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Hill AJ, Pruckner DGJ, Schober T. Childhood Obesity and Health Care Utilization: Empirical Evidence from Austrian Administrative Data. Child Obes 2023; 19:391-398. [PMID: 36103290 DOI: 10.1089/chi.2022.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Increases in pediatric obesity have been associated with higher levels of health care utilization. There is currently a lack of knowledge on the therapeutic drivers of increased health care use. Objective: To examine the association between different measures of health care utilization and BMI among children. Methods: We linked cross-sectional administrative data from a regional health insurance fund in Austria with objectively measured BMI from routine school health examinations in 6-15-year-old children (n = 13,493). Differences in probabilities of annual health care utilization (drug prescriptions by therapeutic classification, physician visits by medical specialty, and hospitalizations) were compared between children with normal weight, overweight, or obesity using Probit regressions. Results: Children with obesity had a 1.6 and 8.6 percentage points (pp) higher probability of outpatient doctor visits and prescribed medication, respectively (all p < 0.05). Children with overweight were intermediate. There was a higher probability of consulting a general practitioner, pediatrician, or orthopedist, and higher levels of prescribing for children with obesity across most common drug groups. Children with obesity were ∼40% more likely to receive medication for musculoskeletal and for mental health problems. This was reflected in orthopedic clinic appointments but not in psychology clinics. There were no major differences by gender or age, or parental socioeconomic status. Conclusions: Our data show clear and objective evidence of higher health care utilization by children with obesity. This highlights the importance of policy interventions to curb obesity in children and young people.
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Affiliation(s)
- Andrew J Hill
- Institute of Health Sciences, University of Leeds School of Medicine, Leeds, United Kingdom
| | - Dr Gerald J Pruckner
- Department of Economics, Johannes Kepler University Linz, Linz, Austria
- Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schober
- Department of Economics, Johannes Kepler University Linz, Linz, Austria
- Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
- New Zealand Work Research Institute, Auckland University of Technology, Auckland, New Zealand
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2
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Woolford SJ, Resnicow K, Davis MM, Nichols LP, Wasserman RC, Harris D, Gebremariam A, Shone L, Fiks AG, Chang T. Cost-effectiveness of a motivational interviewing obesity intervention versus usual care in pediatric primary care offices. Obesity (Silver Spring) 2022; 30:2265-2274. [PMID: 36321279 PMCID: PMC9828545 DOI: 10.1002/oby.23560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to assess the incremental cost-effectiveness ratio (ICER) of a 2-year motivational interviewing (MI) intervention versus usual primary care. METHODS A national trial was implemented in the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics to evaluate MI versus usual care for children (2-8 years old; baseline BMI 85th-97th percentiles). Health care use, food costs, provider fees, and training costs were assessed, and sensitivity analyses were conducted. Primary outcome was the ICER, calculated as cost per unit change in BMI percentile for intervention versus usual care. RESULTS At 2 years, 72% of enrolled parent/child dyads were retained; 312 children were included in the analysis. Mean BMI percentile point change was -4.9 and -1.8 for the intervention and control, respectively, yielding an incremental reduction of 3.1 BMI percentile points (95% CI: 1.2-5.0). The intervention cost $1051 per dyad ($658 for training DVD development). Incorporating health care and non-health care costs, the intervention ICER was $363 (range from sensitivity analyses: cost saving, $3159) per BMI percentile point decrease per participant over 2 years. CONCLUSIONS Training pediatricians, nurse practitioners, and registered dietitians to deliver MI-based interventions for childhood obesity in primary care is clinically effective and acceptably cost-effective. Future work should explore this approach in broader dissemination.
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Affiliation(s)
- Susan J. Woolford
- University of MichiganAnn ArborMichiganUSA
- Susan B. Meister Child Health Evaluation and Research CenterAnn ArborMichiganUSA
| | | | - Matthew M. Davis
- Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | | | | | | | - Achamyeleh Gebremariam
- University of MichiganAnn ArborMichiganUSA
- Susan B. Meister Child Health Evaluation and Research CenterAnn ArborMichiganUSA
| | - Laura Shone
- American Academy of PediatricsItascaIllinoisUSA
| | | | - Tammy Chang
- University of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
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3
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Kyler KE, Hall M, Bettenhausen JL, Clark NA, Hampl S, Davis AM. Medicaid Expenditures among Children with Documented Obesity. Child Obes 2022; 19:160-168. [PMID: 35666560 DOI: 10.1089/chi.2021.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Obesity rates continue to rise among children, but knowledge regarding medical expenditures of Medicaid enrollees with documented obesity is lacking. We aim to describe Medicaid expenditure patterns among children with documented obesity and determine the degree to which specific clinical characteristics and conditions contribute to high expenditures. Methods: We performed a retrospective cross-sectional analysis of children aged 2-17 years with a diagnosis code of obesity continuously enrolled in the 2017 Medicaid MarketScan database. Children were grouped based on annual expenditure percentiles: <80th, 80 to <95th, 95 to <99th, and ≥99th. Inpatient, outpatient, and pharmacy expenditures were analyzed. Covariates included demographics, common obesity comorbid conditions (e.g., hypertension), complex chronic conditions (CCCs), and mental health conditions (MHCs). Logistic regression assessed demographic and clinical characteristics associated with high-spending groups (≥95th%). Results: We identified 300,286 children with a diagnosis of obesity. The 1% of children with the highest spending accounted for 25.4% of annual expenditures among children with documented obesity. Annual expenditures in the highest spending groups were driven primarily by inpatient and outpatient mental health services. Characteristics associated with high-spending groups included the following: age 12-17 years, obesity comorbid conditions, and having ≥1 CCC or MHC. These associations increased with increasing number of CCCs or MHCs. Conclusions: Inpatient and outpatient mental health expenditures made up a large proportion of spending among Medicaid-enrolled children with documented obesity. Important drivers of cost in this population were medical complexity and comorbid MHCs. Future research is needed to determine if some of these costs are avoidable in children with obesity.
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Affiliation(s)
- Kathryn E Kyler
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Matt Hall
- Children's Mercy Kansas City, Kansas City, MO, USA.,Children's Hospital Association, Lenexa, KS, USA
| | - Jessica L Bettenhausen
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nicholas A Clark
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sarah Hampl
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
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4
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Torres W, de Moraes Chagas LG, Fernandes RA, Araujo MYC, Urban JB, Maillane-Vanegas S, Turi-Lynch BC, Codogno JS, Anokye NK. Relationship between vigorous physical activity and health care costs among adolescents: ABCD Growth Study. BMC Pediatr 2022; 22:141. [PMID: 35300655 PMCID: PMC8927523 DOI: 10.1186/s12887-022-03201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between physical activity and health care costs among adolescents is not yet clear in the literature. Objective To analyze the relationship between physical activity and annual health care costs among adolescents. Methods The present sample was composed of 85 adolescents of both sexes with ages ranging from 11 to 18 years (mean age 15.6 ± 2.1). Health care costs were self-reported every month for 12 months, and information on health care values was verified with local pharmacies, private health care plans, and the National Health Service. The time spent in different physical activity intensities was objectively measured by accelerometers. Confounding variables were: sex, age, somatic maturation, body fatness, blood pressure, and components of dyslipidemia and insulin resistance. Multivariate models were generated using generalized linear models with gamma distribution and a log-link function. Results The overall annual health care cost was US$ 733.60/ R$ 2,342.38 (medication: US$ 400.46 / R$ 1,278.66; primary and secondary care: US$ 333.14 / R$ 1,063.70). The time spent in vigorous physical activity (minutes/day) was negatively related to health care costs (r = -0.342 [95% CI: -0.537,—0.139]; β = -0.06 cents (95% CI: -0.089, -0.031). Conclusion Vigorous physical activity seems to be associated with lower health care costs among adolescents.
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Affiliation(s)
- Wésley Torres
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil.
| | - Lucas Gabriel de Moraes Chagas
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil
| | - Rômulo Araújo Fernandes
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil
| | - Monique Yndawe Castanho Araujo
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil
| | - Jacqueline Bexiga Urban
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil
| | - Santiago Maillane-Vanegas
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil
| | - Bruna Camilo Turi-Lynch
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil.,Department of Physical Education & Exercise Science, Lander University, Greenwood, USA
| | - Jamile Sanches Codogno
- Department of Physical Education, Laboratory of InVestigation in Exercise - LIVE, São Paulo State University (UNESP), Roberto Simonsen Street, 305, Presidente Prudente, São Paulo, Brazil
| | - Nana Kwame Anokye
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
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Rhee KE, Herrera L, Strong D, DeBenedetto AM, Shi Y, Boutelle KN. Design of the GOT Doc study: A randomized controlled trial comparing a Guided Self-Help obesity treatment program for childhood obesity in the primary care setting to traditional family-based behavioral weight loss. Contemp Clin Trials Commun 2021; 22:100771. [PMID: 33997462 PMCID: PMC8095104 DOI: 10.1016/j.conctc.2021.100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity. Effective childhood obesity treatment is not widely available or easily accessible. Guided Self-Help (GSH) model of treatment has been developed for pediatric obesity. GSH is easier to implement and can be delivered in the primary care setting. GSH can increase access to much needed treatment. Evaluation of its effectiveness in the primary care setting is needed.
