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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pratt KJ, Boles RE, Michalsky MP, Inge TH, Jenkins TM. Associations between marital status and weight loss trajectories entering into early adulthood: a Teen-LABS study. Surg Obes Relat Dis 2024; 20:376-382. [PMID: 38267352 DOI: 10.1016/j.soard.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Among adolescents who underwent metabolic and bariatric surgery (MBS), it is unclear how relationships and specifically marital status (MS) may be associated with long-term weight loss. OBJECTIVE In this analysis, we tested for associations between the MS of adolescents who underwent MBS and the MS of their primary caregiver and weight loss trajectory over 8 years. SETTING Teen-LABS participating sites. METHODS This sample included 231 participants (75.3% female, 71.4% White, 68.0% Roux-en-Y gastric bypass, 27.7% vertical sleeve gastrectomy, 4.3% laparoscopic adjustable gastric band). A linear mixed model was conducted with the dependent variable percent body mass index (BMI) change from preoperatively through 8 years with between-participant factors (1) participant MS, (2) caregiver MS, and (3) interaction between caregiver and participant MS. RESULTS One third of participants and 87% of caregivers were ever married (EM). Compared with never-married (NM) participants and caregivers (-14.6%), EM participants and caregivers (-20.6%), EM participants and NM caregivers (-25.9%), and NM participants and EM caregivers (-19.8%), each had significantly greater BMI loss at 8 years (each P < .05). No other group comparisons achieved statistical significance. CONCLUSIONS NM participants with NM caregivers had less favorable long-term BMI. Additional research is needed to better understand how relationships affect behavior change and weight loss after MBS.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical School, Aurora, Colorado
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Thomas H Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Todd M Jenkins
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Pratt KJ, Miller HJ, Hanks AS, Focht BC, Noria S, Brethauer S, Needleman B. Transportation Factors and Postoperative Attendance and Weight Loss Through 24 Months. Obes Surg 2024; 34:114-122. [PMID: 38015330 DOI: 10.1007/s11695-023-06906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months. MATERIALS AND METHODS Seven hundred eighty-seven patients (81.3% female; 59.1% White) who had primary surgery (48.6% gastric bypass) from 2015 to 2019 were included. Sidewalk coverage and number of bus stops from patients' homes, driving distance in miles and minutes from patients' homes to the nearest bus stop and the clinic were measured. Bivariate analyses were conducted with the transportation variables and attendance and %TWL at 2 or 3, 6, 12, and 24 months. One mixed multilevel model was conducted with dependent variable %TWL over 24 months with visits as the between-subjects factor and covariates: race, insurance, surgical procedure, and driving distance to the clinic in minutes, attendance, and %TWL over 24 months; an interaction between distance, attendance, and visits. RESULTS There were no significant differences between the majority of the transportation variables and postoperative attendance or %TWL. Patients who had perfect attendance had improved %TWL at 12 months [t(534)=-1.92, p=0.056] and 24 months [t(393)=-2.69, p=0.008] compared to those who missed at least one appointment. Patients with perfect attendance and who had shorter driving times (under 20 min) to the clinic had greater weight loss through 24 months [F(10, 1607.50)=2.19, p=0.016)]. CONCLUSIONS Overall, transportation factors were not associated with attendance and weight loss, with the exception of the interaction between shorter driving minutes to follow-up and perfect attendance.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA.
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Harvey J Miller
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
| | - Andrew S Hanks
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Brian C Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Sabrena Noria
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
| | - Stacy Brethauer
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
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Skelton JA, Vitolins M, Pratt KJ, DeWitt LH, Eagleton SG, Brown C. Rethinking family-based obesity treatment. Clin Obes 2023; 13:e12614. [PMID: 37532265 DOI: 10.1111/cob.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
Emerging research in paediatric obesity has demonstrated that parental involvement in the weight management process can improve weight outcomes in children. Recent guidelines by the American Academy of Pediatrics note the importance of parent and family involvement in treatment. However, it is currently unknown if including the entire family in obesity treatment can supersede outcomes associated with participation of only one parent. Family Systems Theory (FST) provides the theoretical foundation for examining one's healthy behaviours as they exist within the context of their family, defined by family dynamics. This narrative review aims to reconsider prior definitions of paediatric family-based management using the FST framework to be inclusive of family and household diversity and in doing so, inform research not only within weight management but also other domains of clinical care requiring family support or change. Applying FST to paediatric weight management highlights the link between family dynamics and paediatric obesity, demonstrating the association of dysfunctional family dynamics with more severe obesity. While family-based weight management remains the gold standard for treatment of paediatric obesity, more investigation is needed in expanding family-based interventions to impact entire families and potentially improve outcomes more broadly for overall family health and wellbeing.
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mara Vitolins
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development & Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sally G Eagleton
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Pratt KJ, Stroup HJ, Breslin L, Kiser H, Noria S, Brethauer S, Needleman B. Social History of Bariatric Surgery: Relationship to Patient and Associations with Postoperative Outcomes. Obes Surg 2023; 33:2762-2769. [PMID: 37466828 DOI: 10.1007/s11695-023-06738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE There is limited research about the prevalence of patients initiating metabolic and bariatric surgery (MBS) who also know someone who had MBS, referred to as having a social history of MBS. Evidence about the specific relationship of these individuals to the patient, how having a social history of MBS is associated with patients' choice of surgical procedure, and how having a social history of MBS is associated with patients' postoperative outcomes can be used to inform future preoperative assessments. The objective was to (a) define the number of people patients knew who had MBS and relationship to patient, (b) assess congruence between those who had MBS with patients' procedure selection, and (c) explore associations between social history of MBS and postoperative outcomes. MATERIALS AND METHODS The sample included 123 patients who had MBS in 2021 (83.7% female; 44.7% Sleeve Gastrectomy, 55.3% Gastric Bypass). For up to 5 people, patients provided their relationship and surgical procedure, and completed the Family Assessment Device (FAD). Bivariate analyses assessed congruence in type of procedure, and social history of MBS with complications, readmissions, and %TWL. Three mixed multilevel models were conducted with (1) close friend, (2) coworker, and (3) close family history of MBS including the FAD on change in %TWL over 12 months with surgical procedure as a covariate. RESULTS Ninety-one percent of patients knew someone who had MBS, average 2.66±1.45. Patients reported a close friend (56.1%), close family member (43.9%), and coworker (19.5%) who had MBS. Patients with a close family member who had MBS and reported healthy vs impaired family functioning had greater %TWL over 12 months (p=0.016). Patients with a close friend who had MBS had less %TWL (p=0.015), and patients with a coworker who had MBS had greater %TWL (p=0.012), which did not change over time. CONCLUSION Patients with coworkers or close family members with healthy family functioning with a history of MBS had more weight loss, whereas those with close friends with a history of MBS had less weight loss.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH, 43210, USA.
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Hailey J Stroup
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH, 43210, USA
| | - Lindsay Breslin
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Haley Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH, 43210, USA
| | - Sabrena Noria
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Stacy Brethauer
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
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Pratt KJ, Hanks AS, Miller HJ, Outrich M, Breslin L, Blalock J, Noria S, Brethauer S, Needleman B, Focht B. The BARI-hoods Project: neighborhood social determinants of health and postoperative weight loss using integrated electronic health record, census, and county data. Surg Obes Relat Dis 2023; 19:318-327. [PMID: 36739248 DOI: 10.1016/j.soard.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/16/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND While social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery, electronic health record (EHR) data provide limited information beyond demographics associated with disparities in weight loss. OBJECTIVE To integrate EHR, census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio. SETTING Seven hundred seventy-two patients (82.1% female; 37.0% Black) who had primary bariatric surgery (48.7% gastric bypass) from 2015 to 2019 at Ohio State University. METHODS EHR variables included race, insurance, procedure, and percent total weight lost (%TWL) at 2/3, 6, 12, and 24 months. Census variables included poverty and unemployment rates. County variables included food stores, fitness/recreational facilities, and open area within a 5- and 10-minute walk from home. Two mixed multilevel models were conducted with %TWL over 24 months, with visits as the between-subjects factor; race, census, county, insurance, and procedure variables were covariates. Two additional sets of models determined within-group differences for Black and White patients. RESULTS Access to more food stores within a 10-minute walk was associated with greater %TWL over 24 months (P = .029). Black patients with access to more food stores within a 10-minute (P = .017) and White patients with more access within a 5-minute walk (P = .015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (P = .036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open areas. CONCLUSIONS Close proximity to food stores is associated with better weight loss 2 years after bariatric surgery. Lower poverty levels did not negatively affect weight loss in Black patients.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio; Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Andrew S Hanks
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Harvey J Miller
- Department of Geography, Center for Urban and Regional Analysis, Ohio State University, Columbus, Ohio
| | - Michael Outrich
- Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, Ohio
| | - Lindsay Breslin
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jamie Blalock
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Sabrena Noria
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stacy Brethauer
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bradley Needleman
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brian Focht
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
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Pratt KJ, Kiser HM, Feng X, VanFossen C, Spees C, Taylor C, Noria S, Eneli I, Skelton JA. Changes in Child Weight, Behaviors, and Family Dynamics during Parental Participation in a Medical Weight Management Program: A Longitudinal Uncontrolled Pilot Study. Child Obes 2023; 19:102-111. [PMID: 35483051 DOI: 10.1089/chi.2021.0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: There is limited evidence of the effects of parental participation in outpatient medical weight management (MWM) programs on children. The aims of the project were to (1) identify time effects from parental participation in the MWM program on changes in child weight trajectories, healthy and unhealthy weight control practices, physical and sedentary activity, parental restrictive feeding and pressure to eat, and family functioning and communication and (2) determine differences based on child factors. Methods: A longitudinal uncontrolled pilot study was conducted, in which parent-child (ages 7-19) dyads completed assessments at parents' MWM program initiation, 3 months (mid-program), 6 months (end of program), and 12 months to determine sustained effects. Repeated measures analysis of variance (ANOVA) was completed using a mixed multilevel modeling approach using Restricted Maximum Likelihood estimation method; each outcome was additionally analyzed with child baseline weight status, age group, and sex as between-subjects factors. Results: Fifty three dyads met inclusion criteria, 23 completed the initial assessment (enrollment: 43.3%), and 13 completed the 12-month assessment (retention: 56.5%). Significant effects over time were observed for decreased parental restrictive feeding (p < 0.038) over 12 months, and group by time effects were observed for increased restrictive feeding for female compared to male children (p = 0.025) over 12 months. Marginally significant group by time effects were found for increased impaired family functioning (p = 0.054) and communication (p = 0.054) for children with overweight/obesity compared to healthy weight children over 12 months. Conclusions: Female children and children with overweight/obesity may experience increased negative family dynamics (restriction of food, family functioning, and communication) through parental MWM programs.
