1
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Barlow SE, Hampl SE. Extended BMI-for-Age Growth Charts: Putting Them to Use. Pediatrics 2023; 152:e2023062815. [PMID: 37615077 DOI: 10.1542/peds.2023-062815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Medical Center of Dallas, Dallas, Texas
| | - Sarah E Hampl
- Department of Pediatrics, Children's Mercy Kansas City Center for Healthy Lifestyles & Nutrition, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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2
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Jiang Q, Carlson JA, Kaczynski AT, Shook RP, Besenyi GM, Steel C, Moon M, Hampl SE, Wilhelm Stanis S. Neighborhood park access and park characteristics are associated with weight status in youth. Health Place 2023; 83:103116. [PMID: 37713980 DOI: 10.1016/j.healthplace.2023.103116] [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: 02/24/2023] [Revised: 06/02/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
This study investigated park access and park quality in the context of childhood obesity. Participants were 20,638 children ages 6-17y from a large primary care health system. Analyses tested associations of park access and park characteristics with children's weight status, and sociodemographic interactions. Both park access and the quality of nearest park were associated with a lower odds of having obesity. Park quality interacted with age, sex, and income. Findings suggest park access is important for supporting a healthy weight in children. Park quality may be most important among 12-14-year-olds, girls, and higher income groups.
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Affiliation(s)
- Qianxia Jiang
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jordan A Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; School of Medicine, University of Missouri Kansas City, Kansas City, Kansas, USA.
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Robin P Shook
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; School of Medicine, University of Missouri Kansas City, Kansas City, Kansas, USA
| | - Gina M Besenyi
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Chelsea Steel
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Mallory Moon
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Sarah E Hampl
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; School of Medicine, University of Missouri Kansas City, Kansas City, Kansas, USA
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3
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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4
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:190440. [PMID: 36622135 DOI: 10.1542/peds.2022-060641] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sarah E Hampl
- Children's Mercy Kansas City Center for Children's Healthy Lifestyles & Nutrition, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Medical Center of Dallas, Dallas, Texas
| | - Christopher F Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kimberly C Avila Edwards
- Children's Health Policy & Advocacy, Ascension; Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas
| | - Ihuoma Eneli
- Department of Pediatrics, The Ohio State University, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Robin Hamre
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, University of Florida Health Sciences Center-Jacksonville, Jacksonville, Florida
| | | | - Eneida Mendonca
- Departments of Pediatrics and Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marc P Michalsky
- Department of Pediatric Surgery, The Ohio State University, College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Nazrat Mirza
- Children's National Hospital, George Washington University, Washington, DC
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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5
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Dreyer Gillette ML, Bates CR, Pona AA, Reder M, Hampl SE. Effectiveness of family based behavioral treatment in an ethnically diverse sample of young children. Clinical Practice in Pediatric Psychology 2022. [DOI: 10.1037/cpp0000452] [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: 11/08/2022]
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6
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Binns HJ, Joseph M, Ariza AJ, Cuda SE, Skinner AC, Xu H, Tucker JM, Hampl SE, Santos M, Mayo S, King EC, Kirk S. Elevated blood pressure in youth in pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER). J Clin Hypertens (Greenwich) 2022; 24:122-130. [PMID: 35099099 PMCID: PMC8845448 DOI: 10.1111/jch.14423] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 02/01/2023]
Abstract
Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3–17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95th percentile for body mass index (%BMIp95); %BMIp95 was used to group youth by obesity class (class 1, 100% to < 120% %BMIp95; class 2, 120% to < 140% %BMIp95; class 3, ≥140% %BMIp95; class 2 and class 3 are considered severe obesity). Logistic regression evaluated associations with high BP. Data of 7943 patients were analyzed. Patients were: mean 11.7 (SD 3.3) years; 54% female; 19% Black non‐Hispanic, 32% Hispanic, 39% White non‐Hispanic; mean %BMIp95 137% (SD 25). Overall, 48.9% had high BP at the baseline visit, including 60.0% of youth with class 3 obesity, 45.9% with class 2 obesity, and 37.7% with class 1 obesity. Having high BP was positively associated with severe obesity, older age (15–17 years), and being male. Nearly half of treatment‐seeking youth with obesity presented for PWM care with high BP making assessment and management of BP a key area of focus for PWM programs.