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Key Words
- Childhood obesity
- Community-based intervention
- Early and Periodic Screening, Diagnosis, and Treatment program, EPSDT
- Electronic health record, EHR
- Family-Based Behavioral Therapy, FBT
- Family-based behavioral therapy
- Guided Self-Help, GSH
- Guided self-help
- Guided self-help Obesity Treatment in the primary care setting, GOT Doc
- Overweight or obesity, OW/OB
- Primary care
- Primary care provider, PCP
- Quality of Lifev, QOL
- Treatment
- U.S. Preventive Services Task Force, USPSTF
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Affiliation(s)
- Kyung E Rhee
- University of California, San Diego, Department of Pediatrics, United States
| | - Lourdes Herrera
- University of California, San Diego, Department of Pediatrics, United States.,Wake Forrest University, Department of Pediatrics, United States
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | | | - Yuyan Shi
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Kerri N Boutelle
- University of California, San Diego, Department of Pediatrics, Department of Family Medicine and Public Health, And Department of Psychiatry, United States
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6
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Boutelle KN, Strong D, Liang J, Rhee KE, Rock CL, Wilfley D, Epstein L, Crow SJ. Comparative Costs of a Parent-Only and Parent and Child Treatment for Children with Overweight or Obesity. Obesity (Silver Spring) 2021; 29:388-392. [PMID: 33491321 PMCID: PMC9261273 DOI: 10.1002/oby.23069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Models such as family-based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent-based treatment (PBT; or parent-only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models. METHODS A total of 150 children with overweight and obesity and their parents were randomized to one of two 6-month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial-based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective. RESULTS Results suggest that PBT, compared with FBT, had lower costs per parent-child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279). CONCLUSIONS These findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
- Department of Psychiatry, UC San Diego, San Diego, California, USA
| | - David Strong
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - June Liang
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - Denise Wilfley
- Departent of Psychiatry, Washington University St Louis, St Louis, Missouri, USA
| | - Leonard Epstein
- Department of Pediatrics, University of Buffalo, Buffalo, New York, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
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7
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Medehouenou TCM, Roy C, Tremblay PY, St-Jean A, Meziou S, Muckle G, Ayotte P, Lucas M. Metabolic features of adiposity and glucose homoeostasis among school-aged inuit children from Nunavik (Northern Quebec, Canada). Int J Circumpolar Health 2021; 80:1858605. [PMID: 33395372 PMCID: PMC7801047 DOI: 10.1080/22423982.2020.1858605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In contrast to most Indigenous people in Canada, Inuit appeared until recently to have been protected from type 2 diabetes (T2D) related to obesity. We assessed the associations of metabolites (amino acids, acylcarnitines) with adiposity and biomarkers of T2D in school-aged Inuit children of Nunavik (Canada). Concentrations of metabolite were measured in plasma samples from a cross-sectional analysis of 248 children (mean age = 10.8 years). We assessed associations of plasma metabolites with adiposity measures (BMI, skinfold thicknesses) and T2D markers (insulin, glucose, adiponectin). Plasma concentrations of valine and tyrosine were higher in obese and overweight children compared to those of normal weight children (P < 0.05). An increment of 1-SD in BMI (SD = 3.3 kg/m2) was statistically associated with an increment of 0.21 (95% CI: 0.08, 0.33) for valine, 0.15 (95% CI: 0.02, 0.27) for isoleucine and 0.17 (95% CI: 0.04, 0.29) for tyrosine. Insulin concentration increased with concentrations of all amino acids (P < 0.05) except methionine. None of the acylcarnitines measured were statistically significantly associated with adiposity or T2D biomarkers A signature of metabolites, particularly higher levels of branched-chain amino acids, might allow for early detection of T2D among school-aged Inuit children.
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Affiliation(s)
- Thierry Comlan Marc Medehouenou
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada
| | - Cynthia Roy
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada.,Centre de Toxicologie du Québec, INSPQ , Québec, Quebec, Canada
| | - Pierre-Yves Tremblay
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada.,Centre de Toxicologie du Québec, INSPQ , Québec, Quebec, Canada
| | - Audray St-Jean
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada
| | - Salma Meziou
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada
| | - Gina Muckle
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada.,School of Psychology, Université Laval , Québec, Quebec, Canada
| | - Pierre Ayotte
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada.,Centre de Toxicologie du Québec, INSPQ , Québec, Quebec, Canada.,Department of Social and Preventive Medicine, Université Laval , Québec, Quebec, Canada
| | - Michel Lucas
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval , Québec, Quebec, Canada.,Department of Social and Preventive Medicine, Université Laval , Québec, Quebec, Canada
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8
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Schroeder K, Day S, Konty K, Dumenci L, Lipman T. The impact of change in neighborhood poverty on BMI trajectory of 37,544 New York City youth: a longitudinal study. BMC Public Health 2020; 20:1676. [PMID: 33167949 PMCID: PMC7653753 DOI: 10.1186/s12889-020-09772-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neighborhood poverty may increase childhood obesity risk. However, evidence for the neighborhood poverty-obesity relationship is limited. The purpose of this study was to examine how moving to a higher or lower poverty neighborhood impacts body mass index (BMI) z-score trajectories among youth, with the goal of informing policy change, interventions, and clinical practices to reduce childhood obesity. METHODS Methods entailed secondary analysis of existing longitudinal data. The sample included youth attending New York City public schools in grades kindergarten through twelfth from school years 2006/2007 through 2016/2017. Eligibility criteria included moving to a higher or lower poverty neighborhood during the data midpoint [school years 2010/2011 through 2013/2014] of the 12-year data-period; New York City-specific metrics were used to define both neighborhood (Neighborhood Tabulation Area) and relevant neighborhood poverty levels (< 5, 5 to < 10%, 10 to < 20%, 20 to < 30%, 30 to < 40% and ≥ 40% of individuals below Federal Poverty Level). Two-piece latent growth curve models were used to describe BMI z-score trajectories of youth who moved to higher versus lower poverty neighborhoods, with propensity score weighting to account for preexisting differences between the two groups. Primary analyses were stratified by sex and exploratory subgroup analyses were stratified by sex and developmental stage (early childhood, middle childhood, and adolescence) to explore sensitive periods for neighborhood poverty exposure. RESULTS Of 532,513 youth with home address data, 18,370 youth moved to a higher poverty neighborhood and 19,174 moved to a lower poverty neighborhood (n = 37,544). Females and males who moved to a higher poverty neighborhood experienced less favorable BMI z-score trajectories for obesity risk, though effects were small. Exploratory subgroup analyses demonstrated that negative effects of neighborhood poverty were most pronounced among young and adolescent females and young males, whereas effects were mixed for other subgroups. CONCLUSIONS Youth who moved to higher poverty neighborhoods experienced less favorable BMI z-score trajectories for obesity risk, though effects were small and most consistent for females and younger youth. Additional research is needed to illuminate neighborhood poverty's impact on obesity, in order to inform policy, intervention, clinical, and research efforts to reduce obesity and improve child well-being.
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Affiliation(s)
- Krista Schroeder
- Temple University College of Public Health, 1101 West Montgomery Avenue, Philadelphia, PA 19122 USA
| | - Sophia Day
- New York City Department of Health and Mental Hygiene, Office of School Health, 42-09 28th Street, 14th floor, Long Island City, NY 11101 USA
| | - Kevin Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, 42-09 28th Street, 14th floor, Long Island City, NY 11101 USA
| | - Levent Dumenci
- Temple University College of Public Health, 1101 West Montgomery Avenue, Philadelphia, PA 19122 USA
| | - Terri Lipman
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19140 USA
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9
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Carsley S, Pope E, Tu K, Parkin PC, Toulany A, Birken CS. Association between Weight Status and Mental Health Service Utilization in Children and Adolescents. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2020; 29:229-240. [PMID: 33184567 PMCID: PMC7595256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous literature reports inconsistent associations between obesity and mental health. The objective of this study was to determine the association between weight status and mental health service utilization in Ontario children and youth. METHODS A cross-sectional study of children 0 to 18 years, identified using primary care electronic medical records from the EMRPC database in Ontario, Canada was conducted. Height and weight data were extracted to calculate BMI and linked to administrative data on mental health related outpatient visits, emergency department visits, and hospitalizations. Multivariable logistic regression models were performed. RESULTS A total of 50,565 children were included. Overall, 2.2% were underweight, 70.4% had a normal weight, 18.3% were overweight, 6.9% had obesity and 2.2% had severe obesity. 28.2% of all children had at least one mental health visit. Multivariable analyses showed children with overweight, obesity, and severe obesity were 1.11 (95% CI 1.05-1.17), 1.18 (95% CI 1.08-1.27) and 1.39 (95% CI 1.22-1.59) times more likely to have an outpatient mental health visit compared to children with normal weight. CONCLUSION Increased weight status was associated with mental health related outpatient visits and emergency department visits. This study may inform policy makers' planning of mental health resources for children with obesity and severe obesity.
