Validation of remote child weight and height measurements within a weight management trial

OBJECTIVE

The aim of this substudy within the Treatment Efforts Addressing Child Weight Management by Unifying Patients, Parents, and Providers (TEAM UP) pragmatic clinical trial was to compare the validity of anthropometric measurements collected remotely versus in person (≤7 days apart) among youth with obesity who were 6 to 15 years of age.

METHODS

Child (n = 37) weight and height were measured in person by a trained data assessor. These were compared with measurements taken remotely by the child's parent with live videoconferencing observation by a study data assessor. In-person and remote measurements were compared using Bland-Altman plots, Pearson correlations, and two one-sided paired t tests. A priori bounds of acceptability were set at ±0.68 kg to allow for typical weight fluctuations within the 7-day comparison period.

RESULTS

Measurements were highly correlated (height: r = 0.991, p < 0.0001; weight: r = 0.999; p = 0.03). For height, two one-sided t tests for upper, t(36) = 3.95, and lower, t(36) = -2.63, bounds (-1, 1) revealed an overall p = 0.006; absolute error was 3.5 cm. For weight, two one-sided t tests for upper, t(36) = 1.93, and lower, t(36) = -7.91, bounds (-0.68, 0.68) revealed an overall p = 0.03; absolute error was 1.7 kg.

CONCLUSIONS

The present findings support the utility and interpretation of remotely assessed weight management outcomes for both research and clinical purposes. These procedures may offer greater accessibility to evidence-based measurement.

A pragmatic trial of a family-centered approach to childhood obesity treatment: Rationale and study design

BACKGROUND

Family-based behavioral treatment (FBT) is an effective intensive health behavior and lifestyle treatment for obesity reduction in children and adolescents, but families have limited access. The purpose of this randomized, pragmatic, comparative effectiveness trial was to examine changes in child relative weight in a 12-month, enhanced standard of care (eSOC) intervention combined with FBT (eSOC+FBT) vs. eSOC alone.

METHODS

Children aged 6 to 15 years with obesity, and their primary caregiver, were recruited from primary care clinics. Families were randomized 1:1 to eSOC, a staged approach led by the primary care provider that gradually intensified dependent on a child's response to care and aligns with the American Medical Association guidelines, or the eSOC+FBT arm, which included regular meetings with a health coach for healthy eating, physical activity, positive parenting strategies, and managing social and environmental cues. Both treatments align with the 2023 American Academy of Pediatrics clinical practice guidelines. Assessments occurred at baseline, midpoint (month 6), end-of-intervention (month 12), and follow-up (month 18). Primary outcome was change from baseline to 12 months in child percent overweight (percentage above the median body mass index in the general US population normalized for age and sex). Secondary outcomes were parent weight, child psychosocial factors, heterogeneity of treatment effects, and cardiometabolic risk factors. Exploratory outcomes assessed reach, effectiveness, adoption, implementation, and maintenance.

CONCLUSION

This pragmatic trial will generate evidence for the comparative effectiveness of implementing two guidelines-based approaches in primary care for obesity reduction in children and adolescents.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03843424.

Adolescent Diet Quality, Cardiometabolic Risk, and Adiposity: A Prospective Cohort

OBJECTIVE

Examine the prospective association among diet with adolescent cardiometabolic risk (CMR) and anthropometrics.

METHODS

Secondary analysis of an observational study of adolescents aged 10-16 years. Twenty-four-hour food recalls were used to calculate Healthy Eating Index-2015 (HEI-2015) scores. Anthropometrics were assessed using magnetic resonance imaging, dual-energy x-ray absorptiometry, and height/weight measurements. CMR included mean arterial pressure, homeostatic model assessment for insulin resistance, high-density lipoprotein cholesterol, and triglycerides. Associations between HEI-2015 score at baseline with follow-up adiposity and CMR were examined using regression models.

RESULTS

A total of 192 adolescents were included. Baseline HEI-2015 scores were inversely associated with follow-up total CMR z-score (P = 0.01), homeostatic model assessment for insulin resistance (P < 0.01), waist circumference z-score (P = 0.02), body mass index percentile (P = 0.01), fat mass (P = 0.04), lean mass (P = 0.02), and visceral adipose tissue mass (P = 0.01).

CONCLUSIONS AND IMPLICATIONS

Adolescents with lower adherence to dietary guidelines and greater CMR and anthropometry measurements at baseline continued this trajectory across the observation.

Parents, but not their children, demonstrate greater delay discounting with resource scarcity

BACKGROUND

Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity.

METHODS

The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested.

RESULTS

Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders.