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Affiliation(s)
- Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Madeline Joseph
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Adolfo J Ariza
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Suzanne E Cuda
- Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Asheley C Skinner
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jared M Tucker
- Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Sarah E Hampl
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Shawyntee Mayo
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Eileen C King
- Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shelley Kirk
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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7
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Fornander MJ, Bates CR, Hampl SE, Beck AR, Dreyer Gillette ML. Psychological predictors of family-based behavioral treatment response in a diverse sample of youth with obesity. Clinical Practice in Pediatric Psychology 2021. [DOI: 10.1037/cpp0000427] [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: 11/08/2022]
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8
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Fowler LA, Hampl SE, Dreyer Gillette ML, Staiano AE, Kracht CL, Graham AK, Gabbert S, Springstroh K, Thomas F, Nelson L, Hampp AE, Carlson JA, Welch R, Wilfley DE. Translating Family-Based Behavioral Treatment for Childhood Obesity into a User-Friendly Digital Package for Delivery to Low-Income Families through Primary Care Partnerships: The MO-CORD Study. Child Obes 2021; 17:S30-S38. [PMID: 34569844 PMCID: PMC8575055 DOI: 10.1089/chi.2021.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 01/25/2023]
Abstract
Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project 3.0 (CORD), the Missouri CORD (MO-CORD) team aims to increase access to and dissemination of an efficacious pediatric obesity treatment, family-based behavioral treatment (FBT), among low-income families. This article describes the MO-CORD team's approach to translating FBT into a digital package for delivery to low-income families through primary care practices. Methods: Using digital technology, the primary care setting, and existing reimbursement mechanisms, the MO-CORD team is developing a scalable user-centered design informed treatment package of FBT. This package will be implemented in primary care clinics and delivered to children (5-12 years) with obesity from low-income households in rural and urban communities. The digital platform includes three main components: (1) provider and interventionist training, (2) interventionist-facing materials, and (3) family-facing treatment materials. User-centered design techniques and continuous iterative stakeholder feedback are utilized to emphasize tailoring to a low-income population, along with scalability and sustainability of the digital package. Conclusions: The MO-CORD project addresses the critical need to increase access to obesity treatment for children from low-income households and establishes a platform for future large-scale (i.e., nation-wide) dissemination of evidence-based pediatric weight-management interventions. This study determines whether the digital FBT package can be implemented within real-world settings to create a system by which children with obesity and their families can be effectively treated in primary care settings.
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Affiliation(s)
- Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah E. Hampl
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | | | | | | | - Andrea K. Graham
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sherri Gabbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Springstroh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Fanice Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Aubrie E. Hampp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jordan A. Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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9
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Wilfley DE, Fowler LA, Hampl SE, Dreyer Gillette ML, Staiano AE, Graham AK, Grammer AC, Nelson L, Carlson JA, Brown DS, Gabbert S, Springstroh K, Thomas F, Ramel M, Welch R, Johnson W. Implementation of a Scalable Family-Based Behavioral Treatment for Childhood Obesity Delivered through Primary Care Clinics: Description of the Missouri Childhood Obesity Research Demonstration Study Protocol. Child Obes 2021; 17:S39-S47. [PMID: 34569843 PMCID: PMC8575056 DOI: 10.1089/chi.2021.0175] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families who are disproportionately affected by obesity. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project (CORD 3.0), the Missouri team (MO-CORD) aims to increase access to and dissemination of an efficacious pediatric obesity treatment, specifically family-based behavioral treatment (FBT), for low-income families. Methods/Design: The implementation pilot study is a multisite matched-comparison group pilot of packaged FBT in pediatric clinics for low-income children with obesity, of ages 5 to 12 years old. The study is implemented in two Missouri pediatric primary care clinical sites, Freeman Health System Pediatric Clinics (rural Joplin) and Children's Mercy Hospital Pediatric Clinics (urban Kansas City). The design focuses on pragmatism through utilization of PRECIS (Pragmatic Explanatory Continuum Indicator Summary) domains, such as open eligibility criteria, limited follow-up intensity, reliance on medical records for creating a usual care comparison group data, and unobtrusive measurement of participant and provider adherence. The evaluation focuses on effectiveness as well as implementation outcomes and barriers to inform implementation scale up. Conclusions: Findings from this study will advance both science and practice by providing novel and immediately useful information to families, health care providers, health care organizations, payers, and other state Medicaid plans by developing and optimizing evidence-based pediatric weight management treatment for implementation and dissemination in health systems to address health disparities among low-income populations most affected by overweight and obesity.