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Affiliation(s)
- Sarah Carsley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- ICES, Toronto, Ontario
| | - Eliza Pope
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario
| | - Patricia C Parkin
- Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, the Hospital for Sick Children; Pediatric Outcomes Research Team (PORT), Division of Paediatric Medicine, the Hospital for Sick Children, Toronto, Ontario
- Department of Pediatric Medicine, University of Toronto, Toronto, Ontario
| | - Alene Toulany
- ICES, Toronto, Ontario
- Department of Pediatric Medicine, University of Toronto, Toronto, Ontario
| | - Catherine S Birken
- Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, the Hospital for Sick Children; Pediatric Outcomes Research Team (PORT), Division of Paediatric Medicine, the Hospital for Sick Children, Toronto, Ontario
- Department of Pediatric Medicine, University of Toronto, Toronto, Ontario
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Abstract
OBJECTIVE This systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood. DATA SOURCES PubMed, MEDLINE, CINAHL, EMBASE and Web of Science. METHODS Observational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies. OUTCOME MEASURES Included studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay. RESULTS Thirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children. CONCLUSIONS Obesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity. PROSPERO REGISTRATION NUMBER CRD42018091752.
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Affiliation(s)
- Taimoor Hasan
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Tom S Ainscough
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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11
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Galai T, Moran-Lev H, Cohen S, Ben-Tov A, Levy D, Weintraub Y, Amir A, Segev O, Yerushalmy-Feler A. Higher prevalence of obesity among children with functional abdominal pain disorders. BMC Pediatr 2020; 20:193. [PMID: 32375714 PMCID: PMC7201594 DOI: 10.1186/s12887-020-02106-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/28/2020] [Indexed: 02/08/2023] Open
Abstract
Background Functional abdominal pain (FAP) disorders are one of the most common gastrointestinal disorders in children. We aimed to define the association between obesity and functional abdominal pain (FAP) disorders and to assess differences between overweight/obese children and normal weight children with FAP disorders. Methods We conducted a retrospective study of children (2–18 years old) with a clinical diagnosis of FAP who were followed-up in our pediatric gastroenterology unit between 1/2016–10/2018. FAP disorders were defined according to the ROME IV criteria. Body mass index (BMI) percentiles were defined by CDC standards. Patients with BMIs ≥85th percentile were designated as being overweight/obese. A population control group was obtained from the 2015–2016 Israel national health survey. Results Data from 173 children with FAP disorders (median age 11.5 years, 114 females) were included. Seventy-one children (41%) were classified as having functional abdominal pain-NOS, 67 (38.7%) as having irritable bowel syndrome (IBS), and 35 (20.2%) has having functional dyspepsia. Fifty-three children (30.6%) were classified as being overweight/obese. Adolescents with FAP disorders had a significantly higher prevalence of overweight/obesity compared to controls (39.5% vs. 30%, respectively, p = 0.04). Children with FAP and overweight were older [12.4 (range 9.8–15.3) vs. 10.8 (7.4–14.1) years, p = 0.04] and had more hospitalizations due to FAP (20.8% vs. 7.6%, p = 0.01) compared to Children with FAP and normal weight. Conclusions Adolescents with FAP had higher prevalence of overweight/obesity compared to controls. Future studies are warranted to raise awareness of weight issues in FAP and determine the effect of weight loss on FAP.
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Affiliation(s)
- Tut Galai
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Hadar Moran-Lev
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
| | - Amir Ben-Tov
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Dina Levy
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Yael Weintraub
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Achiya Amir
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Or Segev
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
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12
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Kovalerchik O, Powers E, Holland ML, Sharifi M, Langhan ML. Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index. Acad Pediatr 2020; 20:532-539. [PMID: 31904438 DOI: 10.1016/j.acap.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/25/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. METHODS A retrospective study was conducted using 1 year of electronic health records following an index primary care visit for children 3 to 17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates. RESULTS Of those with biologically plausible values for height and weight (n = 30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity. CONCLUSIONS Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.
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Affiliation(s)
- Olga Kovalerchik
- Department of Emergency Medicine, Yale University School of Medicine (O Kovalerchik and ML Langhan), New Haven, Conn.
| | - Emily Powers
- Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine (E Powers and ML Langhan), New Haven, Conn; Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine (E Powers and M Sharifi), New Haven, Conn
| | | | - Mona Sharifi
- Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine (E Powers and M Sharifi), New Haven, Conn
| | - Melissa L Langhan
- Department of Emergency Medicine, Yale University School of Medicine (O Kovalerchik and ML Langhan), New Haven, Conn; Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine (E Powers and ML Langhan), New Haven, Conn
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13
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Challenges of pediatric obesity in perioperative care. Int Anesthesiol Clin 2020; 58:9-13. [PMID: 32282576 DOI: 10.1097/aia.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Ortiz-Pinto MA, Ortiz-Marrón H, Esteban-Vasallo MD, Quadrado-Mercadal A, Casanova-Pardomo D, González-Alcón M, Ordobás-Gavin M, Galán I. Demand for health services and drug prescriptions among overweight or obese preschool children. Arch Dis Child 2020; 105:292-297. [PMID: 31434642 DOI: 10.1136/archdischild-2019-316895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the association between excess weight and the demand of health services in preschool children compared with healthy weight. METHODS The data come from the Longitudinal Study of Childhood Obesity cohort (1884 4-year-old children, residing in the Madrid region, Spain) who provided information through telephone questionnaire, physical examination and electronic medical records. We defined overweight, general and abdominal obesity based on body mass index, waist circumference and waist-to-height ratio. Using mixed models of multivariable negative binomial regression we calculated the incidence rate ratio (IRR) regarding primary care (PC) doctor visits, drug prescriptions and hospital admissions by weight status at the end of the 2-year follow-up. RESULTS Childhood general obesity was associated with a higher demand for PC services related to psychological problems (IRR=1.53; 95% CI 1.02 to 2.28) and childhood abdominal obesity, according to waist-to-height ratio, was related to more frequent problems of the musculoskeletal system (IRR=1.27; 95% CI 1.00 to 1.62). Drugs were prescribed more frequently to children falling under all three definitions of excess weight, compared with healthy weight children. No differences in the number of hospital admissions were observed. CONCLUSIONS The demand of health services related to early childhood obesity was small. Nevertheless, obesity was associated with a slightly greater demand for drug prescriptions and for PC doctor visits related to psychological and musculoskeletal problems.
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Affiliation(s)
- Maira Alejandra Ortiz-Pinto
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.,Departmento de Medicina Preventiva y Salud Pública, Universidad Autonoma de Madrid/IdiPAZ, Madrid, Spain.,Universidad del Norte, Barranquilla, Colombia
| | | | | | | | | | | | | | - Iñaki Galán
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain .,Departmento de Medicina Preventiva y Salud Pública, Universidad Autonoma de Madrid/IdiPAZ, Madrid, Spain
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15
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Kyler KE, Bettenhausen JL, Hall M, Hampl S. Prevalence and Trends in Obesity Among Hospitalized Children. Hosp Pediatr 2019; 9:897-902. [PMID: 31645359 DOI: 10.1542/hpeds.2019-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES As obesity rates rise in children, it is likely that the number of hospitalized children with obesity is also increasing. However, characterization of the inpatient population with obesity as a whole has not been reported. We aimed to examine trends in the annual prevalence of obesity in hospitalized children and to identify demographic and clinical characteristics associated with higher obesity prevalence in children who are hospitalized. METHODS We completed a retrospective cohort analysis of children aged 2 to 19 years admitted to a single tertiary children's hospital system for any reason in 2009-2016. Body mass index was calculated from documented height and weight. Children with obesity were defined by using age- and sex-specific body mass index percentile guidelines established by the Centers for Disease Control and Prevention. Annual obesity prevalence was calculated on the encounter level for service line and All Patients Refined Diagnosis-Related Groups (diagnosis groups). χ2 tests were used to determine statistical differences between groups, and the Cochran-Armitage test of trend was used to describe changes in obesity over time. RESULTS Of 83 329 children who were hospitalized, 17.0% had obesity, increasing from 16.5% of hospitalizations in 2009-2010 to 17.3% in 2015-2016 (P = .002). Service lines with the highest obesity prevalence included orthopedics (22.1%), infectious disease (20.6%), and neuroscience (18.7%). Diagnosis groups with the highest obesity prevalence included cellulitis (22.5%), tonsil/adenoid procedures (22.0%), and some orthopedic procedures (28.7%). CONCLUSIONS Some groups of children who were hospitalized experience higher obesity prevalence, including children hospitalized with orthopedic, infectious disease, and neurologic problems. In future research, investigators should target disproportionately affected groups by examining health outcomes, patient safety, and satisfaction issues.
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Affiliation(s)
| | | | - Matthew Hall
- Division of Hospital Medicine and
- Children's Hospital Association, Lenexa, Kansas
| | - Sarah Hampl
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri; and
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16
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Griffiths LJ, Cortina‐Borja M, Bandyopadhyay A, Tingay K, De Stavola BL, Bedford H, Akbari A, Firman N, Lyons RA, Dezateux C. Are children with clinical obesity at increased risk of inpatient hospital admissions? An analysis using linked electronic health records in the UK millennium cohort study. Pediatr Obes 2019; 14:e12505. [PMID: 30659777 PMCID: PMC6563186 DOI: 10.1111/ijpo.12505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have examined health service utilization of children with overweight or obesity by using linked electronic health records (EHRs). OBJECTIVE/METHODS We analysed EHRs from 3269 children (1678 boys; 51.3% [weighted]) participating in the Millennium Cohort Study, living in Wales or Scotland at age seven whose parents consented to record linkage. We used height and weight measurements at age five to categorize children as obese (>98th centile) or overweight (>91st centile) (UK1990 clinical reference standards) and linked to hospital admissions, up to age 14 years, in the Patient Episode Database for Wales and Scottish Morbidity Records. Negative binomial regression models compared rates of inpatient admissions by weight status at age five. RESULTS At age five, 11.5% and 6.7% of children were overweight or obese, respectively; 1221 (38%) children were subsequently admitted to hospital at least once. Admissions were not increased among children with overweight or obesity (adjusted rate ratio [RR], 95% confidence interval [CI]: 0.87, 0.68-1.10 and 1.16, 0.87-1.54, respectively). CONCLUSIONS In this nationally representative cohort of children in Wales and Scotland, those with overweight or obesity at entry to primary school did not have increased rates of hospital admissions in later childhood and early adolescence.