CONCLUSIONS

These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.

Validation of remote assessment of preschool children's anthropometrics and motor skills

Introduction

Remotely delivered treatment and research procedures were rapidly adopted in response to the COVID-19 pandemic. However, it is unclear if these measures are valid. The purpose of this study was to compare the validity of anthropometry and motor skill proficiency measurements collected in a remote-setting to in-person setting among a sample of children ages 3-4 years.

Methods

Child anthropometry and motor skill performance were measured in-person by trained assessors and by parents at home with remote supervision via videoconference by trained assessors. The following measures from the National Institutes of Health Toolbox were collected: anthropometry (height and weight), manual dexterity/manipulation (9-hole pegboard), motor coordination and agility (supine timed up and go), lower body strength (standing long jump), and postural stability (one-leg standing balance). Differences in expert and parent-based measurements were assessed using Bland-Altman plots, paired samples t-tests, and Pearson correlations.

Results

A total of n = 14 children completed the assessments. No significant differences were observed between measurement locations for weight and motor skills (p > .05). Remote measurement of height (M = 101.1 cm, SD = 5.40) was significantly greater than in-person measurements (M = 98.2 cm, SD = 5.16); p < .0001.

Discussion

Remote measurements of motor skills and weight are valid assessments for researchers and clinicians to utilize in young children. Remote assessment with guidance offers comparable and valid estimates as in-person assessment, potentially offering a solution to resource-constricted barriers in research and access to care. There is an opportunity for researchers to fine-tune remote height and individual-level assessment strategies.

Abstract P2-02-07: Preoperative breast MRI and follow-up recommendations for the contralateral breast influence the rate of contralateral prophylactic mastectomy

Background: Women with breast cancer increasingly choose to undergo contralateral prophylactic mastectomy (CPM) even as the benefit of this procedure for woman at average risk for breast cancer remains uncertain. Many women with newly diagnosed breast cancer undergo pre-operative MRI for a variety of indications. Growing evidence suggests that obtaining a pre-operative MRI increases the likelihood that a patient will choose CPM. This study evaluates the relationship between a pre-operative MRI and the decision to pursue CPM, as well as the rate of contralateral MRI findings for which follow-up is recommended and the choice to undergo CPM. The pathology found in contralateral breasts in this series is also reported.

Methods: Newly diagnosed breast cancer patients were prospectively enrolled in Breast Molecular Epidemiology Resource (B-MER) observational study at the University of Iowa from April 2010 through March 2013. Prophylactic mastectomy is defined as removal of the contralateral breast within 12 months of definitive mastectomy. Univariate logistic regression was used to identify factors predictive of undergoing CPM. Recommended follow-up of the contralateral breast MRI is defined as any imaging or procedure other than immediate ultrasound evaluation.

Results: Among 134 patients (mean age 53) who underwent mastectomy, 53 (40%) underwent CPM. Univariate analysis revealed that patients undergoing CPM were more likely to have had a preoperative bilateral MRI (52%% vs. 28%, p = 0.006) and were more likely to have been given a recommendation for a follow-up test (79% vs, 40%, p = 0.007).

Univariate Analysis of Odds of Electing to Undergo CPMVariableLevelOdds ratioP-valueAge5 year0.62&lt;.001Breast MRIYes vs No2.740.006MRI follow-up recommendationYes or No5.530.007Nodal statusPositive vs Negative0.820.581History of benign breast biopsiesNo vs Yes1.850.209Family history of breast cancerYes vs No1.160.711ER/PR statusNegative vs Positive1.830.134Triple NegativeNo vs Yes1.910.196HER2 statusPositive vs Negative2.470.066BRCA testing doneYes vs No6.04&lt;.001BRCA results*Positive vs Negative3.120.315Tobacco everYes or No1.390.354Alcohol everYes or No1.250.544* Indeterminate and not done levels were excluded from the analysis

Univariate analysis also revealed associations between choice of CPM and younger age (p&lt;0.001) and BRCA testing (p&lt;0.001). In this series, CPM was not associated with nodal status, ER/PR status, history of benign breast biopsies, family history of breast cancer, BRCA result and tobacco or alcohol use, although there was a trend for association with HER2 status. Of the 53 patients who underwent CPM, one had proliferative disease with atypia, 34 had proliferative disease without atypia. A single patient had DCIS found in the contralateral breast which had not been identified on MRI.

Conclusions: The use of preoperative breast MRI and abnormal imaging findings in the contralateral breast, for which follow-up was recommended, led to a higher CPM rate. Contralateral prophylactic mastectomy rarely uncovered occult malignancy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-07.