal pelvis, and thyroid. Results Each year, an estimated 37 670 cancer cases in men (4.7% of all cancer cases excluding nonmelanoma skin cancers) and 74 690 cancer cases in women (9.6%) 30 years or older in the United States were attributable to EBW from 2011 to 2015. In both men and women, there was at least a 1.5-fold difference in the proportions of cancers attributable to EBW between states with the highest and lowest PAFs. Among men, the PAF ranged from 3.9% (95% CI, 3.6%-4.3%) in Montana to 6.0% (95% CI, 5.6%-6.4%) in Texas. The PAF for women was approximately twice as high as for men, ranging from 7.1% (95% CI, 6.7%-7.6%) in Hawaii to 11.4% (95% CI, 10.7%-12.2%) in the District of Columbia. The largest PAFs were found mostly in southern and midwestern states, as well as Alaska and the District of Columbia. Conclusions and Relevance The proportion of cancers attributable to EBW varies among states, but EBW accounts for at least 1 in 17 of all incident cancers in each state. Broad implementation of known community- and individual-level interventions is needed to reduce access to and marketing of unhealthy foods (eg, through a tax on sugary drinks) and to promote and increase access to healthy foods and physical activity, as well as preventive care.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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21
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Poeta M, Lamberti R, Di Salvio D, Massa G, Torsiello N, Pierri L, Delli Bovi AP, Di Michele L, Guercio Nuzio S, Vajro P. Waist Circumference and Healthy Lifestyle Preferences/Knowledge Monitoring in a Preschool Obesity Prevention Program. Nutrients 2019; 11:E2139. [PMID: 31500234 PMCID: PMC6769722 DOI: 10.3390/nu11092139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 01/28/2023] Open
Abstract
Weight and body mass index (BMI) changes appear to be poor measures for assessing the success of most pediatric obesity prevention programs (POPP). The aim of this study is to evaluate the effectiveness of the preschool-age prevention program (3P) in improving and maintaining overtime preschoolers' knowledge/preferences about healthy nutrition and physical activity (PA), and the relationship between acquired healthy behaviors and anthropometrics including waist circumference (WC). Twenty-five preschoolers underwent a 24-month healthy lifestyle multi-component pilot intervention followed by a one-year wash-out period; 25 age-matched served as controls. Anthropometric/behavioral data were monitored. After the 2-year study and wash-out, the rates of children overweight and with obesity decreased only in the intervention group, where, also, normal-weight children with visceral obesity attained WC normal values (p = 0.048). While mean values of BMI Z-scores remained unchanged in both the intervention and control groups, WC (values and percentiles) showed a significant reduction only in the intervention group. Children's adherence to the Mediterranean diet remained acceptable among the entire sample. Although daily sweet beverage consumption remained unchanged in both groups, knowledge/preferences improved significantly more in the intervention group. In conclusion, WC may be more sensitive than BMI for monitoring preschoolers in POPP and reflects healthy behavioral changes acquired during the intervention.
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Affiliation(s)
- Marco Poeta
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Rossella Lamberti
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Dario Di Salvio
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Grazia Massa
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Nives Torsiello
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Luca Pierri
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Anna Pia Delli Bovi
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Laura Di Michele
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Salvatore Guercio Nuzio
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Pietro Vajro
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
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Sherwood NE, Levy RL, Seburg EM, Crain AL, Langer SL, JaKa MM, Kunin‐Batson A, Jeffery RW. The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes. Pediatr Obes 2019; 14:e12523. [PMID: 30873752 PMCID: PMC8853652 DOI: 10.1111/ijpo.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/22/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pediatric primary care is an important setting for addressing obesity prevention. OBJECTIVE The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. METHODS Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile. RESULTS There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up. CONCLUSIONS AND RELEVANCE An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.
