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Wills-Ibarra N, Chemtob K, Hart H, Frati F, Pratt KJ, Ball GD, Van Hulst A. Family systems approaches in pediatric obesity management: a scoping review. BMC Pediatr 2024; 24:235. [PMID: 38566046 PMCID: PMC10985863 DOI: 10.1186/s12887-024-04646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) (n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) (n = 18), mental health (n = 12), FST-related outcomes (n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) (n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research.
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Affiliation(s)
- Natasha Wills-Ibarra
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keryn Chemtob
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Heather Hart
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Francesca Frati
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Centre, Columbus, OH, USA
| | - Geoff Dc Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andraea Van Hulst
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada.
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Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13158. [PMID: 34241961 PMCID: PMC8269148 DOI: 10.1111/mcn.13158] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/20/2022]
Abstract
The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.
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Affiliation(s)
- Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Juliet K. McCann
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Emily Gascoigne
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Diana Allotey
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Dadirai Fundira
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Lundkvist E, Stoltz Sjöström E, Lundberg R, Silfverdal SA, West CE, Domellöf M. Fruit Pouch Consumption and Dietary Patterns Related to BMIz at 18 Months of Age. Nutrients 2021; 13:nu13072265. [PMID: 34208982 PMCID: PMC8308466 DOI: 10.3390/nu13072265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023] Open
Abstract
Concerns have been raised that an overconsumption of baby food fruit pouches among toddlers might increase the risk of childhood obesity. This study aimed to quantify the consumption of fruit pouches and other fruit containing food products and to explore potential correlations between the consumption of these products and body-mass index z-score (BMIz) at 18 months, taking other predictive factors into consideration. The study was based on 1499 children and one-month-recall food frequency questionnaires from the Swedish population-based birth cohort NorthPop. Anthropometric outcome data were retrieved from child health care records. BMIz at 18 months of age was correlated to maternal BMI and gestational weight gain and inversely correlated to fruit juice consumption and breastfeeding. BMIz at 18 months of age was not correlated to consumption of fruit pouches, sugar-sweetened beverages, whole fruit or milk cereal drink. Overweight at 18 months of age was correlated to maternal BMI and inversely correlated to breastfeeding duration. To our knowledge, this is the first study that investigates possible associations between baby food fruit pouch consumption and overweight in toddlers. We found that moderate fruit pouch consumption is not associated with excess weight at 18 months of age.
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Affiliation(s)
- Ellen Lundkvist
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 85 Umeå, Sweden; (E.L.); (R.L.); (S.-A.S.); (C.E.W.)
| | | | - Richard Lundberg
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 85 Umeå, Sweden; (E.L.); (R.L.); (S.-A.S.); (C.E.W.)
| | - Sven-Arne Silfverdal
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 85 Umeå, Sweden; (E.L.); (R.L.); (S.-A.S.); (C.E.W.)
| | - Christina E. West
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 85 Umeå, Sweden; (E.L.); (R.L.); (S.-A.S.); (C.E.W.)
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 85 Umeå, Sweden; (E.L.); (R.L.); (S.-A.S.); (C.E.W.)
- Correspondence:
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Johnson BJ, Golley RK, Zarnowiecki D, Hendrie GA, Huynh EK. Understanding the influence of physical resources and social supports on primary food providers' snack food provision: a discrete choice experiment. Int J Behav Nutr Phys Act 2020; 17:155. [PMID: 33256737 PMCID: PMC7706064 DOI: 10.1186/s12966-020-01062-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Snack eating occasions contribute approximately a third of children's energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers' snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position. METHODS Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute. RESULTS Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (- 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight - 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds. CONCLUSIONS Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers' snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280.
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Affiliation(s)
- Brittany J Johnson
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
- Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Dorota Zarnowiecki
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
- Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Gilly A Hendrie
- Health & Biosecurity Flagship, Commonwealth Scientific Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Elisabeth K Huynh
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Acton, Australian Capital Territory, Australia
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Norman Å, Nyberg G, Berlin A. School-based obesity prevention for busy low-income families-Organisational and personal barriers and facilitators to implementation. PLoS One 2019; 14:e0224512. [PMID: 31689329 PMCID: PMC6830752 DOI: 10.1371/journal.pone.0224512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little research has targeted multiple-level barriers and facilitators in school-based parental support programmes. This qualitative study aims to describe barriers and facilitators, at organisational and personal levels, that teachers and parents in disadvantaged settings in Sweden perceived as influencing the implementation of the Healthy School Start II (HSS II) intervention. METHODS Data collection, analysis and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups and interviews were conducted with 14 parents and ten teachers within the HSS II trial. Data were analysed using qualitative content analysis in a deductive step using the three CFIR domains-inner and outer setting, and personal characteristics-followed by an inductive analysis. RESULTS The theme 'being on the same page-getting burdened teachers and parents to work on common ground' was found. Among teachers, barriers and facilitators were related to the structure of the schoolwork and curriculum, involvement from other staff and school management, the practical school workday, perception of high family needs but low parental interest, insufficient resources in the families, and teacher's personal knowledge, interests, and opinions about health and food. For parents, barriers and facilitators were related to the perceived family needs and resources, parents' health knowledge, consensus about healthy behaviours and ability to cooperate, and school involvement in health issues and the intervention. CONCLUSION Interventions should facilitate parents' and teachers' work on common ground, with activities suitable for a stressful and burdensome workday and everyday life. This could be achieved by integrating evidence-based practices within school routines, and including activities that are practicable despite parents' stressful lives, and that increase parental consensus about promoting health. Strategies to increase involvement of parents in families with high needs are necessary. Also, this study suggests an expansion of the CFIR to capture the interface between different micro-level organisations, and account for several delivering/receiving organisations.