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Affiliation(s)
- Lucy J. Griffiths
- Health Data Research UK, Wales and Northern IrelandSwansea University Medical SchoolSwanseaUK
- Life Course Epidemiology and BiostatisticsUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Mario Cortina‐Borja
- Clinical Epidemiology, Nutrition and BiostatisticsUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing ResearchSwansea University Medical SchoolSwanseaUK
| | - Karen Tingay
- Administrative Data Research Centre WalesSwansea University Medical SchoolSwanseaUK
| | - Bianca L. De Stavola
- Clinical Epidemiology, Nutrition and BiostatisticsUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Helen Bedford
- Life Course Epidemiology and BiostatisticsUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Ashley Akbari
- Health Data Research UK, Wales and Northern IrelandSwansea University Medical SchoolSwanseaUK
- Administrative Data Research Centre WalesSwansea University Medical SchoolSwanseaUK
| | - Nicola Firman
- Life Course Epidemiology and BiostatisticsUCL Great Ormond Street Institute of Child HealthLondonUK
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Ronan A. Lyons
- Health Data Research UK, Wales and Northern IrelandSwansea University Medical SchoolSwanseaUK
- National Centre for Population Health and Wellbeing ResearchSwansea University Medical SchoolSwanseaUK
| | - Carol Dezateux
- Life Course Epidemiology and BiostatisticsUCL Great Ormond Street Institute of Child HealthLondonUK
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
- Health Data Research UK LondonQueen Mary University LondonLondonUK
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17
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Spanish collaborative study: Description of usual clinical practice in infant obesity. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Wilfley DE, Saelens BE, Stein RI, Best JR, Kolko RP, Schechtman KB, Wallendorf M, Welch RR, Perri MG, Epstein LH. Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity: A Multisite Randomized Clinical Trial. JAMA Pediatr 2017; 171:1151-1159. [PMID: 29084318 PMCID: PMC6169780 DOI: 10.1001/jamapediatrics.2017.2960] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Elucidation of optimal dosing and treatment content is critical for health care providers, payers, and policy makers, as well as mechanisms of change to inform intervention delivery and training initiatives for childhood obesity. OBJECTIVES To evaluate effects, following a 4-month family-based behavioral weight loss treatment (FBT), of 2 doses (HIGH or LOW) of a weight-control intervention (enhanced social facilitation maintenance [SFM+]) vs a weight-control education condition (CONTROL; matched for dose with LOW), on child anthropometrics, and to explore putative mediators of weight loss outcomes. DESIGN, SETTING, AND PARTICIPANTS For this parallel-group randomized clinical trial conducted at 2 US academic medical centers from December 2009 to March 2013, 172 parent-child dyads completed FBT and were then randomized to 8 months of SFM+ (HIGH, n = 59; LOW, n = 56) or CONTROL (n = 57). Children (aged 7-11 years) with overweight and obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] ≥85th percentile) with at least 1 parent with overweight and obesity (BMI ≥25) were recruited. INTERVENTIONS HIGH SFM+ vs LOW SFM+ (CONTROL matched the dose of LOW). MAIN OUTCOMES AND MEASURES Intention-to-treat analysis using mixed-effects models estimated change in child percentage overweight (percentage above the median BMI for a child's age and sex) for the FBT period (0-4 months) and the SFM+ period (4-12 months), and proportion of children achieving a clinically significant change in percentage overweight (≥9-unit decrease; months 0-12). Theory-based outcome mediators were also evaluated. RESULTS This study recruited 172 parent-child dyads (mean [SD] age: parents 42.3 [6.4] years; children, 9.4 [1.3] years). The omnibus treatment × time interaction for child percentage overweight was significant (F8, 618.9 = 2.89; P = .004). Planned pairwise comparisons revealed that from months 4 to 12, LOW had better outcomes than CONTROL (difference, -3.34; 95% CI, -6.21 to -0.47; d = -0.40; P = .02). HIGH had better outcomes than LOW (difference, -3.37; 95% CI, -6.15 to -0.59; d = -0.38; P = .02) and CONTROL (difference, -6.71; 95% CI, -9.57 to -3.84; d = -0.77; P < .001). A greater proportion of children in HIGH (45 [82%]) vs LOW (34 [64%]) (difference, 18.00; 95% CI, 1.00-34.00; P = .03; number needed to treat = 5.56) and CONTROL (25 [48%]) (difference, 34.00; 95% CI, 16.00-51.00; P < .001; number needed to treat = 2.94) had clinically significant percentage overweight reductions. Food and activity monitoring and goal setting mediated the effect of LOW vs CONTROL (50%). Monitoring and goal setting, family and home environment, and healthy behaviors with peers mediated the effect of HIGH vs CONTROL (25%-42%). CONCLUSIONS AND RELEVANCE Following FBT, specialized intervention content (SFM+) enhanced children's weight outcomes and outperformed a credible control condition, with high dose delivery yielding the best outcomes. Sustained monitoring and goal setting, support from the family and home environment, and healthy peer interactions explained outcome differences, highlighting key treatment targets. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00759746.
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Affiliation(s)
- Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine,
St. Louis, MO;
| | - Brian E. Saelens
- Department of Pediatrics, University of Washington and Seattle
Children’s Research Institute, Seattle, WA;
| | - Richard I. Stein
- Department of Internal Medicine, Washington University School of
Medicine, St. Louis, MO;
| | - John R. Best
- Department of Psychiatry, Washington University School of Medicine,
St. Louis, MO;
| | - Rachel P. Kolko
- Department of Psychology, Washington University School of Medicine,
St. Louis, MO;
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University School of Medicine
and St. Louis Children’s Hospital, St. Louis, MO;
| | - Michael Wallendorf
- Division of Biostatistics, Washington University School of
Medicine, St. Louis, MO;
| | | | - Michael G. Perri
- University of Florida, Department of Clinical & Health
Psychology, Gainesville, FL;
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19
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Doherty E, Queally M, Cullinan J, Gillespie P. The impact of childhood overweight and obesity on healthcare utilisation. ECONOMICS AND HUMAN BIOLOGY 2017; 27:84-92. [PMID: 28550809 DOI: 10.1016/j.ehb.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/23/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
Rising levels of childhood overweight and obesity represent a major global public health challenge. A number of studies have explored the association between childhood overweight and obesity and healthcare utilisation and costs. This paper adds to the literature by estimating the causal effect of child overweight and obesity status on use of general practitioner (GP) and hospital inpatient stays at two time points using instrumental variable (IV) methods The paper uses data from two waves of the Growing Up in Ireland survey of children when they are 9 and 13 years respectively and uses the biological mother's body mass index (BMI) as an instrument for the child's BMI. Our results demonstrate that child overweight and obesity status do not have a significant effect on healthcare utilisation for children when they are 9 years, but do have a large and significant effect at 13 years. Across all our models, the effects on both GP and hospital inpatient stays are found to be larger when endogeneity in childhood BMI status is addressed. Previous studies that did not address endogeneity concerns are likely to have significantly underestimated the impact of child overweight and obesity status on healthcare utilisation.
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Affiliation(s)
- Edel Doherty
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland.
| | - Michelle Queally
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland
| | - John Cullinan
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland
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20
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Lechuga Sancho A, Palomo Atance E, Rivero Martin MJ, Gil-Campos M, Leis Trabazo R, Bahíllo Curieses MP, Bueno Lozano G. [Spanish collaborative study: Description of usual clinical practice in infant obesity]. An Pediatr (Barc) 2017; 88:340-349. [PMID: 28943259 DOI: 10.1016/j.anpedi.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. MATERIAL AND METHODS An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. RESULTS A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. CONCLUSIONS There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition.
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Affiliation(s)
- Alfonso Lechuga Sancho
- Departamento Materno-Infantil y Radiología, Facultad de Medicina, Universidad de Cádiz, UGC de Pediatría, Hospital Universitario Puerta de Mar, Cádiz, España
| | - Enrique Palomo Atance
- Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Mercedes Gil-Campos
- IMIBIC, Facultad de Medicina, Universidad de Córdoba, Unidad de Metabolismo e Investigación Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España; ciberobn isciii
| | - Rosaura Leis Trabazo
- Departamento de Pediatría, Facultad de Medicina, Universidad de Santiago de Compostela, Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España; ciberobn isciii
| | | | - Gloria Bueno Lozano
- Departamento de Pediatría, Radiología y Medicina Física, Facultad de Medicina, Universidad de Zaragoza, Servicio de Pediatría, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; ciberobn isciii.