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Affiliation(s)
- Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- UW School of Social Work (SSW), Seattle, WA, USA
| | | | | | - Shelby L. Langer
- UW School of Social Work (SSW), Seattle, WA, USA,Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Meghan M. JaKa
- DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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MacMillan Uribe AL, Woelky KR, Olson BH. Exploring Family-Medicine Providers' Perspectives on Group Care Visits for Maternal and Infant Nutrition Education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:409-418. [PMID: 30773444 DOI: 10.1016/j.jneb.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Explore current maternal and infant nutrition education practices and family medicine primary care providers' views on a group care model to deliver nutrition education to mother-infant dyads. DESIGN In-depth interviews. SETTING Family medicine clinics in 1 Midwestern US hospital system. PARTICIPANTS Family medicine primary care providers (n = 17) who regularly see infants during well-baby visits. PHENOMENON OF INTEREST Current maternal and infant nutrition education practices; views on ideal way to deliver nutrition education to mother-infant dyads; feedback on group care model to deliver nutrition education to mother-infant dyads. ANALYSIS Audio recordings transcribed verbatim and coded using conventional content analysis. RESULTS Family medicine primary care providers are limited in the ability to provide maternal and infant nutrition education and desire a different approach. Group care was the preferred method; it was shared most frequently as the ideal approach to nutrition education delivery and participants reacted favorably when presented with this model. However, there were many concerns with group care (eg, moderating difficult conversations, program implementation logistics, sufficient group volume, and interruption in patient-provider relationship). CONCLUSION AND IMPLICATIONS Family medicine primary care providers desire a different approach to deliver nutrition education to mother-infant dyads in clinic. A group care model may be well-accepted among family medicine primary care providers but issues must be resolved before implementation. These results could inform future group care implementation studies and influence provider buy-in.
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Affiliation(s)
| | - Kaitland R Woelky
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Beth H Olson
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI.
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Tucker JM, DeFrang R, Orth J, Wakefield S, Howard K. Evaluation of a Primary Care Weight Management Program in Children Aged 2⁻5 years: Changes in Feeding Practices, Health Behaviors, and Body Mass Index. Nutrients 2019; 11:nu11030498. [PMID: 30818772 PMCID: PMC6471876 DOI: 10.3390/nu11030498] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Primary care offers a promising setting for promoting parenting practices that shape healthy eating and physical activity behaviors of young children. This study assessed the impact of a parent-based, primary care intervention on the feeding habits, health behaviors, and body mass index (BMI) of 2⁻5 year olds with elevated or rapidly-increasing BMI. METHODS Four private pediatric offices in West Michigan were assigned as control (n = 2) or intervention (n = 2) sites based on patient load and demographics. Treatment families were recruited at well-child visits to receive physician health-behavior counseling and four visits with a registered dietitian nutritionist (RDN) over a 6-month period. Intervention outcomes were age- and sex-specific BMI metrics, including BMI z-scores and percent of the 95th percentile (%BMIp95), the Family Nutrition and Physical Activity survey (FNPA), and the Feeding Practices and Structure Questionnaire (FPSQ). RESULTS Of 165 enrolled families, 127 completed follow-up measures (77% retention). Mean (±SD) FNPA scores improved in treatment vs. control (4.6 ± 4.6 vs. 0.1 ± 4.2; p < 0.001), and screen time (h/day) decreased (-0.9 ± 1.8 vs. 0.3 ± 1.1; p < 0.001). Non-responsive feeding practices (i.e., reward for behavior (p = 0.006) and distrust in appetite (p < 0.015)) and structure-related feeding practices (structured meal timing (p < 0.001)) improved in treatment parents vs. controls. Reductions in child BMI measures did not differ between groups. CONCLUSIONS Families with preschool children participating in a low-intensity, primary care intervention improved obesogenic health behaviors, parent feeding habits, and child screen time, but not child adiposity. Future research should assess the sustainability of these family lifestyle improvements, and evaluate their future impact on the health and development of the children.
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Affiliation(s)
- Jared M Tucker
- Healthy Weight Center, Helen DeVos Children's Hospital, 35 Michigan, Suite 1800 MC232, Grand Rapids, MI 49503, USA.
- Department of Pediatrics and Human Development, Michigan State University, Life Sciences Bldg.1355 Bogue St., B240, East Lansing, MI 48824, USA.
| | - Renee DeFrang
- We Are For Children, LLC, 877 Forest Hill Ave SE, Grand Rapids, MI 49546, USA.
| | - Julie Orth
- We Are For Children, LLC, 877 Forest Hill Ave SE, Grand Rapids, MI 49546, USA.
| | - Susan Wakefield
- We Are For Children, LLC, 877 Forest Hill Ave SE, Grand Rapids, MI 49546, USA.
- Forest Hills Pediatrics, 877 Forest Hill Ave SE, Grand Rapids, MI 49546, USA.
| | - Kathleen Howard
- Department of Pediatrics and Human Development, Michigan State University, Life Sciences Bldg.1355 Bogue St., B240, East Lansing, MI 48824, USA.
- Forest Hills Pediatrics, 877 Forest Hill Ave SE, Grand Rapids, MI 49546, USA.