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Affiliation(s)
- Åsa Norman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Anita Berlin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Chai LK, May C, Collins CE, Burrows TL. Development of text messages targeting healthy eating for children in the context of parenting partnerships. Nutr Diet 2018; 76:515-520. [PMID: 30426627 DOI: 10.1111/1747-0080.12498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
Abstract
AIM There has been an increase in the use of text messaging to deliver and support health interventions. The aim was to develop a bank of text messages targeting healthy eating for children in the context of parenting partnerships that could be used in a family intervention. METHODS Text messages were developed using the Theoretical Domains Framework and Behaviour Change Wheel COM-B model by study investigators using a three-phase approach: (i) initial development of a message bank; (ii) messages were reviewed and evaluated by experts and parents on their clarity, usefulness, and relevance using a 5-point Likert scale and open text spaces for additional feedback and (iii) refinement of messages content and finalised the message bank. RESULTS Messages were reviewed for 'clarity', 'usefulness' and 'relevance' by 20 parents and 28 health experts, who were predominantly female (92%), parents of primary school age children (33%), of low to middle socioeconomic status (78%), with a mean age of 39 years (SD ± 9.87). From an initial set of 97 messages developed, 48 messages were retained through consultation. Messages were designed to complement the intervention, while engaging both parents. CONCLUSIONS The three-phase development created a set of text messages acceptable to experts and parents that aim to support improvement in child eating behaviours. The process provides a template and practical guide for researchers and health providers looking to apply a systematic approach to text messages development. Future research should investigate acceptability and impact of these messages as a component of family-based nutrition intervention.
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Affiliation(s)
- Li K Chai
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Chris May
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,Family Action Centre, University of Newcastle, Newcastle, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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Štefanová E, Baška T, Boberová Z, Husárová D, Dankulincová Veselská Z, Hudečková H. "Voice of Children": Qualitative analysis of children's interpretations regarding nutritional behaviour. ACTA GYMNICA 2018. [DOI: 10.5507/ag.2018.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gentile N, Kaufman TK, Maxson J, Klein DM, Merten S, Price M, Swenson L, Weaver AL, Brewer J, Rajjo T, Narr C, Ziebarth S, Lynch BA. The Effectiveness of a Family-Centered Childhood Obesity Intervention at the YMCA: A Pilot Study. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2018; 8:591. [PMID: 29732240 PMCID: PMC5931388 DOI: 10.4172/2161-0711.1000591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Community-based, family-centered obesity prevention/treatment initiatives have been shown to be effective in reducing body mass index (BMI) and improving healthy habits in children if implemented with high intensity and sufficient duration. Let's Go! 5-2-1-0 Program (5-2-1-0) was incorporated into family-centered, monthly physical activity classes and cooking classes over six months delivered by Young Men's Christian Association (YMCA) staff. We hypothesized that implementation of this intervention would improve 5-2-1-0 knowledge attainment, increase healthy behavior (based on 5- 2-1-0 curriculum), and improve BMI and waist circumference measurements in children. METHODS Children attending YMCA summer camps in Rochester, MN, during 2016 were recruited via study packets mailed to their families. Height, weight, and waist circumference measurements as well as the results of the Modified Healthy Habits Survey and the 5-2-1-0 Knowledge Acquisition Survey were recorded for each participating child at baseline and 6-month follow-up. The intervention group received monthly healthy habit reminder emails, and was invited to monthly evening cooking and physical activity classes for 7 sessions over a 6-month period. RESULTS Fifteen families in the intervention group attended classes. Of those, 13 families regularly participated in (attended at least 5 out of 7) both the monthly physical activity and cooking classes. The children in the intervention group had a significant improvement in the number of Knowledge Acquisition Survey questions answered correctly (p<0.001), while there was no improvement in the control group. As compared to children in the control group, there was no significant change in BMI or waist circumference or healthy habits in the intervention group. CONCLUSION Our study findings indicate that our intervention resulted in improved knowledge about healthy habits, but did not significantly impact healthy habits or BMI. Potential reasons for this were the small sample size and the attenuated length and/or intensity of the intervention.
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Affiliation(s)
- N Gentile
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - TK Kaufman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - DM Klein
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Merten
- Viterbo University, La Crosse, WI, USA
| | - M Price
- Viterbo University, La Crosse, WI, USA
| | - L Swenson
- Office of Patient Education, Mayo Clinic, Rochester, MN, USA
| | - AL Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - J Brewer
- Rochester Area Family YMCA, Rochester, MN, USA
| | - T Rajjo
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Narr
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - S Ziebarth
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - BA Lynch
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
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