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Chung SJ, Ersig AL, McCarthy AM. The Influence of Peers on Diet and Exercise Among Adolescents: A Systematic Review. J Pediatr Nurs 2017; 36:44-56. [PMID: 28888511 DOI: 10.1016/j.pedn.2017.04.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 11/28/2022]
Abstract
Adolescents' diet and exercise are modifiable factors contributing to high rates of adolescent obesity. Diverse contextual factors, including family, social environment, and peers, affect adolescents' diet and exercise behaviors. Because peer influence increases during adolescence, peers' contributions to adolescents' diet and exercise behaviors should be examined as potential targets for intervention to reduce the prevalence of adolescent obesity. The purpose of this systematic review is to identify research examining the contribution of peers to diet and exercise of adolescents. The electronic databases PubMed, CINAHL, Web of Science, and SCOPUS were searched. A total of 24 unique articles were included: seven examined diet only, fourteen studied exercise only, and three explored diet and exercise. This review provided evidence that diet and exercise of adolescents were significantly associated with those of their peers. However, these associations differed depending on gender, the type of diet and exercise, and closeness of friends. Findings from this review suggest that peers could be possible targets for interventions to promote healthier diet and exercise among adolescents; however, more studies are needed to identify specific peer influences and develop tailored interventions.
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Affiliation(s)
| | | | - Ann Marie McCarthy
- The University of Iowa, College of Nursing, Iowa City, IA United States.
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Wilfley DE, Staiano AE, Altman M, Lindros J, Lima A, Hassink SG, Dietz WH, Cook S. Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps. Obesity (Silver Spring) 2017; 25:16-29. [PMID: 27925451 PMCID: PMC5373656 DOI: 10.1002/oby.21712] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. METHODS In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. RESULTS Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. CONCLUSIONS Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Myra Altman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Chicago, Illinois, USA
| | - Angela Lima
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sandra G Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Chicago, Illinois, USA
| | - William H Dietz
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, Washington, DC, USA
| | - Stephen Cook
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA
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Charvet A, Brogan Hartlieb K, Yeh Y, Jen KLC. A comparison of snack serving sizes to USDA guidelines in healthy weight and overweight minority preschool children enrolled in Head Start. BMC OBESITY 2016; 3:36. [PMID: 27602232 PMCID: PMC5002112 DOI: 10.1186/s40608-016-0116-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 08/14/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity disproportionately affects children from low-income families and those from racial and ethnic minorities. The relationship between snacking and weight status remains unclear, although snacking is known to be an important eating episode for energy and nutrient intake particularly in young children. The purpose of this pilot study was to examine the snack intake of minority preschool children enrolled in the Head Start Program in four centers in Detroit, Michigan, and investigate differences by child weight status. METHODS This secondary data analysis used snack time food observation and anthropometric data from a convenience sample of 55 African American children (44 % girls, mean age = 3.8 years). Snack intake data was obtained over a mean of 5 days through direct observation of children by dietetic interns, and later converted into food group servings according to the United States Department of Agriculture (USDA) meal patterns and averaged for each child. Height and weight measurements were systematically collected and BMI-for-age percentiles were used to classify children into weight categories. One sample, paired samples and independent samples t-tests were performed to test for differences within and between means. RESULTS Based on BMI-for-age percentiles, 72.7 % of the sample was under/healthy weight and 27.3 % was overweight/obese. Average (mean ± SD) intake of milk (0.76 ± 0.34) and overall fruits/vegetables (0.77 ± 0.34) was significantly lower than one USDA serving, while average intake of grains and breads (2.04 ± 0.89), meat/meat alternates (2.20 ± 1.89) and other foods (1.43 ± 1.08) was significantly higher than one USDA serving (p ≤ 0.05). Children ate more when offered canned versus fresh fruits (0.93 ± 0.57 vs. 0.65 ± 0.37, p = 0.007). Except for a significantly higher milk intake in the overweight/obese group compared to the under/healthy weight group (0.86 ± 0.48 vs. 0.72 ± 0.27, p = 0.021], no relationship was found between snack food intake and weight category. Only in the overweight/obese group was the intake of milk and fresh fruits not significantly different than one USDA serving. CONCLUSIONS Findings suggest that regardless of weight status low-income minority preschool children are consuming larger serving sizes when offered less healthy versus healthier snack foods. Continued efforts should be made to provide healthful snack foods at preschool settings to prevent obesity and promote healthier food habits.
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Affiliation(s)
- Andrea Charvet
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Kathryn Brogan Hartlieb
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Yulyu Yeh
- Department of Nutrition and Food Science, College of Liberal Arts and Sciences, Wayne State University, 3009 Science Hall, Detroit, MI 48202 USA
| | - K-L Catherine Jen
- Department of Nutrition and Food Science, College of Liberal Arts and Sciences, Wayne State University, 3009 Science Hall, Detroit, MI 48202 USA
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Haber JJ, Atti S, Gerber LM, Waseem M. Promoting an obesity education program among minority patients in a single urban pediatric Emergency Department (ED). Int J Emerg Med 2015; 8:38. [PMID: 26511854 PMCID: PMC4624687 DOI: 10.1186/s12245-015-0086-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/29/2015] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this study was to assess the feasibility of the Emergency Department (ED) as a place for obesity education and to evaluate its impact on patient’s lifestyle modification. Methods In this study, children between 8 and 18 years of age, who presented to the ED for non-urgent reasons in a single urban hospital, were enrolled. Parents’ perception of their child’s diet and exercise were assessed prior to the intervention. Both parents and children attended a brief audio-visual presentation that provided educational information on age-appropriate diet and exercise. Following the intervention, the participants were asked about their impressions regarding the ED as a place to receive obesity education and whether they plan to make any changes in diet and exercise. Results One hundred children and their parents participated in this study. Of these, 76 were Latino and 21 were African-Americans. The mean age was 14 years, and the mean body mass index (BMI) was 25.6. Following the intervention, 21 (100 %) of the African-American parents and 73 (98.6 %) of the Latino parents felt that the ED should provide obesity education. Eighteen (85.7 %) of the African-American parents and 72 (97.3 %) of the Latino parents planned to make changes in their child’s diet and exercise. Among the children, 21 (100 %) of African-American participants and 76 (100 %) of Latino participants reported that they found the audio-visual useful. Seventeen (81.0 %) of the African-American children and 73 (96.1 %) of Latino children stated learning new information from the intervention program. Conclusions This study suggests the ED may have a role in primary health promotion and obesity prevention. An ED-based intervention may be used to provide education about obesity prevention and has the potential to impact life style modifications, including diet and exercise.
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Affiliation(s)
- Jordana J Haber
- Department of Emergency Medicine, University Medical Center, 1800 W Charleston Blvd, Las Vegas, NV, 89102, USA.
| | - Sukshant Atti
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, 234 E 149th St, Bronx, NY, 10451, USA.
| | - Linda M Gerber
- Department of Healthcare Policy, Research Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA.
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, 234 E 149th St, Bronx, NY, 10451, USA.
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Rowe S, Siegel D, Benjamin DK. Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Emergency Care Medications. Clin Ther 2015; 37:1924-32. [PMID: 26323523 PMCID: PMC4586086 DOI: 10.1016/j.clinthera.2015.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/13/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE Approximately 1 of 6 children in the United States is obese. This has important implications for drug dosing and safety because pharmacokinetic (PK) changes are known to occur in obesity due to altered body composition and physiologic mechanisms. Inappropriate drug dosing in an emergency setting can limit therapeutic efficacy and increase drug-related toxic effects for obese children. Few systematic reviews examining PK properties and drug dosing in obese children have been performed. METHODS We identified 25 emergency care drugs from the Strategic National Stockpile and Acute Care Supportive Drugs List and performed a systematic review for each drug in 3 study populations: obese children (2-18 years of age), normal weight children, and obese adults (aged >18 years). For each study population, we first reviewed a drug's Food and Drug Administration label and then performed a systematic literature review. From the literature, we extracted drug PK data, biochemical properties, and dosing information. We then reviewed data in 3 age subpopulations (2-7 years, 8-12 years, and 13-18 years) for obese and normal weight children and by route of drug administration (intramuscular, intravenous, oral, and inhaled). If sufficient PK data were not available by age and route of administration, a data gap was identified. FINDINGS Only 2 of 25 emergency care drugs (8%) contained dosing information on the Food and Drug Administration label for obese children and adults compared with 22 of 25 (88%) for normal weight children. We found no sufficient PK data in the literature for any of the emergency care drugs in obese children. Sufficient PK data were found for 7 of 25 emergency care drugs (28%) in normal weight children and 3 of 25 (12%) in obese adults. IMPLICATIONS Insufficient information exists to guide dosing in obese children for any of the emergency care drugs reviewed. This knowledge gap is alarming, given the known PK changes that occur in the setting of obesity. Future clinical trials examining the PK properties of emergency care medications in obese children should be prioritized.