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25
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Drouin O, Sharifi M, Gerber M, Horan C, Orav EJ, Marshall R, Taveras EM. Parents' Willingness to Pay for Pediatric Weight Management Programs. Acad Pediatr 2019; 19:764-772. [PMID: 31128381 PMCID: PMC6731996 DOI: 10.1016/j.acap.2019.05.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/19/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine parents' interest in continuing and willingness to pay (WTP) for 2 pediatric weight management programs following their participation. METHODS Participants were parents of 2- to 12-year-old children with body mass index ≥ 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other received EPC plus individualized coaching (EPC+C). At 1 year, we assessed parents' self-reported WTP for a similar program and the maximum amount ($/month) they would pay. We used multivariable regression to examine differences in WTP and WTP amount by intervention arm and by individual and family-level factors. RESULTS Of 638 parents who completed the survey, 85% were interested in continuing and 38% of those parents were willing to pay (31% in the EPC group and 45% in the EPC+C group). The median amount parents were willing to pay was $25/month (interquartile range, $15-$50). In multivariable models, the EPC+C parents were more likely to endorse WTP than the EPC parents (odds ratio, 1.53; 95% confidence interval, 1.05-2.22). Parents of children with Hispanic/Latino versus white ethnicity and those reporting higher satisfaction with the program were also more likely to endorse WTP. CONCLUSIONS Most parents of children in a weight management program were interested in continuing it after it ended, but fewer were willing to pay out of pocket for it. A greater proportion of parents were willing to pay if the program included individualized health coaching.
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Affiliation(s)
- Olivier Drouin
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA,Harvard-wide Pediatric Health Services Research Fellowship, Boston, MA, USA,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Monica Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
| | - E. John Orav
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, USA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA,Harvard-wide Pediatric Health Services Research Fellowship, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health; Boston, MA, USA
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26
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Solmi M, Köhler CA, Stubbs B, Koyanagi A, Bortolato B, Monaco F, Vancampfort D, Machado MO, Maes M, Tzoulaki I, Firth J, Ioannidis JPA, Carvalho AF. Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials. Eur J Clin Invest 2018; 48:e12982. [PMID: 29923186 DOI: 10.1111/eci.12982] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. MATERIALS AND METHODS PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. RESULTS Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated. CONCLUSIONS Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Francesco Monaco
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, University of Leuven, Leuven-Kortenberg, Belgium
| | - Myrela O Machado
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,IMPACT Strategic Research Center, Deakin University, Geelong, Vic., Australia
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK.,Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Joseph Firth
- NICM, School of Science and Health, University of Western Sydney, Sydney, NSW, Australia.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
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27
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Wake M, Kerr JA, Jansen PW. Child BMI Over Time and Parent-Perceived Overweight. Pediatrics 2018; 142:peds.2017-3985. [PMID: 30409841 DOI: 10.1542/peds.2017-3985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Parents often do not accurately perceive overweight and/or obesity in their children. Changing this is widely considered an essential first step to reducing child overweight, but recent research suggests that, in fact, this could promote greater weight gain. We aimed to determine the directionality over time between higher child adiposity and parental perception of child overweight. METHODS Participants were from 2 cohorts of the population-based Longitudinal Study of Australian Children followed biennially since 2004. Repeated measures of BMI z scores and parental perceptions of overweight were available for the kindergarten cohort at 6 waves (ages 4-5, 6-7, 8-9, 10-11, 12-13, and 14-15 years; n = 4632) and for the birth cohort at 4 waves (ages 2-3, 4-5, 8-9, and 10-11 years; n = 4445). Bidirectionality between overweight perception and BMI z score was examined by using cross-lagged regression models. RESULTS In both cohorts, wave-on-wave lagged effects were strong (all: P < .001) but much larger from BMI z score to parent perception. For every unit increase in the BMI z score, the odds of a child being perceived as overweight in the next wave ranged from 2.9 (birth cohort: age 2-3 years) to 10.4 (kindergarten cohort: age 6-7 years). These effects were ∼3 to 12 times larger than the reverse, whereby the perception of overweight predicted 0.2 to 0.5 higher BMI z score in the next wave. CONCLUSIONS Higher child BMI z scores strikingly predicted a subsequent parental perception of child overweight. Parent-perceived overweight preceded rising (not falling) BMI, but these effects were small. Clinician efforts to make parents aware of overweight may not be harmful but seem unlikely to improve children's BMI status.