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Affiliation(s)
- Keeley J Pratt
- Human Development and Family Science Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital Center for Healthy Weight and Nutrition, The Ohio State University, Columbus, OH, USA
| | - Haley M Kiser
- Human Development and Family Science Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Xin Feng
- Human Development and Family Science Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Catherine VanFossen
- Human Development and Family Science Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Colleen Spees
- Division of Medical Dietetics Program, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christopher Taylor
- Division of Medical Dietetics Program, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ihuoma Eneli
- Department of Pediatrics, Nationwide Children's Hospital Center for Healthy Weight and Nutrition, The Ohio State University, Columbus, OH, USA
| | - Joseph A Skelton
- Department of Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Pratt KJ, Hanks AS, Miller HJ, Swager LC, Noria S, Brethauer S, Needleman B, Focht BC. Proximity to High/Moderate vs Low Diversity Selection Food Stores and Patient Weight loss through 24 Months. Obes Surg 2023; 33:1184-1191. [PMID: 36847921 PMCID: PMC9969018 DOI: 10.1007/s11695-023-06501-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Explorations into the neighborhood food environment have not adequately extended to adults with obesity who undergo bariatric surgery. The objective of this study is to determine how diversity of food selection at food retail stores within proximities of 5- and 10-min walks associate with patient postoperative weight loss over 24 months. MATERIALS AND METHODS Eight hundred eleven patients (82.1% female; 60.0% White) who had primary bariatric surgery (48.6% gastric bypass) from 2015 to 2019 at The Ohio State University were included. EHR variables included race, insurance, procedure, and percent total weight loss (%TWL) at 2, 3, 6, 12, and 24 months. Proximity from patients' home addresses to food stores within a 5- (0.25 mile)- and 10-min (0.50 mile) walk were totaled for low (LD) and moderate/high (M/HD) diversity food selections. Bivariate analyses were conducted with %TWL at all visits and LD and M/HD selections within 5- (0, ≥ 1) and 10-min (0, 1, ≥ 2) walk proximities. Four mixed multilevel models were conducted with dependent variable %TWL over 24 months with visits as the between subjects factor and covariates: race, insurance, procedure, and interaction between proximity to type of food store selections with visits to determine association with %TWL over 24 months. RESULTS There were no significant differences for patients living within a 5- (p = 0.523) and 10-min (p = 0.580) walk in proximity to M/HD food selection stores and weight loss through 24 months. However, patients living in proximity to at least 1 LD selection store within a 5- (p = 0.027) and 1 or 2 LD stores within a 10-min (p = 0.015) walk had less weight loss through 24 months. CONCLUSION Overall, living in proximity to LD selection stores was a better predictor of postoperative weight loss over 24 months than living within proximity of M/HD selection stores.
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Affiliation(s)
- Keeley J. Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH 43210 USA ,Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Andrew S. Hanks
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH 43210 USA
| | - Harvey J. Miller
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH 43210 USA
| | - LeeAnn C. Swager
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH 43210 USA
| | - Sabrena Noria
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Stacy Brethauer
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Bradley Needleman
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Brian C. Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH 43210 USA
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Kiser HM, Pratt KJ, Focht BC, Wallace L, Slesnick N, Noria S, Needleman B, Pona AA. Preoperative Psychological Evaluation Outcomes, Reasoning, and Demographic and Diagnostic Correlates. Obes Surg 2023; 33:539-547. [PMID: 36538213 PMCID: PMC9765350 DOI: 10.1007/s11695-022-06414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about associations between preoperative psychiatric, disordered eating, and substance use diagnoses with the clinical decision to require follow-up after the preoperative psychological evaluation. To determine the proportion of patients who require follow-up (no required follow-up (NFU), required follow-up (RFU), placed on hold (POH)) from the preoperative psychological evaluation, associations with diagnoses, and noted reasons for follow-up. MATERIALS AND METHODS The sample included 508 patients (77.6% female; 64.4% White) pursuing bariatric metabolic surgery with completed psychological evaluations between August 2019 and December 2020 at a Midwest medical center. Patient demographics, psychological evaluation outcome and corresponding reasoning, and psychiatric, disordered eating, and substance use diagnoses were extracted from the health record. Descriptive and bivariate analyses determined associations between demographics and diagnoses with psychological evaluation outcomes and corresponding reasoning. RESULTS The breakdown of psychological evaluation outcomes was 60.6% (n = 308) NFU, 38.4% (n = 195) RFU, and 1.0% (n = 5) POH. Demographic correlates of RFU included higher BMI, being single, lower educational attainment, unemployment, public/no insurance, and receiving multiple or any psychiatric diagnosis (all p-values < 0.05). Diagnostic correlates of RFU included anxiety, depression, not having a current trauma or stressor-related disorder, disordered eating, and substance use diagnoses (all p-values < 0.001). RFU/POH was primarily due to psychiatric (61%) reasons. CONCLUSION Higher rates of RFU were observed for patients with higher economic need and with psychiatric, disordered eating, or substance use diagnoses. Future work should establish preoperative programming to assist patients with addressing ongoing psychiatric concerns prior to bariatric metabolic surgery.
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Affiliation(s)
- Haley M. Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Keeley J. Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA ,Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Brian C. Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Lorraine Wallace
- Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Ashleigh A. Pona
- Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
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Kiser HM, Pona AA, Focht BC, Wallace L, Slesnick N, Noria S, Needleman B, Pratt KJ. Associations between psychological evaluation outcomes, psychiatric diagnoses, and outcomes through 12 months after bariatric surgery. Surg Obes Relat Dis 2022; 19:594-603. [PMID: 36610864 DOI: 10.1016/j.soard.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited evidence about how patients' initial preoperative psychological evaluation outcomes (require follow-up [RFU], no required follow-up [NFU], and place on hold [POH]) and current psychiatric diagnoses associate with postoperative outcomes. OBJECTIVES To test the hypotheses that patients who receive a clinical decision of RFU versus NFU from their initial psychological evaluation will be (1) more likely to experience postoperative complications, readmissions, and emergency room visits and (2) experience less weight loss over 12-months. Specific diagnoses (any psychiatric diagnosis, depression, and anxiety) are also examined for their association with weight loss over 12 months. SETTING Midwestern medical center, United States. METHODS The sample included 322 patients (81.1% female and 64.0% White) with completed psychological evaluations between August 2019 and December 2020. Patient demographics, psychological evaluation outcomes, current diagnoses, and postoperative outcomes were extracted from the health record. Bivariate analyses determined associations between NFU/RFU and postoperative complications (yes, no), readmissions (yes, no), and emergency room visits (yes, no). Mixed multilevel models were conducted with dichotomous variables NFU/RFU, any psychiatric diagnoses (yes, no), depression diagnoses (yes, no), or anxiety diagnoses (yes, no) as the main fixed within-group factors with weight loss (weight or percent total weight loss) used as the repeated measures. Insurance and surgical procedure were included as covariates. RESULTS There were no significant differences in postoperative complications, readmissions, and emergency room visits between NFU and RFU groups. Patients who received a RFU versus an NFU had higher weights over 12 months (P = .001). CONCLUSION Hypothesis 2 was only partially supported. Patients who received an RFU versus an NFU had higher weights over 12 months, but this association was not found for percent total weight loss or any of the psychiatric within-subjects variables (i.e., psychiatric diagnoses, depression, and anxiety).