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Affiliation(s)
- Stevie Rowe
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - David Siegel
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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Carey FR, Singh GK, Brown III HS, Wilkinson AV. Educational outcomes associated with childhood obesity in the United States: cross-sectional results from the 2011-2012 National Survey of Children's Health. Int J Behav Nutr Phys Act 2015; 12 Suppl 1:S3. [PMID: 26222699 PMCID: PMC4663995 DOI: 10.1186/1479-5868-12-s1-s3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Past research examining the effects of childhood obesity has largely focused on its projected effects into adulthood. However, there is emerging evidence that childhood obesity may have more immediate effects on school-related outcomes. We examine a range of educational attainment indicators to examine the possible pathway between obesity status and academic performance, while investigating the proximal effects of childhood obesity on health and utilization of health services, and whether these variables attenuate the relationship between obesity status and educational outcomes. METHODS Data for the current study come from the 2011-2012 National Survey of Children’s Health, which details the impacts of childhood obesity on a range of outcomes among a nationally representative sample of children and adolescents aged 10-17 years (N=45,255). Educational outcomes (school absences, school problems, repeating a grade and school engagement) were modeled by logistic regression as a function of BMI, overall health status, health care utilization, and a range of sociodemographic variables. RESULTS BMI status was significantly associated with all educational outcomes (p<0.001 for all), overall health status (p<0.001), and health care utilization (p=0.016). Prior to adjustment for covariates, obese children were significantly more likely to have school absences and school problems, to repeat a grade, and to have lower school engagement than non-overweight children. After adjustment for sociodemographic and health/healthcare variables, these outcomes remained significant for all but repeating a grade. The odds of having school problems, repeating a grade, and low school engagement that were associated with obesity were attenuated by the addition of sociodemographic variables into the model, while the addition of health and health care variables in the model decreased the odds of school absences. CONCLUSIONS This study provides evidence that increased weight status in children is associated with poorer educational outcomes. While recognizing that these are cross-sectional data, we suggest that 1) health-related and sociodemographic factors should be a focus point of intervention, and 2) a socio-structural approach including Coordinated School Health intervention is crucial to reducing childhood obesity and improving educational outcomes in this population.
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Affiliation(s)
- Felicia R Carey
- Michael and Susan Dell Center for Healthy Living, The University of Texas School of Public Health Austin Regional Campus, Austin, TX, 78701, USA
| | - Gopal K Singh
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, 20857, USA
| | - H Shelton Brown III
- Michael and Susan Dell Center for Healthy Living, The University of Texas School of Public Health Austin Regional Campus, Austin, TX, 78701, USA
| | - Anna V Wilkinson
- Michael and Susan Dell Center for Healthy Living, The University of Texas School of Public Health Austin Regional Campus, Austin, TX, 78701, USA
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Lee FA, Hervey AM, Gates C, Stringer B, Berg GM, Harrison PB. Assessing the Relationship Between BMI and Resource Utilization in a Pediatric Trauma Population. Hosp Pediatr 2015; 5:371-376. [PMID: 26136311 DOI: 10.1542/hpeds.2014-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Felecia A Lee
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - Ashley M Hervey
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - Clint Gates
- Wichita Center for Graduate Medical Education General Surgery Residency, University of Kansas School of Medicine-Wichita, Wichita, Kansas; and
| | - Brandon Stringer
- Wichita Center for Graduate Medical Education General Surgery Residency, University of Kansas School of Medicine-Wichita, Wichita, Kansas; and
| | - Gina M Berg
- Wichita Center for Graduate Medical Education General Surgery Residency, University of Kansas School of Medicine-Wichita, Wichita, Kansas; and Wesley Medical Center Trauma Services, Wichita, Kansas
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Medehouenou TCM, Ayotte P, St-Jean A, Meziou S, Roy C, Muckle G, Lucas M. Overweight and Obesity Prevalence Among School-Aged Nunavik Inuit Children According to Three Body Mass Index Classification Systems. J Adolesc Health 2015; 57:31-6. [PMID: 26095406 PMCID: PMC4477285 DOI: 10.1016/j.jadohealth.2015.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Little is known about the suitability of three commonly used body mass index (BMI) classification system for Indigenous children. This study aims to estimate overweight and obesity prevalence among school-aged Nunavik Inuit children according to International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) BMI classification systems, to measure agreement between those classification systems, and to investigate whether BMI status as defined by these classification systems is associated with levels of metabolic and inflammatory biomarkers. METHODS Data were collected on 290 school-aged children (aged 8-14 years; 50.7% girls) from the Nunavik Child Development Study with data collected in 2005-2010. Anthropometric parameters were measured and blood sampled. Participants were classified as normal weight, overweight, and obese according to BMI classification systems. Weighted kappa (κw) statistics assessed agreement between different BMI classification systems, and multivariate analysis of variance ascertained their relationship with metabolic and inflammatory biomarkers. RESULTS The combined prevalence rate of overweight/obesity was 26.9% (with 6.6% obesity) with IOTF, 24.1% (11.0%) with CDC, and 40.4% (12.8%) with WHO classification systems. Agreement was the highest between IOTF and CDC (κw = .87) classifications, and substantial for IOTF and WHO (κw = .69) and for CDC and WHO (κw = .73). Insulin and high-sensitivity C-reactive protein plasma levels were significantly higher from normal weight to obesity, regardless of classification system. Among obese subjects, higher insulin level was observed with IOTF. CONCLUSIONS Compared with other systems, IOTF classification appears to be more specific to identify overweight and obesity in Inuit children.
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Affiliation(s)
- Thierry Comlan Marc Medehouenou
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada
| | - Pierre Ayotte
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada; Department of Social and Preventive Medicine, Université Laval, Québec, Canada
| | - Audray St-Jean
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada
| | - Salma Meziou
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada
| | - Cynthia Roy
- Institut national de santé publique du Québec, Québec, Canada
| | - Gina Muckle
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada; School of Psychology, Université Laval, Québec, Canada
| | - Michel Lucas
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada; Department of Social and Preventive Medicine, Université Laval, Québec, Canada.
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Harskamp-van Ginkel MW, Hill KD, Becker K, Testoni D, Cohen-Wolkowiez M, Gonzalez D, Barrett JS, Benjamin DK, Siegel DA, Banks P, Watt KM. Drug Dosing and Pharmacokinetics in Children With Obesity: A Systematic Review. JAMA Pediatr 2015; 169:678-85. [PMID: 25961828 PMCID: PMC4494887 DOI: 10.1001/jamapediatrics.2015.132] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Obesity affects nearly one-sixth of US children and results in alterations to body composition and physiology that can affect drug disposition, possibly leading to therapeutic failure or toxic side effects. The depth of available literature regarding obesity's effect on drug safety, pharmacokinetics, and dosing in obese children is unknown. OBJECTIVE To perform a systematic literature review describing the current evidence of the effect of obesity on drug disposition in children. EVIDENCE REVIEW We searched the MEDLINE, Cochrane, and EMBASE databases (January 1, 1970-December 31, 2012) and included studies if they contained data on drug clearance, volume of distribution, or drug concentration in obese children (aged ≤18 years). We compared exposure and weight-normalized volume of distribution and clearance between obese and nonobese children. We explored the association between drug physicochemical properties and clearance and volume of distribution. FINDINGS Twenty studies met the inclusion criteria and contained pharmacokinetic data for 21 drugs. The median number of obese children studied per drug was 10 (range, 1-112) and ages ranged from newborn to 29 years (1 study described pharmacokinetics in children and adults together). Dosing schema varied and were either a fixed dose (6 [29%]) or based on body weight (10 [48%]) and body surface area (4 [19%]). Clinically significant pharmacokinetic alterations were observed in obese children for 65% (11 of 17) of the studied drugs. Pharmacokinetic alterations resulted in substantial differences in exposure between obese and nonobese children for 38% (5 of 13) of the drugs. We found no association between drug lipophilicity or Biopharmaceutical Drug Disposition Classification System class and changes in volume of distribution or clearance due to obesity. CONCLUSIONS AND RELEVANCE Consensus is lacking on the most appropriate weight-based dosing strategy for obese children. Prospective pharmacokinetic trials in obese children are needed to ensure therapeutic efficacy and enhance drug safety.
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Affiliation(s)
- Margreet W. Harskamp-van Ginkel
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin D. Hill
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Kristian Becker
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Daniela Testoni
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | | | - Daniel Gonzalez
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Jeffrey S. Barrett
- Department of Clinical Pharmacology and Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Daniel K. Benjamin
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - David A. Siegel
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Patricia Banks
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Kevin M. Watt
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
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Firm maternal parenting associated with decreased risk of excessive snacking in overweight children. Eat Weight Disord 2015; 20:195-203. [PMID: 25370704 PMCID: PMC4420721 DOI: 10.1007/s40519-014-0164-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/26/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To examine the relationship between parent feeding practices (restriction, monitoring, pressure to eat), general parenting behaviors (acceptance, psychological control, firm control), and aberrant child eating behaviors (emotional eating and excessive snacking) among overweight and normal weight children. METHODS Overweight and normal weight children between 8 and 12 years old and their mothers (n = 79, parent-child dyads) participated in this study. Mothers completed surveys on parent feeding practices (Child Feeding Questionnaire) and child eating behaviors (Family Eating and Activity Habits Questionnaire). Children reported on their mothers' general parenting behaviors (Child Report of Parent Behavior Inventory). Parent and child height and weight were measured and demographic characteristics assessed. Logistic regression models, stratified by child weight status and adjusting for parent BMI, were used to determine which parenting dimensions and feeding practices were associated with child emotional eating and snacking behavior. RESULTS Overweight children displayed significantly more emotional eating and excessive snacking behavior than normal weight children. Mothers of overweight children used more restrictive feeding practices and psychological control. Restrictive feeding practices were associated with emotional eating in the overweight group (OR = 1.26, 95 % CI, 1.02, 1.56) and excessive snacking behavior in the normal weight group (OR = 1.13, 95 % CI, 1.01, 1.26). When examining general parenting, firm control was associated with decreased odds of excessive snacking in the overweight group (OR = 0.51, 95 % CI, 0.28, 0.93). CONCLUSION Restrictive feeding practices were associated with aberrant child eating behaviors in both normal weight and overweight children. Firm general parenting however, was associated with decreased snacking behavior among overweight children. Longitudinal studies following children from infancy are needed to better understand the direction of these relationships.