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Affiliation(s)
- Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; .,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics and Liggins Institute, University of Auckland, Grafton, New Zealand
| | - Jessica A Kerr
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Pauline W Jansen
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, Netherlands; and.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Netherlands
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28
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Yackobovitch-Gavan M, Wolf Linhard D, Nagelberg N, Poraz I, Shalitin S, Phillip M, Meyerovitch J. Intervention for childhood obesity based on parents only or parents and child compared with follow-up alone. Pediatr Obes 2018; 13:647-655. [PMID: 29345113 DOI: 10.1111/ijpo.12263] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The study aims to assess the effects of family-based interventions targeted to parents only or to parents-and-child for the prevention and treatment of childhood obesity. METHOD An open-label randomized study was conducted in 247 children (166 girls, 5-11 years) with body mass index (BMI) in the 85-98th percentile. Participants were allocated to three groups: parents-only (n = 89), parents-and-child (n = 84) and follow-up alone (n = 74). The intervention consisted of 12 once-weekly meetings with a dietician and psychologist. All children were followed for 2 years. Changes in anthropometric, clinical and lifestyle outcomes were assessed. RESULTS The 3-month intervention was completed by 58 (65.2%) in the parents-only, 61 (72.6%) in the parents-child and 49 (66.2%) in the control group (P = .554). BMI-standard deviation score (SDS) decreased from baseline to 3 months in both intervention groups (parents-only: from 1.74 ± 0.31 to 1.66 ± 0.36, P < .001; parents-child, 1.83 ± 0.33 to 1.76 ± 0.36, P = .012), with no significant change in the controls (1.73 ± 0.32 to 1.70 ± 0.31, P = .301). The 2-year follow-up was completed by 45 in each of the intervention groups (50.5% and 53.5%, respectively) and 37 controls (50%) (P = .896). Compared with baseline, only the parents-child group showed a significant decrease in BMI-SDS (1.56 ± 0.46, P = .006). The rate of children who met the criteria for metabolic syndrome tended to drop from 6.0% at baseline (14/232) to 1.5% at 3 months (12/137) (P = .109), with no significant between-group differences in the rate of metabolic syndrome at baseline or at completion of the intervention. CONCLUSIONS An intervention programme that focuses on both parents and children was found to have positive short-term and long-term effects on BMI-SDS.
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Affiliation(s)
- M Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Wolf Linhard
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Nagelberg
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - I Poraz
- Department of Clinical Nutrition and Dietetics, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - S Shalitin
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Meyerovitch
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Medicine Wing, Community Division, Clalit Health Services, Tel Aviv, Israel
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29
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Bidirectional associations between diet and body composition measures from 2 to 15 years: Longitudinal Study of Australian Children. Br J Nutr 2018; 121:212-220. [PMID: 30375296 DOI: 10.1017/s0007114518003173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study investigates how dietary patterns and scores are associated with subsequent BMI and waist:height ratio (WHtR), and how BMI and WHtR are associated with subsequent dietary patterns or scores, from 2-3 to 10-11 and 4-5 to 14-15 years of age. In the Longitudinal Study of Australian Children, height, weight and waist circumference were measured biennially in children, yielding BMI z-score and WHtR. Parents, latterly children, reported frequency of child consumption of 12-16 food/drink items during the previous 24 h. At each wave, we empirically derived dietary patterns using factor analyses, and dietary scores based on the 2013 Australian Dietary Guidelines. We used structural-equation modelling to investigate cross-lagged associations (n 1972-2882) between diet and body composition measures in univariable and multivariable analyses. Dietary scores/patterns did not consistently predict WHtR and BMI z-score in the next wave, nor did BMI z-score and WHtR consistently predict diet in the next wave. The few associations seen were weak and often in the opposite direction to that hypothesised. The largest effect, associated with each standard deviation increase in BMI in wave 5 of the K cohort (age 12-13 years), was a 0·06 standard deviation estimated mean increase in dietary score (higher quality diet) in the subsequent wave (95 % CI 0·02, 0·11, P=0·003). Associations between dietary patterns/scores and body composition were not strongly evident in either direction. Better quantitative childhood dietary tools feasible for large-scale administration are needed to quantify how dietary patterns, energy intake and anthropometry co-develop.