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Affiliation(s)
- Haley M Kiser
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Ashleigh A Pona
- Department of Psychiatry and Behavioral Health, College of Medicine, Ohio State University, Columbus, Ohio
| | - Brian C Focht
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Lorraine Wallace
- Department of Biomedical Education and Anatomy, College of Medicine, Ohio State University, Columbus, Ohio
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Sabrena Noria
- Department of Surgery, Ohio State University Medical Wexner Center, Columbus, Ohio
| | - Bradley Needleman
- Department of Surgery, Ohio State University Medical Wexner Center, Columbus, Ohio
| | - Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio; Department of Surgery, Ohio State University Medical Wexner Center, Columbus, Ohio.
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11
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Van Fossen CA, Wexler R, Purtell KM, Slesnick N, Taylor C, Pratt KJ. Family functioning screening, referral, and behavioral health utilization in a family medicine setting. Fam Syst Health 2022; 40:21-34. [PMID: 35311324 DOI: 10.1037/fsh0000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The objective of this study was to determine the preliminary feasibility and acceptability of screening for family functioning in a family medicine setting, and secondarily to explore differences in parent-child dyad interest in behavioral health service utilization by demographics, pediatric behavioral symptoms, and pediatric QOL. METHOD The McMaster Family Assessment Device General Functioning subscale was used to assess family functioning among 58 parent-child (ages 11-26) dyads in family medicine. Feasibility and acceptability were assessed through study interest and participation and interest and attendance in behavioral health services. Associations with interest in services, Child Behavior Checklist, Pediatric QOL Inventory, and select demographics were conducted using independent samples t-tests and Mann-Whitney tests. RESULTS Fifty-eight parent-child dyads participated in the study. Close to half of dyads who expressed interest in the survey completed the assessment (46%). Dyads who completed the assessment had a family functioning impairment rate of 45%, and 54% of dyads with impairment expressed interest in services. Interest in services was significantly associated with several domains of childrens' behavioral health symptoms and pediatric QOL, but no demographics. DISCUSSION Dyads experienced high rates of clinically significant family functioning impairment, without interest in receiving colocated behavioral health services. Future research should continue to explore how family functioning assessment can be utilized to identify child behavioral health symptoms broadly and engage families in colocated behavioral health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Catherine A Van Fossen
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University
| | - Randell Wexler
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University
| | - Kelly M Purtell
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University
| | - Natasha Slesnick
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University
| | | | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University
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Lamson AL, Hodgson JL, Pratt KJ, Mendenhall TJ, Wong AG, Sesemann EM, Brown BJ, Taylor ES, Williams-Reade JM, Blocker DJ, Harsh Caspari J, Zubatsky M, Martin MP. Couple and family interventions for high mortality health conditions: A strategic review (2010-2019). J Marital Fam Ther 2022; 48:307-345. [PMID: 34741539 DOI: 10.1111/jmft.12564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.
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Affiliation(s)
- Angela L Lamson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Jennifer L Hodgson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Services, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education & Human Ecology, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tai J Mendenhall
- Department of Family Social Science, University of Minnesota, Saint Paul, Minnesota, USA
| | - Alison G Wong
- Department of Marriage and Family Therapy, Fuller School of Psychology and Marriage and Family Therapy, Pasadena, California, USA
| | | | - Braden J Brown
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Athletics Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Erika S Taylor
- Department of Family Medicine, Behavioral Medicine Section, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Daniel J Blocker
- Pomona Valley Family Medicine Residency, Pomona Valley Hospital Medical Center, Pomona, California, USA
| | - Jennifer Harsh Caspari
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Matthew P Martin
- Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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13
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Papadakis JL, Poquiz JL, Buchanan CL, Chan YM, Crerand CE, Hansen-Moore J, Kapa HM, Nahata L, Pratt KJ, Tishelman AC, Chen D. Fertility Discussions: Perspectives of Adolescents and Young Adults With Differences of Sex Development. Clin Pract Pediatr Psychol 2021; 9:372-383. [PMID: 35310824 PMCID: PMC8932642 DOI: 10.1037/cpp0000373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Fertility-related health care and decision-making needs for youth with differences of sex development (DSD) are complex and vary by condition and the values and preferences of each individual and their partner and/or family. Discussing fertility implications can be a challenging aspect of clinician and family communication about a DSD diagnosis. This qualitative study assesses fertility-related communication experiences of adolescents and young adults (AYA) with DSD. METHOD Participants included 97 AYA with DSD ages 12-26 years (M = 18.5, SD = 3.9) who completed questionnaires on demographic and medical information and patient-clinician communication. A subsample of 33 AYA also completed semistructured interviews about experiences with fertility discussions. RESULTS Two major themes, each with subthemes, were identified: (1) understanding of fertility related to (1a) one's own fertility status, (1b) reproductive and parenting options, and (1c) emotional reactions to one's own fertility status and (2) conversations about fertility related to (2a) reflections on conversations, (2b) barriers, and (2c) advice. CONCLUSIONS AYA perspectives in this study provide important information about how youth with DSD learn about their fertility status, the impact their fertility status has on them, and the fertility-related conversations they have with their providers and families. Specific recommendations for providers and parents or caregivers include the following: inform youth of their fertility status as early as possible; be direct but patient in delivering information; begin by giving basic information and provide more detail as the conversation unfolds; revisit the conversation over time to allow for further discussion or information-seeking; offer additional information or resources, including behavioral health resources.
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Affiliation(s)
- Jaclyn L Papadakis
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jonathan L Poquiz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Cindy L Buchanan
- Children's Hospital Colorado, Aurora, Colorado, and University of Colorado Anschutz Medical Campus
| | - Yee-Ming Chan
- Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School
| | - Canice E Crerand
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | | | | | - Leena Nahata
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | | | - Amy C Tishelman
- Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School
| | - Diane Chen
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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14
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Pratt KJ, Blalock J, Breslin L, Kiser H, Hanks A, Focht BC, Outrich M, Noria S, Needleman B. Patient Access, Utilization, and Perceptions of Neighborhood and Built Environment Resources. Obes Surg 2021; 32:416-427. [PMID: 34783960 PMCID: PMC8593850 DOI: 10.1007/s11695-021-05788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
Purpose There is a critical need to explore bariatric patients’ perceptions of existing neighborhood and built environment resources and supports to assist with postoperative behavior change and weight loss maintenance. The objective of this study was to survey postoperative patients to determine neighborhood food retail, fitness facility, and options for outdoor activity access, utilization, satisfaction, and perceptions of resources. Materials and Methods A convenience sample of postoperative patients from a single academic surgical center in the USA (N = 44) completed an online survey about access, utilization, satisfaction, and safety for food retail, fitness facility, and outdoor activity options in their neighborhoods. Analysis included descriptives (frequency, percent, Chi-square), and independent samples t tests and ANOVA determined differences based on race, insurance status, geographic location, and receipt of governmental assistance programs. Open-ended questions were analyzed using summative content analysis. Results Patients reported the highest access to lower-cost national food retailers and fitness facilities. The most prevalent challenge in finding food products to meet patients’ goals was financial (39%). Patients’ top suggestions for fitness facilities included training staff/facilities (59%) and trainers (35%) in postoperative patient care and exercise. The highest access for outdoor activity options was for walking/running trails, city/metro parks, and sidewalks. Significant differences in access, utilization, and safety were found based on geographic location, receipt of at least one assistant program, and race. Conclusion The development of targeted resources may benefit patients in non-suburban areas and who receive governmental assistant programs to increase safety of outdoor options and access to lower-cost food retailers and to increase utilization of lower-cost fitness facilities. Graphical abstract ![]()
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA.
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH, USA.
| | - Jamie Blalock
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Lindsay Breslin
- Information Technology Department, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Haley Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Andrew Hanks
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Brian C Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Michael Outrich
- The Kirwan Institute for the Study of Race and Ethnicity, The Ohio State University, Columbus, OH, USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH, USA
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH, USA
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15
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Van Fossen CA, Wexler R, Purtell KM, Slesnick N, Taylor CA, Pratt KJ. Family Functioning Assessment and Child Psychosocial Symptoms in Family Medicine. J Pediatr Nurs 2021; 61:284-291. [PMID: 34388440 DOI: 10.1016/j.pedn.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Children and young adults underutilize behavioral health services, in part due to the challenges with identifying and providing services for child behavioral health in primary care. The objective of this study was to determine if a brief assessment of family functioning captures specific child psychosocial symptoms in a Family Medicine practice. DESIGN AND METHODS Eighty-three parent child dyads, in which the parent or child was a patient at the Family Medicine practice, participated in a cross-sectional study, including assessments of demographics, family functioning, child behavioral health symptoms, and health related pediatric quality of life (HRQOL). Bivariate correlations, independent samples t-test, and linear and logistic regression tested associations of parent and child reported family functioning with child behavioral health symptoms and HRQOL. RESULTS Parent and child reports of family functioning were significantly associated. Child, but not parent reports of family functioning were significantly associated with parent and child reports of behavioral health symptoms. Parent's reports of increased family functioning impairment were only significantly associated with parent's reports of decreased HRQOL. Family functioning impairment was associated with parent and child reports of increased behavioral health symptoms and decreased HRQOL. CONCLUSION Future work should determine if screening for family functioning impairment, may serve as a means of identifying and treating child behavioral health symptoms in Family Medicine. PRACTICE IMPLICATIONS Identifying impaired family functioning may serve to engage children and their parents in services, who may otherwise not be identified as having symptoms.