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Affiliation(s)
- Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | - Sherri Gabbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Springstroh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Fanice Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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10
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Black WR, Borner KB, Beauchamp MT, Davis AM, Dreyer Gillette ML, Sweeney B, Hampl SE. Health-Related Quality of Life across Recent Pediatric Obesity Classification Recommendations. Children (Basel) 2021; 8:303. [PMID: 33921016 PMCID: PMC8071434 DOI: 10.3390/children8040303] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
Extreme body mass index (BMI) values (i.e., above the 97th and below the 3rd percentiles) are inaccurately represented on the Centers for Disease Control and Prevention's growth curves, which may limit the utility of BMI percentile and BMI z-score for capturing changes in clinical outcomes for patients at extreme weights. Modeling child obesity severity based upon the percentage of BMI in excess of the 95th percentile (BMI95pct) has been proposed as an improved metric to better capture variability in weight at extreme ends of growth curves, which may improve our understanding of relationships between weight status and changes in clinical outcomes. However, few studies have evaluated whether the use of BMI95pct would refine our understanding of differences in clinical psychosocial constructs compared to previous methods for categorization. This cross-sectional study evaluated child obesity severity based on BMI95pct to examine potential group differences in a validated, obesity-specific measure of Health-Related Quality of Life (HRQoL). Four hundred and sixty-five children with obesity completed Sizing Me Up, a self-report measure of HRQoL. Children were classified into categories based on BMI95pct (i.e., class I: ≥100% and <120%; class II: ≥120% and <140%; class III: ≥140%). The results indicate that children with class III obesity reported lower HRQoL than children with class I and class II obesity; however, there were no differences between Class II and Class I. In much of the previous literature, children with class II and class III obesity are often combined under the category "Severe Obesity" based upon BMI above the 99th percentile. This study suggests that grouping children from various classes together would neglect to capture critical differences in HRQoL. Future research including children with severe obesity should consider obesity classes to best account for functioning and clinical outcomes.
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Affiliation(s)
- William R. Black
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kelsey B. Borner
- Department of Psychology and Behavioral Health, Children’s National Hospital, Washington, DC 20010, USA;
| | - Marshall T. Beauchamp
- Department of Psychology, University of Missouri–Kansas City, Kansas City, MO 6110, USA;
| | - Ann M. Davis
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Meredith L. Dreyer Gillette
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Brooke Sweeney
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Sarah E. Hampl
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO 64108, USA; (A.M.D.); (M.L.D.G.); (B.S.); (S.E.H.)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
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Skelton JA, Woolford SJ, Skinner A, Barlow SE, Hampl SE, Lazorick S, Armstrong S. Weight Management without Stigma or Harm: A Roundtable Discussion with Childhood Obesity Experts. Child Obes 2021; 17:79-85. [PMID: 33728995 DOI: 10.1089/chi.2021.29010.roundtable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joseph A Skelton
- Professor, Department of Pediatrics, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Brenner FIT® (Families in Training), Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Susan J Woolford
- Associate Professor, Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Asheley Skinner
- Professor, Duke University Population Health Sciences, Durham, NC, USA
| | - Sarah E Barlow
- Professor of Pediatrics, Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Director of Children's Health Integrated Program in Childhood Obesity, Dallas, TX, USA
| | - Sarah E Hampl
- General Academic Pediatrics and Weight Management, Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.,Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Suzanne Lazorick
- Professor, Departments of Pediatrics and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Sarah Armstrong
- Professor of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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12