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30
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Brown CL, Perrin EM. Obesity Prevention and Treatment in Primary Care. Acad Pediatr 2018; 18:736-745. [PMID: 29852268 DOI: 10.1016/j.acap.2018.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022]
Abstract
Despite extensive public health and clinical interventions, obesity rates remain high, and evidence-based preventive strategies are elusive. Many consensus guidelines suggest that providers should screen all children after age 2 years for obesity by measuring height and weight, calculating body mass index (BMI), and sensitively communicating weight status in the context of health to the family at each visit. However, preventive counseling should begin in infancy and focus on healthy feeding, activity, and family lifestyle behaviors. For children with overweight or obesity, the American Academy of Pediatrics outlines 4 stages of treatment: 1) Primary care providers should offer "prevention plus," the use of motivational interviewing to achieve healthy lifestyle modifications in family behaviors or environments; 2) children requiring the next level of obesity treatment, structured weight management, need additional support beyond the primary care provider (such as a dietitian, physical therapist, or mental health counselor) and more structured goal setting with the team, including providers adept at weight management counseling; 3) children with severe obesity and motivated families may benefit from referral to a comprehensive multidisciplinary intervention, such as an obesity treatment clinic; and 4) tertiary care interventions are provided in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols for evaluation of interventions, including medications and surgery. Although it is certainly a challenge for providers to fit in all the desired prevention and treatment counseling during preventive health visits, by beginning to provide anticipatory guidance at birth, providers can respond to parents' questions, add to parents' knowledge base, and partner with parents and children and adolescents to help them grow up healthy. This is especially important in an increasingly toxic food environment with numerous incentives and messages to eat unhealthfully, barriers to appropriate physical activity, and concomitant stigma about obesity. Focusing on key nutrition and physical activity habits and establishing these healthy behaviors at an early age will allow children to develop a healthy growth trajectory. However, much more work is needed to determine the best evidence-based practices for providers to counsel families on improving target behaviors, environmental modifications, and parenting skills and to decrease abundant disparities in obesity prevalence and treatment.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC.
| | - Eliana M Perrin
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC
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31
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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32
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Jean-St-Michel E, Toulany A. Should the severity of obesity affect our decision for heart transplant candidacy in pediatrics? Pediatr Transplant 2018. [PMID: 29542275 DOI: 10.1111/petr.13177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Emilie Jean-St-Michel
- Division of Cardiology, The Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alene Toulany
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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33
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Darling KE, Fahrenkamp AJ, Ruzicka E, Levitt M, Broerman L, Sato A. Provider perceptions of pediatric obesity management in clinical practice. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1471997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Katherine E. Darling
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Amy J. Fahrenkamp
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Elizabeth Ruzicka
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Michelle Levitt
- Pediatrics, Akron Children’s Hospital, Akron, OH, United States
| | - Lisa Broerman
- Pediatrics, Akron Children’s Hospital, Akron, OH, United States
| | - Amy Sato
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
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34
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A randomized controlled trial of orthodontist-based brief advice to prevent child obesity. Contemp Clin Trials 2018; 70:53-61. [PMID: 29747047 DOI: 10.1016/j.cct.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We conducted a randomized controlled trial to test whether brief exercise and diet advice provided during child patient visits to their orthodontic office could improve diet, physical activity, and age-and-gender-adjusted BMI. METHODS We enrolled orthodontic offices in Southern California and Tijuana, Mexico, and recruited their patients aged 8-16 to participate in a two-year study. At each office visit, staff provided the children with "prescriptions" for improving diet and exercise behaviors. Multilevel models, which adjusted for clustering, determined differential group effects on health outcomes, and moderation of effects. RESULTS We found differential change in BMI favoring the intervention group, but only among male participants (p < 0.001; Cohen's d = 0.085). Of four dietary variables, only junk food consumption changed differentially, in favor of the intervention group (p = 0.020; d = 0.122); the effect was significant among overweight/obese (p = 0.001; d = 0.335) but not normal weight participants. Physical activity declined non-differentially in both groups and both genders. CONCLUSION The intervention, based on the Geoffrey Rose strategy, had limited success in achieving its aims. IMPLICATIONS Orthodontists can deliver non-dental prevention advice to complement other health-practitioner-delivered advice. Higher fidelity to trial design is needed to adequately test the efficacy of clinician-based brief advice on preventing child obesity and/or reversing obesity.
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Drouin O, Winickoff JP. Screening for Behavioral Risk Factors Is Not Enough to Improve Preventive Services Delivery. Acad Pediatr 2018; 18:460-467. [PMID: 29367020 DOI: 10.1016/j.acap.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Unhealthy behaviors are a major cause of chronic disease. Preappointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounter will lead to higher counseling rate and service delivery by clinicians. METHODS We used a pre/post design in one practice with a control practice to evaluate the effects of preappointment screening for 3 behavioral risk factors (tobacco smoke exposure, no recent dental care visit, and consumption of sugar-sweetened beverages). After their clinic visit, we asked English-speaking parents whose child had one or more risk factor whether they had received counseling or services from their pediatrician to address them. RESULTS We recruited 264 parents in the pre phase and 242 in the post phase. Among 215 parents whose child had one or more risk factors, parents in the post phase were as likely to report receiving counseling than parents in the pre phase for each of the risk factors: smoking odds ratio 6.75 (95% confidence interval, 0.51, 88.88), dental health odds ratio 1.44 (95% confidence interval, 0.47, 4.41), and sugar-sweetened beverage consumption odds ratio 0.34 (95% confidence interval, 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases. CONCLUSIONS Counseling rates for tobacco, dental health, or sugar-sweetened beverage consumption were low in pediatric primary care, and preappointment screening did not significantly affect clinician counseling. Future efforts will require a more robust approach to effect change in counseling, provision of service, and family behavior.