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Affiliation(s)
- Catherine A Van Fossen
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, USA; Department of Human Sciences, Human Dev. & Family Science Program, College of Education & Human Ecology, The Ohio State University, OH, USA.
| | - Randell Wexler
- Department of Family Medicine, The Ohio State Wexner Medical Center, OH, USA
| | - Kelly M Purtell
- Department of Human Sciences, Human Dev. & Family Science Program, College of Education & Human Ecology, The Ohio State University, OH, USA
| | - Natasha Slesnick
- Department of Human Sciences, Human Dev. & Family Science Program, College of Education & Human Ecology, The Ohio State University, OH, USA
| | - Christopher A Taylor
- Department of Family Medicine, The Ohio State Wexner Medical Center, OH, USA; Department of Health Sciences and Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University, OH, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Dev. & Family Science Program, College of Education & Human Ecology, The Ohio State University, OH, USA; Department of Surgery, The Ohio State University Wexner Medical Center, USA
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Pratt KJ, Hill EB, Kiser HM, VanFossen CE, Braun A, Taylor CA, Spees C. Changes in Parent and Child Skin Carotenoids, Weight, and Dietary Behaviors over Parental Weight Management. Nutrients 2021; 13:2227. [PMID: 34209574 PMCID: PMC8308330 DOI: 10.3390/nu13072227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.
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Affiliation(s)
- Keeley J. Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA; (H.M.K.); (C.E.V.)
- The Ohio State Wexner Medical Center, Department of Surgery, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Emily B. Hill
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
| | - Haley M. Kiser
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA; (H.M.K.); (C.E.V.)
| | - Catherine E. VanFossen
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA; (H.M.K.); (C.E.V.)
| | - Ashlea Braun
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
| | - Christopher A. Taylor
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
| | - Colleen Spees
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
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Brown CL, Skelton JA, Palakshappa D, Pratt KJ. High Prevalence of Food Insecurity in Participants Attending Weight Management and Bariatric Surgery Programs. Obes Surg 2021; 30:3634-3637. [PMID: 32363554 DOI: 10.1007/s11695-020-04645-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated the prevalence and correlates of household food insecurity (HFI) in participants attending weight management and bariatric surgery programs (WMP). We surveyed participants (N = 298) residing with a child and romantic partner from two WMP offering bariatric surgery and medical weight management. We assessed HFI using the Hunger Vital Sign and conducted multivariate logistic regression to assess correlates of HFI. HFI was present in 29.2% of participants. There were increased odds of HFI in participants with lower income and those with three or more children living at home. There was no association with sex, race, program type, education, or BMI. HFI is highly prevalent among participants of WMP. WMP should screen all participants for food insecurity to address this potential barrier to a healthy lifestyle.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA. .,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.,Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Keeley J Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA.,Deparment of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
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Abstract
PURPOSE OF REVIEW The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity. RECENT FINDINGS Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Catherine Van Fossen
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Onengiya Harry
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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19
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Ferber MF, Noria S, Focht B, Wallace L, Needleman B, Pratt KJ. The Effect of Family Member Attendance at Bariatric Surgery Appointments on Patient and Family Weight-Related Outcomes. Obes Surg 2020; 31:1073-1081. [PMID: 33067769 DOI: 10.1007/s11695-020-05041-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the effect of family member attendance at routine pre- and postoperative appointments on early postoperative patients' weight loss and physical activity levels and family members' weight control practices. MATERIALS AND METHODS As part of a RCT, patients were randomized to (1) invite a romantic partner or cohabitating family member to attend routine appointments (FA arm) or (2) proceed with treatment as usual (TAU arm). Patients in FA arm were asked to invite their family member to attend four routine appointments (T1 = pre-surgery class, T2 = 1 month pre-surgery, T3 = 2 weeks post-surgery, T4 = 2 months post-surgery). Assessments of patients' percent excess weight loss (%EWL), change in body mass index (ΔBMI), and levels of physical activity and family members' weight control practices (dietary control, self-monitoring, physical activity, and psychological coping) were conducted at T1-T4 with all dyads, and attendance was documented. Of the 213 dyads approached, 63 dyads consented to participate. RESULTS There were no significant differences in patient outcomes between FA and TAU arms or based on consistent attendance of family members. There were no significant differences in weight control practices between FA and TAU dyads. At T3 and T4, family members with consistent attendance reported higher self-monitoring, physical activity, and psychological control practices. Family members with consistent attendance reported significant increases in physical activity and psychological control practices from T1 to T4. CONCLUSIONS Family member attendance at routine appointments had greater positive effects on family members rather than on patient outcomes.
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Affiliation(s)
- Megan Ferriby Ferber
- Department of Human Sciences, Human Development and Family Science Program, The Ohio State University, Columbus, OH, USA.
| | - Sabrena Noria
- Department of Surgery, Division of General and GI Surgery, The Ohio State University, Columbus, OH, USA
| | - Brian Focht
- Department of Human Sciences, Kinesiology Program, The Ohio State University, Columbus, OH, USA
| | - Lorraine Wallace
- Department of Family Medicine, The Ohio State University, Columbus, OH, USA
| | - Bradley Needleman
- Department of Surgery, Division of General and GI Surgery, The Ohio State University, Columbus, OH, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, The Ohio State University, Columbus, OH, USA.,Department of Surgery, Division of General and GI Surgery, The Ohio State University, Columbus, OH, USA
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Pratt KJ, Ferriby M, Noria S, Skelton J, Taylor C, Needleman B. Perceived child weight status, family structure and functioning, and support for health behaviors in a sample of bariatric surgery patients. Fam Syst Health 2020; 38:300-309. [PMID: 29376660 DOI: 10.1037/fsh0000317] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The purpose of this study is to describe the associations between bariatric surgery patients' perspectives of their child's weight status, family support for eating and exercise behavior change, and family structure and functioning. METHOD A cross-sectional descriptive design with pre- and postsurgery (N = 224) patients was used. Demographics, perceptions of child weight status, family support for eating habits and exercise, and family functioning were assessed from patients at a University Bariatric Clinic. RESULTS Patients who perceived their child to be overweight/obese reported more impaired family functioning, less family exercise participation, and more discouragement for eating habit change in the family compared to patients who did not perceive their child to be overweight/obese. Single parents more often perceived their children to be overweight/obese, and had more impaired family functioning, and less support for changing eating habits and family exercise participation. Patients with impaired family functioning reported less support for changing eating habits and family exercise participation. DISCUSSION Bariatric patients who perceived their child to be overweight/obese and identified as single parents reported more impaired family functioning and less support for eating habits and family participation in exercise. Assessing pre- and postsurgery measures from parents and children will allow the further identification of relationship variables that can be targeted to promote positive family changes that benefit parents and children long-term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, The Ohio State University
| | - Megan Ferriby
- Department of Human Sciences, Human Development and Family Science Program, The Ohio State University
| | - Sabrena Noria
- Department of Surgery, College of Medicine, The Ohio State University Wexner Medical
| | - Joseph Skelton
- Epidemiology and Prevention Medicine, Wake Forest University
| | - Christopher Taylor
- Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University
| | - Bradley Needleman
- Department of Surgery, College of Medicine, The Ohio State University Wexner Medical
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Pratt KJ, Skelton JA, Lewis KH, Taylor CA, Spees C, Brown CL. Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children. J Nutr Educ Behav 2020; 52:579-587. [PMID: 32527416 PMCID: PMC10173866 DOI: 10.1016/j.jneb.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children. DESIGN Cross-sectional survey. SETTING Two US weight management centers. PARTICIPANTS 259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2-18 years) MAIN OUTCOME MEASURE(S): Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation. ANALYSIS Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates. RESULTS Patients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021). CONCLUSIONS AND IMPLICATIONS Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.
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Affiliation(s)
- Keeley J Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH; Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, OH.