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Siegel RM, Haemer M, Kharofa RY, Christison AL, Hampl SE, Tinajero-Deck L, Lockhart MK, Reich S, Pont SJ, Stratbucker W, Robinson TN, Shaffer LA, Woolford SJ. Community Healthcare and Technology to Enhance Communication in Pediatric Obesity Care. Child Obes 2018; 14:453-460. [PMID: 29878851 PMCID: PMC6422001 DOI: 10.1089/chi.2017.0339] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Childhood obesity continues to be a critical healthcare issue and a paradigm of a pervasive chronic disease affecting even our youngest children. When considered within the context of the socioecological model, the factors that influence weight status, including the social determinants of health, limit the impact of multidisciplinary care that occurs solely within the medical setting. Coordinated care that incorporates communication between the healthcare and community sectors is necessary to more effectively prevent and treat obesity. In this article, the Expert Exchange authors, with input from providers convened at an international pediatric meeting, provide recommendations to address this critical issue. These recommendations draw upon examples from the management of other chronic conditions that might be applied to the treatment of obesity, such as the use of care plans and health assessment forms to allow weight management specialists and community personnel (e.g., school counselors) to communicate about treatment recommendations and responses. To facilitate communication across the healthcare and community sectors, practical considerations regarding the development and/or evaluation of communication tools are presented. In addition, the use of technology to enhance healthcare-community communication is explored as a means to decrease the barriers to collaboration and to create a web of connection between the community and healthcare providers that promote wellness and a healthy weight status.
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Affiliation(s)
- Robert M. Siegel
- Cincinnati Children's Hospital and Department of Pediatrics, Center for Better Health and Nutrition, University of Cincinnati College of Medicine, Cincinnati, OH.,Address correspondence to:Robert M. Siegel, MDCincinnati Children's Hospital and Department of PediatricsCenter for Better Health and NutritionUniversity of CincinnatiCollege of Medicine3333 Burnet AvenueCincinnati, OH 45229
| | - Matthew Haemer
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.,Obesity Treatment Program, Children's Hospital Colorado, Aurora, CO
| | - Roohi Y. Kharofa
- Division of General and Community Pediatrics, Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amy L. Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Sarah E. Hampl
- General Pediatrics and Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO
| | | | - Mary Kate Lockhart
- Department of Pediatrics, School of Medicine at SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO
| | - Sarah Reich
- Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Stephen J. Pont
- Texas Department of State Health Services, Office of Science and Population Health, Austin, TX
| | - William Stratbucker
- Helen DeVos Children's Hospital, Michigan State University, Grand Rapids, MI
| | - Thomas N. Robinson
- Division of General Pediatrics, Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital Stanford, Stanford, CA
| | - Laura A. Shaffer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
| | - Susan J. Woolford
- Department of Pediatrics, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI
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13
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Abstract
BACKGROUND Growth in the prevalence of severe pediatric obesity and tertiary care pediatric weight management programs supports the application of chronic disease management models to the care of children with severe obesity. One such model, the medical neighborhood, aims to optimize care coordination between primary and tertiary care by applying principles of the Patient-Centered Medical Home to all providers. METHODS An exploration of the literature was performed describing effective programs, approaches, and coordinated care models applied to pediatric weight management and other chronic conditions. RESULTS Though there was a paucity of literature discovered with applications specific to pediatric weight management, relevant disease management and care coordination approaches were found. Proposed applications to the care of children with severe obesity can be made. CONCLUSION The application of the medical neighborhood framework, with its inclusion of healthcare and community partners, may optimize the management of children with severe obesity.
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Affiliation(s)
- Amy L Christison
- 1 Department of Pediatrics, University of Illinois College of Medicine at Peoria , Peoria, IL
| | - Susma Vaidya
- 2 Department of Pediatrics, Children's National Medical Center , Washington, DC
| | | | - Sarah E Hampl
- 4 Department of Pediatrics, Children's Mercy Hospital , Kansas City, MO
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Rhodes ET, Boles RE, Chin K, Christison A, Testa EG, Guion K, Hawkins MJ, Petty CR, Sallinen Gaffka B, Santos M, Shaffer L, Tucker J, Hampl SE. Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition. Child Obes 2017; 13:120-127. [PMID: 28092464 PMCID: PMC5369386 DOI: 10.1089/chi.2016.0215] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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 Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition. PATIENTS AND METHODS A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months. RESULTS From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children <12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02). CONCLUSIONS Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01753063.