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Affiliation(s)
- Olivier Drouin
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass; Harvard-wide Pediatric Health Services Research Fellowship, Boston, Mass.
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass; Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Ill
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Tripicchio GL, Ammerman AS, Ward DS, Faith MS, Truesdale KP, Burger KS, Dean K, Dumenci L, Davis A. Clinical-Community Collaboration: A Strategy to Improve Retention and Outcomes in Low-Income Minority Youth in Family-Based Obesity Treatment. Child Obes 2018; 14:141-148. [PMID: 29584452 DOI: 10.1089/chi.2017.0266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Clinical-community collaboration is a promising strategy for pediatric obesity treatment, but current research is limited. This study examined the effect of a family-based treatment program embedded in a primary care clinic on retention and changes in child weight status at 1 year. METHODS Children (2-16 years, BMI ≥85th percentile, 87.0% Hispanic) and their parents were recruited from a single pediatric clinic for Healthy Hawks Primary Plus (HHP+). Children were referred by physicians and enrolled by a bilingual clinic-based recruitment coordinator. Participants received 12 weekly 2-hour sessions focused on lifestyle modification and health behavior change and then received bimonthly follow-up visits with their clinic-based physician through 1-year follow-up. Child body mass index (BMI) percentage of the 95th percentile (%BMIp95) was measured as the primary outcome at baseline, postintervention, and 1-year follow-up. Random effect multilevel models assessed changes in child weight status over time accounting for clustering by family. To further evaluate the impact, HHP+ retention and changes in child weight status were compared to a standard 12-week treatment program only. RESULTS HHP+ participants had significantly better retention at 1 year (73.9%, p ≤ 0.001) compared to the standard treatment program (38.3%). In HHP+, physician visit attendance was significantly correlated with retention at 1 year (r = 0.69, p ≤ 0.001), and HHP+ completers had significant reductions in %BMIp95 between baseline and 1-year follow-up (p = 0.03). CONCLUSION Clinical-community partnerships might be a promising strategy to improve retention and reduce child weight status in populations currently underrepresented in obesity treatment.
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Affiliation(s)
- Gina L Tripicchio
- 1 Center for Obesity Research and Education, Temple University , Philadelphia, PA
| | - Alice S Ammerman
- 2 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC.,3 Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, NC
| | - Dianne S Ward
- 2 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC.,3 Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, NC
| | - Myles S Faith
- 4 Department of Counseling, School, and Educational Psychology, University at Buffalo- SUNY , Buffalo, NY
| | - Kimberly P Truesdale
- 2 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC
| | - Kyle S Burger
- 2 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC
| | - Kelsey Dean
- 5 Center for Children's Healthy Lifestyles & Nutrition , Kansas City, MO.,6 Children's Mercy Hospital , Kansas City, MO
| | - Levent Dumenci
- 7 Department of Epidemiology and Biostatistics, Temple University , Philadelphia, PA
| | - Ann Davis
- 5 Center for Children's Healthy Lifestyles & Nutrition , Kansas City, MO.,8 Department of Pediatrics, University of Kansas Medical Center , Kansas City, KS
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Sharifi M, Franz C, Horan CM, Giles CM, Long MW, Ward ZJ, Resch SC, Marshall R, Gortmaker SL, Taveras EM. Cost-Effectiveness of a Clinical Childhood Obesity Intervention. Pediatrics 2017; 140:peds.2016-2998. [PMID: 29089403 PMCID: PMC5654390 DOI: 10.1542/peds.2016-2998] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. CONCLUSIONS A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.