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston Salem, NC; Department of Epidemiology and Prevention, Wake Forest University, Winston Salem, NC
| | - Kristina H Lewis
- Department of Epidemiology and Prevention, Wake Forest University, Winston Salem, NC
| | - Christopher A Taylor
- Medical Dietetics Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Colleen Spees
- Medical Dietetics Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University, Winston Salem, NC
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Albright CA, Pratt KJ, Martin SB, Hulshult H, Brown CL, Lewis KH, Skelton JA. Family members' experiences with adult participation in weight management programs: Triadic perspectives from patients, partners and children. Clin Obes 2020; 10:e12354. [PMID: 31965733 PMCID: PMC9107074 DOI: 10.1111/cob.12354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Spouses are known to influence the outcomes of an individual's attempt at weight loss, but little is known about the broader influence of, and on, the family. The objectives were to explore: (a) the effects of an adult weight management program on the family and (b) family factors that help or hinder patient weight loss. METHODS A qualitative design was employed to explore triadic family members' experiences of patient participation in a weight management program. Semi-structured interviews were conducted with patients, partners and children (ages 7-18). Questions included support for patient participation and weight loss, dietary choices, meal preparation, physical activity routines, the home-food environment, communication about health and family dynamics. Thematic analysis was used, where codes and categories of codes were then grouped together to create themes and subthemes. RESULTS Nineteen triadic interviews were conducted (57 total). Seven themes emerged, including four related to Outcomes (objective 1): (a) shift in family dynamics, (b) family behaviour change, (c) child observations of family change, (d) indirect benefit to partner; and three related to Process (objective 2): (e) level of accountability, (f) patient perception of support and (g) support is essential and flexible. CONCLUSIONS Future research and clinical applications from these themes should seek to determine the positive behaviour change that was evident in the families that were interviewed, where the culmination of family interactions, expectations and concurrent partner weight loss indicates the potential longevity of weight management programs beyond patients' own participation.
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Affiliation(s)
| | - Keeley J. Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Sarah B. Martin
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Pratt KJ, Sonney JT. Family science and family-based research in integrated and health care contexts: Future considerations for Families, Systems, & Health. Fam Syst Health 2020; 38:1-5. [PMID: 32202829 DOI: 10.1037/fsh0000477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The focus on families and application to health sets Families, Systems, & Health apart from other sister journals. Family science is a thriving field of study experiencing rapid advances in the discovery, verification, and application of knowledge about families (Burr, Day, & Bahr, 1993; Doherty, Boss, LaRossa, Schumm, & Steinmetz, 1993; National Council on Family Relations [NCFR] Task Force on the Development of a Family Discipline, 1988). It is essential that these advances in family science are transferable to research focused on families in integrated health care contexts, and it is our hope that Families, Systems, & Health with be at the forefront in disseminating this work. While there is an abundance of research focused on families and health outcomes, there is much less focused on the dissemination and implementation of family-based interventions in health care and integrated health care contexts. In order to advance our understanding how family members are included in family-based interventions, it is essential to operationalize how family-based interventions involve and assess families. In this editorial, we describe the foundations of family science and health, how these foundations inform family-based research, and the translational bridge of family-based research in health care. We conclude by describing a tiered approach for family involvement and assessment in family-based interventions taking place in health care, with specific attention on dissemination and implementation research in integrated care settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology
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Gunther C, Rogers C, Holloman C, Hopkins LC, Anderson SE, Miller CK, Copeland KA, Dollahite JS, Pratt KJ, Webster A, Labyk AN, Penicka C. Child diet and health outcomes of the simple suppers program: a 10-week, 2-group quasi-experimental family meals trial. BMC Public Health 2019; 19:1657. [PMID: 31823753 PMCID: PMC6902334 DOI: 10.1186/s12889-019-7930-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Racial minority children, particularly from low-income households, are at risk for obesity. Family meals have a protective effect on child nutritional health. However, the current evidence is limited in racial and socioeconomic diversity. The objective of this study was to evaluate the impact of a family meals intervention, Simple Suppers, on improvements in diet and health outcomes from baseline (T0) to post-intervention (T1) in intervention compared to waitlist control participants, and determine retention of change in outcomes among intervention participants at 10-week follow-up (T2). METHODS Simple Suppers was a 10-week family meals intervention implemented as a 2-group quasi-experimental trial. Ten 90-min lessons were delivered weekly. Data were collected at T0 and T1, and from intervention participants at T2. Participants were racially diverse 4-10 year-old children from low-income households. Setting was a faith-based community center. Main outcomes were daily servings of fruit, vegetables, and sugar-sweetened beverages and diet quality; z-scores for body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP); weight status categories; food preparation skills; and family meals (frequency of dinner, breakfast, TV viewing during meals, meals in dining area). Generalized linear mixed models (GLMMs) and mixed-effects ordinal regression models were used to assess intervention impact (T0:T1). Paired t-tests examined retention of change among intervention participants (T1:T2). RESULTS One hundred forty children enrolled and 126 completed T1 (90% retention); 71 of 87 intervention participants completed T2(79% retention). Mean (SD) age was 6.9(1.9) yr, 62% female, 60% Black, and 42% low-income. Intervention vs waitlist controls had higher food preparation skills (p < 0.001) and lower TV viewing during meals (p = 0.04) at T1.There were no group differences in dietary intake or quality or z-scores for BMI, waist circumference, or BP, however intervention versus waitlist controls experienced a greater change toward healthy weight (p = 0.04) At T2, intervention participants demonstrated a retention of improved food preparation skills. CONCLUSIONS Simple Suppers led to improvements in children's weight status, food preparation skills, and TV viewing during meals, but not diet or z-scores for BMI, waist circumference, or BP. Future research should examine the preventive effects of healthy family mealtime routines in children at greatest risk for obesity. TRIAL REGISTRATION NCT02923050; Simple Suppers Scale-up (S3); Retrospectively registered on Oct 2016; First participant enrolled on Jan 2015.
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Affiliation(s)
- Carolyn Gunther
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
| | - Catherine Rogers
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
- Present Address: Department of Nutrition, Case Western Reserve University, 10900 Euclid Ave, Wood Building, Cleveland, OH 44106 USA
| | - Christopher Holloman
- Department of Statistics, The Ohio State University, Columbus, USA
- Present Address: Information Control Company (ICC), 2500 Corporate Exchange Dr, Columbus, OH 43231 USA
| | - Laura C. Hopkins
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
| | - Sarah E. Anderson
- Division of Epidemiology, The Ohio State University, 1841 Neil Avenue, Cunz Hall, Columbus, OH 43210 USA
| | - Carla K. Miller
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
| | - Kristen A. Copeland
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
| | - Jamie S. Dollahite
- Division of Nutritional Sciences, Cornell University, 408 Savage Hall, Ithaca, NY 14853 USA
| | - Keeley J. Pratt
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
| | - Alison Webster
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
- Present Address: Food Directions, 1101 K St NW #650, Washington, DC 20005 USA
| | - Allison N. Labyk
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
| | - Christine Penicka
- Department of Human Sciences, The Ohio State University, 1787 Neil Ave, 313 Campbell Hall, Columbus, OH 43210 USA
- Present Address: Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208 USA
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Pratt KJ, Lazorick S, Eneli I, Collier DN, Skelton JA. Providers' involvement of blended families in pediatric weight management programs. Fam Syst Health 2019; 37:320-327. [PMID: 31613126 DOI: 10.1037/fsh0000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Family based interventions are the standard for pediatric weight management programs (PWMPs), yet the details of how to involve additional family members, when youth are part of blended families (i.e., step families) or reside in multiple households is not well understood. The objective of this study is to describe how providers involve blended families and multiple households in PWMPs. METHOD A cross-sectional exploratory survey was conducted of providers at PWMPs in the United States and Canada. The survey questions included had both multiple choice and open-ended responses. Univariate analyses were conducted. RESULTS 71 providers participated, representing 47 centers/clinics. The majority (96%) reported assessing multiple households, most often during the medical history. Providers reported including the primary caretakers at all known residences (59%), but not immediate family members beyond the primary caretakers. Providers reported adapting dietary (88%) and physical activity (77%) recommendations to accommodate multiple households. The most frequent adaptations included the goals at each family/household, adjustments on a per family basis or based on family resources, and making materials available to all family members. The most frequent challenges in extending treatment plans to multiple households included one caretaker/household not willing to participate or being present at visits, and inconsistency between households. Despite providers reporting that they assess multiple households, they did not have a formal interview template or form to use in assessments (27%). DISCUSSION Providers recognize the challenges and complexity that blended families present with in obesity treatment. Further research is need to increase provider assessment and involvement of blended families and the extension of goals and treatment plans to multiple homes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University
| | - Suzanne Lazorick
- Department of Pediatrics, Brody School of Medicine, East Carolina University
| | - Ihuoma Eneli
- Nationwide Children's Hospital, Center for Healthy Weight and Nutrition
| | - David N Collier
- Department of Pediatrics, Brody School of Medicine, East Carolina University
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Pratt KJ, Ferriby M, Brown CL, Noria S, Needleman B, Skelton JA. Adult weight management patients' perceptions of family dynamics and weight status. Clin Obes 2019; 9:e12326. [PMID: 31232524 PMCID: PMC10179550 DOI: 10.1111/cob.12326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 01/26/2023]
Abstract
Our overall objective was to describe the parent-child, romantic, and family dynamics of adult weight management program (WMP) patients, and associations with children's and partners' weight status. First, we determined if family functioning mediated the effect between parent-child feeding practices and perceived child weight status, and romantic relationship anxiety and avoidance and perceived partner weight status. Second, we assessed if perceived child and partner weight status moderated the associations between family functioning and parent-child feeding practices and romantic relationship anxiety and avoidance, respectively. Patients (N=203) who resided with a child and partner from two WMPs completed assessments of parent-child feeding practices (Child Feeding Questionnaire), romantic relationship anxiety and avoidance (Relationship Structures Questionnaire), family functioning (Family Assessment Device General Functioning Scale), and perceived child and partner weight status. Bivariate analyses determined differences in weight status and relationship dynamics and family functioning, and mediation and moderation analyses were conducted to answer the two research questions. Family functioning was not a mediator between romantic relationship dynamics and partner weight status or parent-child dynamics and child weight status. Lower family functioning was associated with higher parent-child restrictive feeding practices, only among children with overweight/obesity. Similarly, lower family functioning was associated with higher anxiety and avoidance in romantic relationships, only for partners with overweight/obesity. Patients with children and/or partners with overweight/obesity reported more impaired family dynamics and functioning, compared to patients with children and/or partners with a healthy weight status.