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Affiliation(s)
- Erinn T. Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | | | - Kimberly Chin
- Clinical Research Center, Boston Children's Hospital, Boston, MA
| | | | | | | | | | - Carter R. Petty
- Clinical Research Center, Boston Children's Hospital, Boston, MA
| | - Bethany Sallinen Gaffka
- Pediatric Comprehensive Weight Management Center, University of Michigan Health System, Ann Arbor, MI
| | | | | | - Jared Tucker
- Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Sarah E. Hampl
- Pediatrics and Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO
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Hampl SE, Borner KB, Dean KM, Papa AE, Cordts KP, Smith TR, Wade KR, Davis AM. Patient Attendance and Outcomes in a Structured Weight Management Program. J Pediatr 2016; 176:30-5. [PMID: 27289497 DOI: 10.1016/j.jpeds.2016.05.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 01/25/2016] [Revised: 04/15/2016] [Accepted: 05/10/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine service utilization and identify patient characteristics associated with service utilization in youth with obesity presenting for structured weight management, and to explore weight-related outcomes associated with service utilization. STUDY DESIGN In this retrospective study conducted between January 2008 and December 2013, we examined variables associated with the care of 2089 patients aged 2-18 years presenting for an initial visit to 2 tertiary care-based, multidisciplinary structured weight management clinics. RESULTS Only 53% of patients returned for a second visit, 29% returned for a third visit, and virtually none (0.5%) completed the recommended 6 visits within 6 months. Patients who were Hispanic, government-insured, and whose parent/s spoke Spanish were more likely to return to clinic. Of those patients who returned for at least a second visit, 70% demonstrated a reduction in or maintenance of body mass index z-score. CONCLUSIONS Patient retention remains a significant barrier to effective pediatric weight management. Structured weight management programs should increase their efforts to engage patients and families at the initial visit and identify and address barriers to follow up.
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Affiliation(s)
- Sarah E Hampl
- Division of General Pediatrics, Children's Mercy Hospital, Kansas City, MO; Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO.
| | - Kelsey B Borner
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO; Clinical Child Psychology Program, University of Kansas, Lawrence, KS
| | - Kelsey M Dean
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO
| | - Amy E Papa
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO
| | | | - T Ryan Smith
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Kerri R Wade
- Division of General Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO; Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
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Dreyer Gillette ML, Odar Stough C, Best CM, Beck AR, Hampl SE. Comparison of a condensed 12-week version and a 24-week version of a family-based pediatric weight management program. Child Obes 2014; 10:375-82. [PMID: 25260025 DOI: 10.1089/chi.2014.0037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 11/13/2022]
Abstract
BACKGROUND The current study compares the effectiveness of a condensed 12-week version and a 24-week version of the same pediatric behavioral weight management program. METHODS Children (n=162) between the ages of 8 and 18 years (baseline BMIz=2.39; standard deviation=0.29) were randomized to either a 12- or 24-week version of the same behavioral weight management program. Child anthropometric data were recorded at baseline, 6 weeks, 12 weeks, 24 weeks, and 12 months. A two-level longitudinal model was used to examine within- and between-group differences in BMIz change over time. RESULTS A significant group-by-time interaction was found (β=-0.01; standard error, <0.01; p<0.01) with the 24-week group showing greater reductions in BMIz. Children in the 24-week group showed significant BMIz reductions over time (z=-5.18; p<0.01), but children in the 12-week group did not (z=-0.85; p=0.39). CONCLUSIONS Children in the 24-week program demonstrated greater reductions in BMIz than children in the 12-week group. Therefore, there may be additional benefit to sessions above and beyond the 8- to 12-week minimum suggested for pediatric weight management programs.