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Affiliation(s)
- Mona Sharifi
- Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
| | - Calvin Franz
- Eastern Research Group Inc, Lexington, Massachusetts
| | - Christine M. Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Michael W. Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia; and
| | | | - Stephen C. Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates and Atrius Health Inc, Boston, Massachusetts
| | | | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;,Nutrition, and
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Kerr JA, Long C, Clifford SA, Muller J, Gillespie AN, Donath S, Wake M. Early-life exposures predicting onset and resolution of childhood overweight or obesity. Arch Dis Child 2017; 102:915-922. [PMID: 28235833 DOI: 10.1136/archdischild-2016-311568] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine which of multiple early-life exposures predict onset or resolution of overweight/obesity during a 9-year period. METHODS Design: longitudinal cohort from three harmonised community-based cohorts enriched for overweight and obesity. Early-life exposures: child-gestational age; delivery; birth weight; breast feeding; solids introduction; baseline body mass index (BMI); waist circumference; diet; activity; global, physical and psychosocial health. Mother-baseline BMI; education; age; neighbourhood disadvantage; concern for child's weight. Outcome: change in BMI category. Analyses: adjusted logistic regression. RESULTS On average, the 363 children (57% retention) were 6 and 15 years old at baseline and follow-up. Children were classified as 'never' overweight/obese (38%), 'resolving' overweight/obese (15%), 'becoming' overweight/obese (8%) or 'always' overweight/obese (39%). Compared with 'never overweight/obese' children, odds of 'becoming overweight/obese' were greater with higher child (OR 2.33, 95% CI 1.02 to 5.29) and maternal BMI (OR 1.18, CI 1.07 to 1.31), and lower with higher maternal education (OR 0.09, CI 0.02 to 0.34). Compared with 'always overweight/obese' children, odds of 'resolving overweight/obese' were lower with higher maternal BMI (OR 0.87, CI 0.78 to 0.97), and higher with better child physical health (OR 1.06, CI 1.02 to 1.10) and higher maternal age (OR 1.11, CI 1.01 to 1.22) and education (OR 4.07, CI 1.02 to 16.19). CONCLUSIONS Readily available baseline information (child/maternal BMI, maternal age, education and child health) were the strongest predictors of both onset and resolution of overweight/obesity between the primary school and adolescent years. Perinatal, breastfeeding and lifestyle exposures were not strongly predictive. Results could stimulate development of algorithms identifying children most in need of targeted prevention or treatment.
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Affiliation(s)
- Jessica A Kerr
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Long
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan A Clifford
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Joshua Muller
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Alanna N Gillespie
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan Donath
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics & Liggins Institute, University of Auckland, Grafton, Auckland, New Zealand
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Lycett K, Miller A, Knox A, Dunn S, Kerr JA, Sung V, Wake M. ‘Nudge’ interventions for improving children's dietary behaviors in the home: A systematic review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.obmed.2017.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Gerber MW, Orav EJ, Price SN, Sequist T, Slater D. Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:e171325. [PMID: 28586856 PMCID: PMC6075674 DOI: 10.1001/jamapediatrics.2017.1325] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes. OBJECTIVE To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. DESIGN, SETTING, AND PARTICIPANTS This 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts. INTERVENTIONS Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI ≥ 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. MAIN OUTCOMES AND MEASURES One-year changes in age- and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. RESULTS At 1 year, we obtained BMI z scores from 664 children (92%) and family-centered outcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baseline and 1.85 (0.58) at 1 year, an improvement of -0.06 BMI z score units (95% CI, -0.10 to -0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of -0.09 BMI z score units (95% CI, -0.13 to -0.05). However, there was no significant difference between the 2 intervention arms (difference, -0.02; 95% CI, -0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child's health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, -0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, -0.56 to 2.33). CONCLUSIONS AND RELEVANCE Two interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02124460.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health; Boston, MA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Christine Horan
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Monica W. Gerber
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - E. John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah N. Price
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | | | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