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Bettenhausen J, Puls H, Queen MA, Peacock C, Burrus S, Miller C, Daly A, Colvin JD. Childhood obesity and in-hospital asthma resource utilization. J Hosp Med 2015; 10:160-4. [PMID: 25449960 DOI: 10.1002/jhm.2296] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/27/2014] [Accepted: 11/14/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization. CONCLUSIONS Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful.
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Affiliation(s)
- Jessica Bettenhausen
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Lynch BA, Rutten LJF, Jacobson RM, Kumar S, Elrashidi MY, Wilson PM, Jacobson DJ, St. Sauver JL. Health Care Utilization by Body Mass Index in a Pediatric Population. Acad Pediatr 2015; 15:644-50. [PMID: 26443036 PMCID: PMC4760684 DOI: 10.1016/j.acap.2015.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We tested the hypothesis that the frequency of emergency department (ED) visits, outpatient clinic visits, and hospitalizations were higher among children with higher body mass index (BMI) categories, even after controlling for demographics, socioeconomic status, and presence of other chronic medical conditions. METHODS We obtained electronic height, weight, and utilization data for all residents of Olmsted County, Minnesota, aged 2 to 18 years on January 1, 2005 (n = 34,335), and calculated baseline BMI (kg/m(2)). At least 1 BMI measurement and permission to use medical record information was available for 19,771 children (58%); 19,528 with follow-up comprised the final cohort. BMIs were categorized into underweight/healthy weight (<85th percentile), overweight (85th to <95th percentile), and obese (≥95th percentile). Negative binomial models were used to compare the rate of utilization across BMI categories. Multivariable models were used to adjust for the effects of age, race, sex, socioeconomic status, and chronic medical conditions. RESULTS Compared to children with BMI <85th percentile, overweight and obese status were associated with increased ED visits (adjusted incident rate ratio [IRR] 1.16, 95% confidence interval [CI] 1.10, 1.23; and IRR 1.27, 95% CI 1.19, 1.35, respectively; P for trend <.0001), and outpatient clinic visits (IRR 1.05, 95% CI 1.02, 1.08; and IRR 1.07, 95% CI 1.04, 1.11, respectively; P for trend <.0001). No associations were observed between baseline BMI category and hospitalizations in the adjusted analyses. CONCLUSIONS Children who are overweight or obese utilize the ED and outpatient clinics more frequently than those who are underweight/healthy weight, but are not hospitalized more frequently.
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Affiliation(s)
- Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | | | - Patrick M Wilson
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905
| | - Debra J Jacobson
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Department of Health Sciences Research, Mayo Clinic, 200 First St., Rochester, MN, 55905
| | - Jennifer L St. Sauver
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery Population Health Science Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, Department of Health Sciences Research, Mayo Clinic, 200 First St., Rochester, MN, 55905
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Sabhaney V, Boutis K, Yang G, Barra L, Tripathi R, Tran TT, Doan Q. Bone fractures in children: is there an association with obesity? J Pediatr 2014; 165:313-318.e1. [PMID: 24836073 DOI: 10.1016/j.jpeds.2014.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/24/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relationship between body mass index (BMI) and odds of extremity bone fractures in children. STUDY DESIGN This was a prospective cross-sectional study conducted at 2 tertiary care pediatric emergency departments. A convenience sample of children 2-17 years of age with a nonpenetrating extremity injury was enrolled. Demographics, activity level, mechanism of injury, participant BMI, and presence of a fracture were recorded. The main outcome was the odds of an extremity bone fracture based on BMI category; logistic regression was used to estimate the odds of fracture by BMI category. RESULTS We enrolled 2213 children, of whom 1078 (48.7%) sustained a fracture and 316 (14.3%) were classified as obese. The mean (SD) age was 9.5 (4.2) years, and percentage of male children was 56.8%. Compared with children with a normal BMI, the adjusted odds of fracture among obese, overweight, and underweight children were 0.75 (0.58, 0.97), 1.15 (0.89, 1.48), and 1.44 (1.00, 2.07) respectively. CONCLUSIONS Obese children had a minor but statistically significant decreased odds of fracture relative to children with a normal BMI, but no association was observed in overweight children. However, underweight children were found to be at an increased odds of fracture. This study suggests that overweight and obese children do not have increased odds of extremity fracture.
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Affiliation(s)
- Vikram Sabhaney
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Gaby Yang
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Lorena Barra
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reetika Tripathi
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tinh Trung Tran
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quynh Doan
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
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Wright DR, Prosser LA. The impact of overweight and obesity on pediatric medical expenditures. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:139-150. [PMID: 24652198 DOI: 10.1007/s40258-014-0088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Published studies do not consistently find overweight and obesity to be associated with higher medical expenditures for US children. Previous analyses use varying samples and methods, making results difficult to compare. OBJECTIVE To examine whether methodological choices or temporal trends are driving differences in estimates of the association between weight and pediatric medical expenditures. METHODS We analyzed the medical expenditures and use of 6- to 17-year-old individuals in the 2006-2010 US Medical Expenditure Panel Surveys. The impact of overweight and obesity on annual medical expenditures and use was assessed, controlling for age, income, race, sex, geographic region, urban/rural residency, insurance status, and survey year. A two-part regression model, in which part one estimated the likelihood of incurring any expenditure and part two estimated non-zero expenditures, was used to predict total expenditures. Expenditures were inflated to 2012 dollars using the medical care component of the Consumer Price Index. Poisson and logistic regression models were used to predict differences in healthcare use between normal weight, overweight, and obese youth. RESULTS We found that overweight and obese youth have higher, but not significantly higher medical expenditures than normal weight youth. Conclusions were robust to various methodological assumptions. We found that obese adolescents have a higher use of prescriptions drugs and healthcare visits compared with normal weight youth (0.04-1.3 visits), but differences in use only translated into marginally higher expenditures. CONCLUSIONS These findings may reflect new trends in healthcare use among obese youth. Future research should assess whether services are being underused by obese youth and the impact of persistent obesity on long-term medical expenditures.
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Affiliation(s)
- Davene R Wright
- Department of Pediatrics, University of Washington, Seattle, WA, USA,
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Boutelle KN, Kuckertz JM, Carlson J, Amir N. A pilot study evaluating a one-session attention modification training to decrease overeating in obese children. Appetite 2014; 76:180-5. [PMID: 24512975 DOI: 10.1016/j.appet.2014.01.075] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 01/14/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
There are a number of neurocognitive and behavioral mechanisms that contribute to overeating and obesity, including an attentional bias to food cues. Attention modification programs, which implicitly train attention away from specific cues, have been used in anxiety and substance abuse, and could logically be applied to food cues. The purpose of this study was to evaluate the initial efficacy of a single session attention modification training for food cues (AMP) on overeating in overweight and obese children. Twenty-four obese children who eat in the absence of hunger participated in two visits and were assigned to an attention modification program (AMP) or attentional control program (ACC). The AMP program trained attention away 100% of the time from food words to neutral words. The ACC program trained attention 50% of the time to neutral and 50% of the time to food. Outcome measures included the eating in the absence of hunger free access session, and measures of craving, liking and salivation. Results revealed significant treatment effects for EAH percent and EAH kcal (group by time interactions p<.05). Children in the ACC condition showed a significant increase over time in the number of calories consumed in the free access session (within group t=3.09, p=.009) as well as the percent of daily caloric needs consumed in free access (within group t=3.37, p=.006), whereas children in the AMP group demonstrated slight decreases in these variables (within group t=-0.75 and -0.63, respectively). There was a trend suggesting a beneficial effect of AMP as compared to ACC for attentional bias (group by time interaction p=.073). Changes in craving, liking and saliva were not significantly different between groups (ps=.178-.527). This is the first study to demonstrate that an AMP program can influence eating in obese children. Larger studies are needed to replicate and extend these results.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA 92037, United States; Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, United States.
| | - Jennie M Kuckertz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, United States; Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Jordan Carlson
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA 92037, United States; Department of Family and Preventive Medicine, University of California, San Diego, CA, United States
| | - Nader Amir
- Department of Psychology, San Diego State University, San Diego, CA, United States
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Abstract
In this article, several aspects of childhood obesity are discussed, including epidemiology, associated metabolic complications, management strategies, and therapy with particular attention to the impact of obesity on the liver, resulting in nonalcoholic or metabolic fatty liver disease. The deleterious effects of obesity on the liver and health overall can be significantly impacted by a culture that fosters sustained nutritional improvement and regular physical activity. The current evidence is summarized supporting pharmacologic, behavioral, and dietary interventions for the management of obesity and fatty liver disease in children.