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Affiliation(s)
- Keeley J Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
- Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Megan Ferriby
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University, Winston Salem, North Carolina
| | - Sabrena Noria
- Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Bradley Needleman
- Department of Surgery, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston Salem, North Carolina
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Pratt KJ, Van Fossen CA, Berge JM, Murray R, Skelton JA. Youth weight status and family functioning in paediatric primary care. Clin Obes 2019; 9:e12314. [PMID: 31115182 DOI: 10.1111/cob.12314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study is to examine the associations between family functioning and youth overweight and obesity in a sample of primary care paediatric patients. Specially, we hypothesize that caregivers of youth with an overweight/obese weight status will report more impaired family functioning. A cross-sectional descriptive study was conducted with 329 caregivers of youth ages 2 to 18 seen in paediatric primary care. Caregivers completed the Family Assessment Device General Functioning Scale and clinical demographics, including parent-reported youth height and weight to calculate body mass index (BMI). Family functioning was used as a continuous total variable, and as a dichotomous variable based on clinically impaired or healthy family functioning. Analyses included descriptive statistics, Pearson's correlations, and independent t tests. Caregivers who reported impaired family functioning based on the clinical cutoff score were more likely to report that their youth had a higher BMI and BMI z-score. Caregivers with impaired family functioning and who identified as being in two-parent families, with at least a Bachelor's degree, and a moderate to high family income were more likely to report their youth was a higher weight status. Further screening and assessment of family functioning in combination with youth weight status among a larger diverse sample of primary care paediatric patients over time will provide insight into what aspects of family functioning may contribute to maintaining a healthy lifestyle or adopting new health behaviours to prevent and/or treat obesity in youth.
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Affiliation(s)
- 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, Ohio
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine A Van Fossen
- 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, Ohio
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Robert Murray
- Ohio Chapter of the American Academy of Pediatrics, Columbus, Ohio
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Pratt KJ, Skelton JA, Eneli I, Coliler DN, Lazorick S. Providers' Involvement of Parents, Families, and Family Dynamics in Youth Weight Management Programs. Glob Pediatr Health 2018; 5:2333794X18817134. [PMID: 30547061 PMCID: PMC6287309 DOI: 10.1177/2333794x18817134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 12/04/2022] Open
Abstract
Family-based interventions are the current standard for the treatment of pediatric obesity, yet the details of how providers are involving family members, and the barriers to family involvement, are largely unknown. The objective of this study is to describe how providers in pediatric weight management (PWM) involve family members, identify barriers to family involvement, and how they address challenging family dynamics. A cross-sectional survey was administered to PWM centers/clinics and their providers in the United States and Canada. Analyses included descriptive statistics at the participant (N = 71) and clinic/center (N = 47) levels. Providers indicated that they assessed patients and parents’ perspectives, not other family members, motivation, weight/medical history, dietary and activity behaviors, goals, and barriers. Providers also reported that they asked patients’ perspectives about their parents’ aforementioned behaviors, and siblings’ dietary, activity, and sedentary/screen time behaviors, and weight/medical history. Providers reported that the balance between the patient and parent changed as children aged, with more focus given to the child, and less to the parent, as the child grew older. The most frequent barrier to involving family members in treatment included challenging family dynamics. The most challenging family dynamics were divorce/separation and parent-child conflicts. Providers often refer to and rely on mental/behavioral health providers to address barriers to family involvement and challenging family dynamics. Further research is needed to determine adequate provider training and comfort in dealing with family dynamics in treatment, and ways to mitigate barriers to involving families in PWM.
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Affiliation(s)
| | | | - Ihuoma Eneli
- Ohio State University, Columbus, OH, USA.,Nationwide Children's Hospital, Columbus, OH, USA
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Abstract
INTRODUCTION The purpose of this study was to pilot a brief measure of family functioning (Family Assessment Device-General Functioning [FAD_GF]) with caregivers of children aged 2 to 18 years, seen for routine pediatric primary care visits. METHODS This study evaluated the psychometric properties of the FAD_GF in a pediatric primary care sample of 400 families. Confirmatory factor analysis was used to validate the FAD_GF using R, and WLSMV was used to estimate missing variables. RESULTS The FAD_GF was found to be reliable with this sample, α = .90. The model fit was χ2(54) = 56.44, P = .38, with root mean square error of approximation = .01 and comparative fit index = .99. The 12 items were significantly predicted by family functioning, and family functioning explained more than 20% of the variance in the items, R2 > .25. Overall, 12.6% (n = 46) of families were identified as having clinically impaired family functioning. DISCUSSION The FAD_GF provides clinicians the ability to make evidence-informed decisions regarding referrals to family therapists.
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Affiliation(s)
| | - Keeley J Pratt
- 1 The Ohio State University, Columbus, OH, USA.,2 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert Murray
- 3 Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Joseph A Skelton
- 4 Wake Forest School of Medicine, Winston-Salem, NC, USA.,5 Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Pratt KJ, Jalilvand A, Needleman B, Urse K, Ferriby M, Noria S. Postoperative outcomes based on patient participation in a presurgery education and weight management program. Surg Obes Relat Dis 2018; 14:1714-1723. [PMID: 30274740 DOI: 10.1016/j.soard.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The benefits of presurgery weight management programs (WMPs) for bariatric patients are mixed; some show a positive impact on percent excess weight loss (%EWL) at 12 months postsurgery, while others show no effect. OBJECTIVES The purpose of this study was to compare pre- and postoperative 6- and 12-month outcomes between patients who attended a 12-week presurgery WMP and patients who did not participate. SETTING Ohio State Wexner Medical Center, University Hospital, United States. METHODS A retrospective medical record analysis was conducted to compare preoperative and 6- and 12-month postoperative outcomes for patients who attend the presurgery WMP (n = 56) and patients who did not (n = 441) within a 2-year time period (N = 497). Descriptive statistics and independent t tests were conducted to determine mean differences between groups, while controlling for surgery type, for weight status outcomes (%EWL, change in body mass index) preoperatively and 6 and 12 months postsurgery, and length of stay and readmission rate. RESULTS Patients who attended the preoperative WMP had significantly higher %EWL at 12 months postsurgery compared with patients who did not attend the WMP. Additional findings indicated a positive, but nonsignificant effect, from the WMP on presurgery body mass index, and postsurgery %EWL at 6 months and body mass index change at 6 and 12 months postsurgery. CONCLUSIONS Patients attending the WMP had better 12-month %EWL and outcomes compared with those who did not attend the WMP, though this was not true for 6-month outcomes and differed based on surgery type.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, Columbus, Ohio; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Anahita Jalilvand
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kelly Urse
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Megan Ferriby
- Department of Human Sciences, College of Education and Human Ecology, Columbus, Ohio
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Pratt KJ, Skelton JA. Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach. Acad Pediatr 2018; 18:620-627. [PMID: 29654905 PMCID: PMC8111666 DOI: 10.1016/j.acap.2018.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/28/2018] [Accepted: 04/04/2018] [Indexed: 01/21/2023]
Abstract
Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.
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Affiliation(s)
- Keeley J. Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Brenner FIT (Families In Training) Program, Brenner Children’s Hospital, Wake Forest Baptist Health, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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Hicks White AA, Pratt KJ, Cottrill C. The relationship between trauma and weight status among adolescents in eating disorder treatment. Appetite 2018; 129:62-69. [PMID: 29969660 DOI: 10.1016/j.appet.2018.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
A relationship between trauma and eating disorders in adolescence is well established, though less is known about how different types of trauma, apart from childhood sexual abuse, associate with eating disorders. The purpose of this study is to describe the prevalence of various trauma types in a clinical sample of adolescents presenting at an outpatient eating disorder treatment facility (N = 182). Thirty-five percent of the sample reported experiencing one or more traumatic events during their lifetime. Bullying was the most prevalent type of trauma (10%), followed by significant death/loss (9%), and sexual abuse (8%). Adolescents with any trauma exposure had higher body mass index (BMI), BMI percentile, and percent expected body weight (%EBW) compared to those without any trauma exposure. Specifically, patients who were exposed to bullying and domestic violence reported a significantly higher %EBW than those who were not exposed. On average, adolescents exposed to bullying had a %EBW that was 7 percentage points higher than their non-exposed peers. Patients with bulimia nervosa were more likely to report trauma exposure than those with other eating disorder diagnosis. Providers working with adolescents diagnosed with eating disorders of all weight statuses should consider assessing for past and current trauma, including bullying and exposure to domestic violence. Trauma informed approaches to eating disorder treatment are needed to avoid potentially activating or exacerbating trauma related distress for adolescents in eating disorder treatment.