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Affiliation(s)
- Meredith L Dreyer Gillette
- 1 Department of Pediatrics, Developmental and Behavioral Sciences, Children's Mercy Kansas City , Kansas City, MO
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Hampl SE, Davis AM, Sampilo ML, Stephens KL, Dean K. Insurer and employer views on pediatric obesity treatment: a qualitative study. Obesity (Silver Spring) 2013; 21:795-9. [PMID: 23712982 PMCID: PMC4152225 DOI: 10.1002/oby.20112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/25/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The effectiveness of group-based comprehensive, multidisciplinary (stage 3) pediatric weight management programs is backed by a growing body of literature, yet insurance coverage of these programs is scarce to nonexistent, limiting their reach and long-term survival. The objective of this study was to better understand the perspectives of insurers and large employers on the issue of group-based treatment coverage. DESIGN AND METHODS The authors performed a qualitative study utilizing structured interviews with these stakeholders, following accepted techniques. RESULTS Six major themes emerged: cost, program effectiveness, corporate social responsibility, secondary parental (employee) benefits, coverage options and new benefit determination. CONCLUSION Future efforts to secure payment for group-based pediatric weight management programs should address these key themes.
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Affiliation(s)
- S E Hampl
- Department of General Pediatrics, Children's Mercy Hospitals and Clinics/University of MO-Kansas City School of Medicine, Kansas City, Missouri, USA.
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Abstract
BACKGROUND This study examined physician experience with the 2007 Expert Committee Recommendations (ECR) on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity. METHODS Pediatricians and family physicians (n = 194) practicing in the Midwest completed a survey designed to assess knowledge of, adherence to, and self-efficacy in implementing the 2007 Expert Committee recommendations. RESULTS The majority of physicians (71%) were aware of the ECR and adhered to approximately 60% of the recommendations. Adherence was significantly higher for physicians who were aware of the ECR. Differences in awareness of and adherence to the ECR were noted among physician groups by specialty and location. Self-efficacy for assessing and treating pediatric obesity was significantly positively correlated with adherence to the ECR (Pearson r = 0.46). When asked for strategies that would facilitate improved pediatric weight management, physicians most often reported desiring to learn effective methods to increase patient motivation. CONCLUSIONS Efforts to improve adherence to the Expert Committee recommendations should focus on improving physician awareness of and training in the use of the recommendations and on improved training and development of self-efficacy in pediatric weight assessment and patient counseling skills.
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Affiliation(s)
- Paula J Harkins
- University of Missouri-Kansas City, Department of Psychology, USA
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Affiliation(s)
- Sarah E Hampl
- Weight Management, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Abstract
OBJECTIVES To compare health care utilization and expenditures for healthy-weight patients, overweight patients, and patients with diagnosed and undiagnosed obesity and to examine factors associated with a diagnosis of obesity. DESIGN Retrospective study using claims data from a large pediatric integrated delivery system. SETTING An urban academic children's hospital. PARTICIPANTS Children aged 5 to 18 years who presented to a primary care clinic for well-child care visits during the calendar years 2002 and 2003 and who were followed up for 12 months. MAIN OUTCOME MEASURES Diagnosis of obesity, primary care visits, emergency department visits, laboratory use, and health care charges. RESULTS Of 8404 patients, 57.9% were 10 years or older, 61.2% were African American, and 72.9% were insured by Medicaid. According to the criteria of body mass index (calculated as weight in kilograms divided by the square of height in meters), 17.8% were overweight and 21.9% were obese. Of the obese children, 42.9% had a diagnosis of obesity. Increased laboratory use was found in both children with diagnosed obesity (odds ratio [OR], 5.49; 95% confidence interval [CI], 4.65-6.48) and children with undiagnosed obesity (OR, 2.32; 95% CI, 1.97-2.74), relative to the healthy-weight group. Health care expenditures were significantly higher for children with diagnosed obesity (adjusted mean difference, $172; 95% CI, $138-$206) vs the healthy-weight group. Factors associated with the diagnosis of obesity were age 10 years and older (OR, 2.7; 95% CI, 2.0-3.4), female sex (OR, 1.5; 95% CI, 1.2-1.8), and having Medicaid (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSIONS Increased health care utilization and charges reported in obese adults are also present in obese children. Most children with obesity had not been diagnosed as having obesity in this administrative data set.
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Affiliation(s)
- Sarah E Hampl
- Department of General Pediatrics, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
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