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Chen JL, Guedes CM, Cooper BA, Lung AE. Short-Term Efficacy of an Innovative Mobile Phone Technology-Based Intervention for Weight Management for Overweight and Obese Adolescents: Pilot Study. Interact J Med Res 2017; 6:e12. [PMID: 28768612 PMCID: PMC5559653 DOI: 10.2196/ijmr.7860] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In the United States, approximately one-third of adolescents are now overweight or obese, and one in six is obese. This financial cost and the larger nonfinancial costs of obesity make obesity prevention and management for adolescents imperative for the health of the nation. However, primary care visits are typically brief, and primary care providers may lack adequate resources to help overweight or obese adolescents to manage weight issues. To augment the efficacy of primary care visits for adolescent weight management, mobile phone technology can be used as an adjunct treatment that provides additional opportunities for encouraging improvement in lifestyle, attainment, and maintenance of healthy weight. OBJECTIVE The purposes of this study were to (1) measure effects of an innovative mobile phone technology-based intervention for overweight and obese adolescents and to (2) examine the intervention's feasibility for use in primary care clinics. METHODS The mobile phone-based intervention had three components: use of the Fitbit Flex, participation in an online educational program, and receipt of biweekly text messages during the maintenance phase. A randomized controlled study design was utilized. Data regarding anthropometrics (body mass index [BMI] and waist-to-hip ratio), blood pressure, levels of physical and sedentary activity, diet, and self-efficacy regarding physical activity and diet were collected at baseline and at 3 and 6 months after the baseline assessment. RESULTS A total of 40 adolescents participated in the study. At the 6-month follow-up visit, compared to participants in the control group, the mobile phone-based intervention participants had significant improvement in BMI (z=-4.37, P=.001), diastolic blood pressure (z=-3.23, P=.001), physical activity days per week (z=2.58, P=.01), TV and computer time (z=-3.34, P=.001), servings of fruits and vegetables per day (z=2.74, P=.006), servings of soda and sweetened drinks (z=-3.19, P=.001), physical activity self-efficacy (z=2.75, P=.006), and dietary self-efficacy (z=5.05, P=.001). Medium to large effect sizes were found in these outcome variables. CONCLUSIONS The use of mobile technologies may offer a practical, reliable adjunct to weight management for overweight and obese adolescents in busy primary care clinics serving adolescents. TRIAL REGISTRATION Clinicaltrials.gov NCT 01693250; https://clinicaltrials.gov/ct2/show/NCT01693250? term=Adolescent+ obesity+AND+mhealth&rank=5 (Archived by WebCite at ).
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Affiliation(s)
- Jyu-Lin Chen
- School of Nursing, Department of Family Health Care Nursing, University of California San Francico, San Francisco, CA, United States
| | - Claudia M Guedes
- Department of Kinesiology, San Francisco State University, San Francisco, CA, United States
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francsico, CA, United States
| | - Audrey E Lung
- Department of Pediatrics, North East Medical Services, San Francisco, CA, United States
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Islami F, Miller KD, Siegel RL, Fedewa SA, Ward EM, Jemal A. Disparities in liver cancer occurrence in the United States by race/ethnicity and state. CA Cancer J Clin 2017; 67:273-289. [PMID: 28586094 DOI: 10.3322/caac.21402] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/11/2022] Open
Abstract
Liver cancer is highly fatal, and death rates in the United States are increasing faster than for any other cancer, having doubled since the mid-1980s. In 2017, it is estimated that the disease will account for about 41,000 new cancer cases and 29,000 cancer deaths in the United States. In this article, data from the Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics are used to provide an overview of liver cancer incidence, mortality, and survival rates and trends, including data by race/ethnicity and state. The prevalence of major risk factors for liver cancer is also reported based on national survey data from the Centers for Disease Control and Prevention. Despite the improvement in liver cancer survival in recent decades, only 1 in 5 patients survives 5 years after diagnosis. There is substantial disparity in liver cancer death rates by race/ethnicity (from 5.5 per 100,000 in non-Hispanic whites to 11.9 per 100,000 in American Indians/Alaska Natives) and state (from 3.8 per 100,000 in North Dakota to 9.6 per 100,000 in the District of Columbia) and by race/ethnicity within states. Differences in risk factor prevalence account for much of the observed variation in liver cancer rates. Thus, in contrast to the growing burden, a substantial proportion of liver cancer deaths could be averted, and existing disparities could be dramatically reduced, through the targeted application of existing knowledge in prevention, early detection, and treatment, including improvements in vaccination against hepatitis B virus, screening and treatment for chronic hepatitis C virus infections, maintaining a healthy body weight, access to high-quality diabetes care, preventing excessive alcohol drinking, and tobacco control, at both the state and national levels. CA Cancer J Clin 2017;67:273-289. © 2017 American Cancer Society.
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Affiliation(s)
- Farhad Islami
- Strategic Director, Cancer Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information Services, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director, Risk Factors and Screening Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Elizabeth M Ward
- Senior Vice President, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Dooley D, Moultrie NM, Sites E, Crawford PB. Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals. J Public Health Dent 2017. [DOI: 10.1111/jphd.12229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Diane Dooley
- School of Medicine; University of California San Francisco; San Francisco CA USA
| | | | | | - Patricia B. Crawford
- Nutrition Policy Institute; Agriculture and Natural Resources, University of California; Berkeley CA USA
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Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center. J Community Health 2016; 42:466-471. [PMID: 27757596 DOI: 10.1007/s10900-016-0278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.
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Armstrong SC, Skinner AC. Defining "Success" in Childhood Obesity Interventions in Primary Care. Pediatrics 2016; 138:peds.2016-2497. [PMID: 27621411 DOI: 10.1542/peds.2016-2497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 12/30/2022] Open
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