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Affiliation(s)
- Ashley A Hicks White
- The Ohio State University, Department of Human Sciences, 1787 Neil Ave., Columbus, OH, 40210, USA.
| | - Keeley J Pratt
- Human Development and Family Science, The Ohio State University, Department of Human Sciences, 1787 Neil Ave., Columbus, OH, 40210, USA
| | - Casey Cottrill
- Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatrics, The Ohio State University, 410 W 10th Avenue, Columbus, OH, 43210, USA
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Pratt KJ, Balk EK, Ferriby M, Wallace L, Noria S, Needleman B. Bariatric Surgery Candidates' Peer and Romantic Relationships and Associations with Health Behaviors. Obes Surg 2017; 26:2764-2771. [PMID: 27143096 DOI: 10.1007/s11695-016-2196-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim was to assess the romantic and peer relationships of bariatric surgery candidates and associations with health behaviors. METHOD Adults seeking bariatric surgery (N = 120) completed surveys addressing health behaviors and social relationships at information sessions. Analysis was done to compare male/female differences in peer and romantic relationships and associations with health behaviors. Previously published reference (REF) data on the Relationship Structures questionnaire was used for comparison, and to split our sample into those ≤ or > REF mean for relationship anxiety and avoidance. RESULTS Our sample reported higher avoidance and lower anxiety in their close friendships and romantic relationships compared to the REF sample. Men in our sample had higher peer and romantic relationships avoidance compared to the REF sample and had significantly higher close friendship avoidance than women in our sample. Participants with lower anxiety in their romantic relationships (≤ REF) had higher uncontrolled eating and physical activity; those with more anxiety in their romantic relationships (> REF) had a higher BMI. CONCLUSIONS Our findings highlight the potential influence that social relationships may have on health behaviors within the bariatric surgery population. Further investigation is warranted to explore male bariatric surgery candidates' relationships to inform understanding and intervention development.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA. .,Department of Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Elizabeth K Balk
- Department of Health Promotion and Exercise Studies, Western Connecticut State University, Danbury, CT, 06810, USA
| | - Megan Ferriby
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Lorraine Wallace
- Department of Family Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sabrena Noria
- Department of Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Department of Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
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Pratt KJ, Van Fossen C, Cotto-Maisonet J, Palmer EN, Eneli I. Mothers' Perspectives on the Development of Their Preschoolers' Dietary and Physical Activity Behaviors and Parent-Child Relationship: Implications for Pediatric Primary Care Physicians. Clin Pediatr (Phila) 2017; 56:766-775. [PMID: 28056539 DOI: 10.1177/0009922816684598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study explores female caregivers' reflections on their relationship with their child (2-5 years old) and the development of their child's dietary and physical activity behaviors. Five, 90-minute semistructured focus groups were conducted to inquire about children's growth, eating behaviors and routines, physical activity, personality, and the parent-child relationship. Nineteen female caregivers diverse in race/ethnicity, age, and educational attainment participated. Participants reported that they maintained a schedule, but needed to be flexible to accommodate daily responsibilities. Family, social factors, and day care routines were influences on their children's behaviors. The main physical activity barriers were safety and time constraints. Guidance from pediatric primary care providers aimed at supporting female caregivers to build a positive foundation in their parent-child relationship, and to adopt and model healthy diet and physical activity behaviors that are respectful of schedules and barriers should be a priority for childhood obesity prevention.
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Affiliation(s)
- Keeley J Pratt
- 1 Department of Human Sciences, Human Development and Family Science Program, The Ohio State University
| | - Catherine Van Fossen
- 1 Department of Human Sciences, Human Development and Family Science Program, The Ohio State University
| | - Jennifer Cotto-Maisonet
- 1 Department of Human Sciences, Human Development and Family Science Program, The Ohio State University
| | - Elizabeth N Palmer
- 1 Department of Human Sciences, Human Development and Family Science Program, The Ohio State University
| | - Ihuoma Eneli
- 2 Director, Center for Healthy Weight and NutritionNationwide Children's Hospital, Columbus, Oh 43205
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Rogers C, Anderson SE, Dollahite JS, Hill TF, Holloman C, Miller CK, Pratt KJ, Gunther C. Methods and design of a 10-week multi-component family meals intervention: a two group quasi-experimental effectiveness trial. BMC Public Health 2017; 17:50. [PMID: 28069006 PMCID: PMC5223369 DOI: 10.1186/s12889-016-3908-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/07/2016] [Indexed: 01/14/2023] Open
Abstract
Background Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research, specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age range to include younger children, who are laying the foundation of their eating patterns and capable of participating in family meal preparations. The purpose of this paper is to address this research gap by presenting the objectives and research methods of a 10-week multi-component family meals intervention study aimed at eliciting positive changes in child diet and weight status. Methods This will be a group quasi-experimental trial with staggered cohort design. Data will be collected via direct measure and questionnaires at baseline, intervention completion (or waiting period for controls), and 10-weeks post-intervention. Setting will be faith-based community center. Participants will be 60 underserved families with at least 1, 4–10 year old child will be recruited and enrolled in the intervention (n = 30) or waitlist control group (n = 30). The intervention (Simple Suppers) is a 10-week family meals program designed for underserved families from racial/ethnic diverse backgrounds. The 10, 90-min program lessons will be delivered weekly over the dinner hour. Session components include: a) interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b) engagement in age-appropriate food preparation activities for children; and c) group family meal for caregivers and children. Main outcome measures are change in: child diet quality; child standardized body mass index; and frequency of family meals. Regression models will be used to compare response variables results of intervention to control group, controlling for confounders. Analyses will account for clustering by family and cohort. Significance will be set at p < 0.05. Discussion This is the first experimentally designed family meals intervention that targets underserved families with elementary school age children and includes an examination of health outcomes beyond weight status. Results will provide researchers and practitioners with insight on evidence-based programming to aid in childhood obesity prevention. Trial registration NCT02923050. Registered 03 October 2016. Retrospectively registered.
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Affiliation(s)
- Catherine Rogers
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, 325 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Sarah E Anderson
- Division of Epidemiology, The Ohio State University, 336 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Jamie S Dollahite
- Division of Nutritional Sciences, Cornell University, 408 Savage Hall, Ithaca, NY, 14853, USA
| | - Tisa F Hill
- Division of Nutritional Sciences, Cornell University, 342 MVR, Ithaca, NY, 14853, USA
| | - Chris Holloman
- Department of Statistics, The Ohio State University, 404 Cockins Hall, 1958 Neil Avenue, Columbus, OH, 43210, USA
| | - Carla K Miller
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, 347B Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, The Ohio State University, 130B Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Carolyn Gunther
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, 313 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA.
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Pratt KJ, Palmer E, Cravens JD, Ferriby M, Balk E, Cai Y. Marriage and Family Therapy Trainees' Reports of Explicit Weight Bias. J Marital Fam Ther 2016; 42:288-298. [PMID: 25728034 DOI: 10.1111/jmft.12116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Discrimination based on an individual's weight has been observed in health care, education, retail, and other public sectors (Puhl & Huer, Obesity, 17, 941, 2007). Such inequity, known as "weight bias," generates negative short-term and long-term consequences for the individuals that experience it (Puhl & Brownell, Weight bias in health care settings, 2007). Past research has shown that healthcare trainees exhibit weight bias (Phelan et al., Obesity, 22, 1201, 2014; Wigton & McGaghie, Journal of General Internal Medicine, 16, 262, 2001), yet little focus is given to weight bias in marriage and family therapy (MFT) education. The purpose of this study was to survey MFT students (N = 162) to explore weight bias and how contextual factors associate with weight bias. Participants in MFT programs reported explicit weight bias, with specific contextual factors associating with more bias. Female participants reported more fear of gaining weight, and individuals who identified as overweight had higher rates of explicit weight bias. Contextual differences and implications for training programs are discussed.
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Cravens JD, Pratt KJ, Palmer E, Aamar R. Marriage and Family Therapy Students’ Views on Including Weight Bias Training into Their Clinical Programs. Contemp Fam Ther 2016. [DOI: 10.1007/s10591-015-9366-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pratt KJ, McRitchie S, Collier DN, Lutes LD, Sumner S. Parent & Family Influences on Adopting Healthy Weight-Related Behaviors: Views and Perceptions of Obese African-American Female Adolescents. J Natl Med Assoc 2015; 107:74-9. [DOI: 10.1016/s0027-9684(15)30027-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Attrition is a significant problem for health care providers working with youth and parents involved in childhood obesity treatment. Barriers for families in childhood obesity treatment have been explored, but less is known about factors that may be associated with follow-up attendance. The purpose of this study is to explore youth and parent variables, pediatrician's evaluations of youth and parents' likelihood to change (LTC), and their association with attendance at follow-up. One hundred ninety-three youth and parent dyads were included in the sample; slightly more than half of the sample did not return for a follow up visit. Descriptive statistics, paired and independent t tests, and correlations were used to determine associations between youth and parent demographic factors, attendance at follow-up, and pediatricians' evaluation of likelihood to change. Evaluations of LTC and demographic factors did not significantly associate with follow-up appointment attendance. Single parents were more likely to be rated by pediatricians as likely to make changes. Implications for future research and clinical practice are discussed.
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Pratt KJ, Lamson AL, Radley SV. The Self-Reported Strengths and Concerns of Treatment-seeking Obese Youth and Their Caregivers. Children's Health Care 2015. [DOI: 10.1080/02739615.2014.891206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Carraway ME, Lutes LD, Crawford Y, Pratt KJ, McMillan AG, Scripture LG, Henes S, Cox J, Vos P, Collier DN. Camp-based immersion treatment for obese, low socioeconomic status, multi-ethnic adolescents. Child Obes 2014; 10:122-31. [PMID: 24628415 DOI: 10.1089/chi.2013.0111] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Immersion treatment (IT) provided in a camp setting has been shown to promote short-term improvements in weight and health status in obese adolescents. However, evidence of IT's long-term efficacy and efficacy for multi-ethnic and lower socioeconomic status (SES) adolescents is limited. METHODS This was a cohort study with a pre/post design and longitudinal follow-up. The intervention was a 19-day camp-based IT program comprising (1) a nutrition curriculum and ad-lib access to a nutritious diet, (2) several hours of physical activity daily, (3) group therapy, and (4) cognitive-behavioral therapy (CBT). This analysis included 52 low-SES adolescents that participated in 2009 and 2010. A subgroup of 33 campers and their families was offered follow-up monthly for 10 months. Primary outcome measures were change in weight-related parameters immediately postcamp and after 10 months of follow-up. RESULTS Campers had significant short-term improvements in mean waist circumference (mean [M], 2.6; standard deviation [SD], 3.2 cm), weight (M, 2.6; SD, 1.9 kg), BMI (M, 1.1; SD, 0.9 kg/m2), BMI z-score (M, 0.06; SD, 0.07), and percent overweight (M, 6.1; SD, 4.7). Campers offered follow-up had a modest increase in mean percent overweight (M, 2.0; SD, 8.4) during 10 months of follow-up. However, 33% experienced continuing decline in percent overweight during follow-up, and long-term follow-up was associated with significant overall (precamp vs. end of follow-up) improvements in percent overweight (M, 4.9; SD, 7.2). CONCLUSIONS Camp-based IT with CBT is a promising intervention for improving short- and long-term weight status of low-SES adolescents. Additional research is needed to increase long-term efficacy.
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Pratt KJ, Lazorick S, Lamson AL, Ivanescu A, Collier DN. Quality of life and BMI changes in youth participating in an integrated pediatric obesity treatment program. Health Qual Life Outcomes 2013; 11:116. [PMID: 23837620 PMCID: PMC3710490 DOI: 10.1186/1477-7525-11-116] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 07/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL. METHODS A sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate. RESULTS Overall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression. CONCLUSIONS We encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth's BMI changes, but also psychosocial changes including QOL.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Development and Family Science, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, USA.
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Selewski DT, Collier DN, MacHardy J, Gross HE, Pickens EM, Cooper AW, Bullock S, Earls MF, Pratt KJ, Scanlon K, McNeill JD, Messer KL, Lu Y, Thissen D, DeWalt DA, Gipson DS. Promising insights into the health related quality of life for children with severe obesity. Health Qual Life Outcomes 2013; 11:29. [PMID: 23452863 PMCID: PMC3598567 DOI: 10.1186/1477-7525-11-29] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 02/19/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity. METHODS The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8-17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to<99th percentile versus ≥99th percentile. RESULTS 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p<0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p<0.05). CONCLUSIONS Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life.
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Affiliation(s)
- David T Selewski
- Division of Nephrology, Department of Pediatrics, University of Michigan, CS Mott Children's Hospital Room 12-250, 1540 E Hospital Drive, SPC 4297, Ann Arbor, MI 48109-4297, USA.
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Affiliation(s)
- Keeley J. Pratt
- Adjunct Graduate Faculty, Department of Child Development and Family Relations, College of Human Ecology, East Carolina University, Greenville, North Carolina
| | - Annette G. Greer
- Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Mendenhall TJ, Pratt KJ, Phelps KW, Baird MA. Advancing Medical Family Therapy Through Research: A Consideration of Qualitative, Quantitative, and Mixed-Methods Designs. Contemp Fam Ther 2012. [DOI: 10.1007/s10591-012-9186-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pratt KJ, Lamson AL. Supervision in Behavioral Health: Implications for Students, Interns, and New Professionals. J Behav Health Serv Res 2011; 39:285-94. [DOI: 10.1007/s11414-011-9267-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pratt KJ, Lamson AL, Lazorick S, Swanson MS, Cravens J, Collier DN. A biopsychosocial pilot study of overweight youth and care providers' perceptions of quality of life. J Pediatr Nurs 2011; 26:e61-8. [PMID: 22055385 DOI: 10.1016/j.pedn.2011.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 03/11/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
This pilot study examined the relationship between youth and care provider self-reports of depressive symptoms assessed through the Patient Health Questionnaire and reports of youth physical and psychosocial functioning assessed by PedsQL4.0 in a rural outpatient overweight pediatric population (N = 66 child and care provider pairs). The relationship between youth body mass index (BMI), youth and care provider depression, youth quality of life (QOL), care provider perception of youth QOL, and youth and care provider congruence of QOL perceptions was examined. Paired t tests were completed to assess the differences between QOL scores for youth and care providers for subgroups based on age, age and gender, and age and race. The mean age of youth participants was 11.9 years; youth BMI ranged from 26.76 to 54.10 (M = 37.20). Our results showed that there are significant differences in youth and care providers' perceptions of QOL when specific demographic categories are assessed by age, gender, and race.
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Pratt KJ, Lamson AL, Collier DN, Harris N, Ballard S, Saporito M, Sarvey S, Gross K, Crawford YS. Camp Golden Treasures: a multidisciplinary weight-loss and a healthy lifestyle camp for adolescent girls. Fam Syst Health 2009; 27:116-124. [PMID: 19630452 DOI: 10.1037/a0014912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Camp Golden Treasures, (CGT) the first non-profit weight loss camp for overweight adolescent girls in the nation, was held for six weeks from June 24 to August 3, 2007 at the East Carolina University campus in Greenville, NC. The primary goal was to support campers to lose weight, raise self esteem, and to learn the tools necessary to lead a healthy lifestyle while reducing risks for developing chronic disease or mitigating the effects of existing obesity-related conditions (sleep apnea, insulin resistance, hypertension, lower extremity dysfunction, etc.). While at CGT, campers learned about the importance of physical activity and proper nutrition through workshops, discussion groups and hands-on activities. Additionally campers were taught the necessary tools and strategies needed to make concrete, positive lifestyle changes so they can achieve a healthy weight. Due to the nature of a chronic disease such as obesity, multidisciplinary collaborators including physical therapy, nutrition, health education, management, family therapy, risk management, fundraising, public relations, medical, nursing, and physician coverage were involved in designing, planning, and implementing CGT.
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Affiliation(s)
- Keeley J Pratt
- East Carolina University, Department of Child Development and Family Studies, 150 Rivers Building, Greenville, NC 27858, USA. kjp0504@ecu
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Pratt KJ. Antibiotic prophylaxis in dentistry. Br Dent J 2000; 188:292. [PMID: 10800231 DOI: 10.1038/sj.bdj.4800460a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Eierman DF, Yagami M, Erme SM, Minchey SR, Harmon PA, Pratt KJ, Janoff AS. Endogenously opsonized particles divert prostanoid action from lethal to protective in models of experimental endotoxemia. Proc Natl Acad Sci U S A 1995; 92:2815-9. [PMID: 7708730 PMCID: PMC42309 DOI: 10.1073/pnas.92.7.2815] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We report that, in rats, the lethal consequences of high-dose endotoxin challenge are exacerbated by the intravascular administration of prostaglandin E1 but attenuated by the intravascular administration of endocytosable particles. This protection is mediated by opsonins. Nonopsonizable particles were unable to provide protection unless first pseudoopsonized with antibody directed against the CR3 (CD11b/CD18) phagocyte receptor. We show that endogenously opsonized particles can act in concert with prostaglandin E1 (putatively by elevation of neutrophil intracellular cAMP and the resultant downregulation of CR3) to completely rescue animals from the lethal late-stage sequelae of experimental endotoxemia. These data illustrate that the interaction of particles with cellular receptors can transform the overall systemic response to prostaglandin E1 from pro- to antiinflammatory. This suggests a role for multiple receptor engagement events in defining the systemic prostaglandin response and offers a rationale for developing new therapeutic modalities in the treatment of sepsis and other inflammatory diseases.
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Affiliation(s)
- D F Eierman
- Liposome Company, Inc., Princeton, NJ 08540-6619, USA
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