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Affiliation(s)
- Ariel E. Feldstein
- Department of Pediatric Gastroenterology, Rady Children’s Hospital, University of California San Diego, San Diego, CA 92123
| | - Dana Patton-Ku
- Department of Pediatric Gastroenterology, Rady Children’s Hospital, University of California San Diego, San Diego, CA 92123
| | - Kerri N. Boutelle
- Department of Pediatric Gastroenterology, Rady Children’s Hospital, University of California San Diego, San Diego, CA 92123,Department of Pediatrics, University of California San Diego, La Jolla, CA 92093,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093
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Trasande L. Quantifying the economic consequences of childhood obesity and potential benefits of interventions. Expert Rev Pharmacoecon Outcomes Res 2014; 11:47-50. [DOI: 10.1586/erp.10.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fleming-Dutra KE, Mao J, Leonard JC. Acute care costs in overweight children: a pediatric urban cohort study. Child Obes 2013; 9:338-45. [PMID: 23767806 DOI: 10.1089/chi.2012.0134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Evidence indicates obese children have increased health care utilization. It is unknown if this is true within the emergency department (ED) setting. Our purpose is to determine if overweight children presenting for emergency care have increased resource utilization over normal weight peers. METHODS We conducted a retrospective cohort study of children 2 to <18 years old presenting to a pediatric ED in 2007. Overweight was defined as >95th percentile sex-specific weight-for-age, and normal weight was defined as ≤95(th) percentile. We used a subsample validation to compare these study definitions to BMI-based definitions. We compared total billed charges and secondary outcomes of ED length of stay and admission rate using multivariate and logistic regression models. Outcomes were reported for admitted and discharged patients. Four diagnoses were examined for primary and secondary outcomes. RESULTS Of 32,996 included visits, 6333 (19.2%) were for overweight children. Study definitions correctly classified 98.3% of normal weight children but only 51.3% of overweight children. Overweight children were more likely to be older, black, and publicly insured. Median charges for overweight and normal weight children, whether discharged or admitted, were not different in the adjusted model. Admitted overweight children with asthma and fractures or dislocations had higher median charges than normal weight $4617 (2065-375,669) versus $4177 (1980-37,432, p=0.01) and $9855 (6681-58,546) versus $8137 (1461-52,557, p=0.01), respectively. CONCLUSIONS Overall acute care costs for overweight children are not different from normal weight children. However, admitted overweight children have disease-specific increased use of resources.
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Woolford SJ, Esperanza Menchaca ADM, Sami A, Blake N. Let's face it: patient and parent perspectives on incorporating a Facebook group into a multidisciplinary weight management program. Child Obes 2013; 9:305-10. [PMID: 23869854 PMCID: PMC4128247 DOI: 10.1089/chi.2013.0047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Social media may have the potential to enhance weight management efforts. However, the acceptability of incorporating this entity into pediatrics is unknown. The objective of this project was to explore patients' and parents' perspectives about developing a Facebook group as a component of a pediatric weight management program. METHODS Semistructured interviews were performed between September, 2011, and February, 2012, with patients and parents in a multidisciplinary weight management program. Interviews explored participants' perceptions of potential benefits, concerns, and preferences related to a program-specific Facebook group. Transcripts were reviewed and themes identified. The study concluded when thematic saturation was achieved. RESULTS Participants (n=32) were largely enthusiastic about the idea of a program-specific Facebook group for adolescents. Most preferred a secret group, where only participants would know of the group's existence or group members' identity. No parents expressed concern about security or privacy related to a program-specific Facebook group; one parent expressed concern about undesirable advertisements. Participants endorsed a variety of ideas for inclusion on the page, including weight loss tips, live chats with providers, quizzes, and an incentive system where participants could gain points for making healthy choices. Many parents requested a separate parent-focused page, an idea that was supported by the adolescents. CONCLUSIONS This study suggests that participants perceive potential benefits from incorporating social media interventions into pediatric weight management efforts. Privacy and security issues do not appear to be major parental concerns. Future work should explore the impact of program-specific social media interventions on outcomes for patients in weight management programs.
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Affiliation(s)
- Susan J. Woolford
- The Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | - Areej Sami
- The Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Natalie Blake
- The Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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Nader N, Singhal V, Javed A, Weaver A, Kumar S. Temporal trends in the diagnosis and management of childhood obesity/overweight in primary care. J Prim Care Community Health 2013; 5:44-9. [PMID: 24327587 DOI: 10.1177/2150131913495739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the temporal trends in diagnosis and management of pediatric overweight/obesity by primary care providers at a single medical center. PATIENTS Children 2 to 18 years old undergoing a general medical examination during 3 calendar years (2003, 2006, and 2009). The number of visits for general medical examination were 6390 in 2003, 6646 in 2006, and 7408 in 2009. METHODS We performed a retrospective review of the electronic medical records for weight related diagnostic and/or management terms and laboratory screening in children with body mass index at or greater than the 85th percentile (n = 1630 in 2003, 1495 in 2006, and 1730 in 2009). RESULTS There was a significant increase in the diagnosis of obesity among obese children seen in 2009 (53.3%) compared with 2006 (36%, P < .001) and 2003 (24.3%, P < .001). Weight-related counseling was documented in a higher proportion of obese children in 2009 (49.4%) compared with 2006 (34.8%) and 2003 (26.6%). There was a significant increase in counseling regarding screen time in 2009 compared with 2006. A significant increase in screening for nonalcoholic fatty liver disease was also noted (30.5% in 2009 vs 21.9% in 2006, P = .018). CONCLUSIONS There has been steady improvement in the rates of obesity diagnosis and obesity-related counseling by primary care providers. However, continued efforts to increase awareness of these issues are needed as nearly half of obese children remained undiagnosed and recommended laboratory screening for obesity-related comorbidities was performed in only a third of obese children.
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Jones Nielsen JD, Laverty AA, Millett C, Mainous III AG, Majeed A, Saxena S. Rising obesity-related hospital admissions among children and young people in England: national time trends study. PLoS One 2013; 8:e65764. [PMID: 23776541 PMCID: PMC3680468 DOI: 10.1371/journal.pone.0065764] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 05/02/2013] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the trends in hospital admissions associated with obesity as a primary diagnosis and comorbidity, and bariatric surgery procedures among children and young people in England. DESIGN National time trends study of hospital admissions data between 2000 and 2009. PARTICIPANTS Children and young people aged 5 to 19 years who were admitted to hospital with any diagnosis of obesity. MAIN OUTCOME MEASURES Age- and sex-specific admission rates per million children. RESULTS Between 2000 and 2009, age- and sex-specific hospital admission rates in 5-19 year olds for total obesity-related diagnoses increased more than four-fold from 93.0 (95% CI 86.0 to 100.0) per million children to 414.0 (95% CI 410.7 to 417.5) per million children, largely due to rising admissions where obesity was mentioned as a co-morbidity. The median age of admission to hospital over the study period was 14.0 years; 5,566 (26.7%) admissions were for obesity and 15,319 (73.3%) mentioned obesity as a comorbidity. Admissions were more common in girls than boys (56.2% v 43.8%). The most common reasons for admission where obesity was a comorbid condition were sleep apnoea, asthma, and complications of pregnancy. The number of bariatric surgery procedures has risen from 1 per year in 2000 to 31 in 2009, with the majority were performed in obese girls (75.6%) aged 13-19 years. CONCLUSIONS Hospital admission rates for obesity and related comorbid conditions have increased more than four-fold over the past decade amongst children and young people. Although some of the increase is likely to be due to improved case ascertainment, conditions associated with obesity in children and young people are imposing greater challenges for health care providers in English hospitals. Most inpatient care is directed at dealing with associated conditions rather than primary assessment and management of obesity itself.
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Affiliation(s)
- Jessica D. Jones Nielsen
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Arch G. Mainous III
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Sonia Saxena
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
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Ehrmann DE, Sallinen BJ, IglayReger HB, Gordon PM, Woolford SJ. Slow and steady: readiness, pretreatment weekly strengthening activity, and pediatric weight management program completion. Child Obes 2013; 9:193-9. [PMID: 23635312 DOI: 10.1089/chi.2013.0006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric weight management programs have substantial attrition rates, which have led to recommendations to assess readiness prior to enrollment. Both pretreatment readiness scales and behaviors, such as exercise, have been theorized to predict subsequent program completion. The purpose of this study was to explore the role of self-reported pretreatment exercise in adolescents on completion of a pediatric weight management program and to explore the predictive ability of standard readiness scales. METHODS A total of 146 obese (BMI≥95(th) percentile) pediatric (ages 11-18) participants joined a 6-month multidisciplinary weight management program between March, 2007, and July, 2010. Completers were compared retrospectively to noncompleters on demographic, readiness, and pretreatment exercise practices from clinic-developed intake questionnaires using univariate analyses. Regression analyses specified the degree to which these variables predicted program completion. RESULTS The 6-month completion rate was 53%. There was no relationship between self-reported readiness and program completion. Self-reported pretreatment weekly strengthening activity (SA) was significantly associated with program completion, compared to those who performed SA either never [univariate odds ratio (OR) 3.18, 95% confidence interval (CI) 1.51-6.68, p=0.002; multivariate OR 2.43, 95% CI 1.06-5.58, p=0.036] or daily (univariate OR 4.90, 95% CI 1.74-13.77, p=0.002; multivariate OR 4.69, 95% CI 1.45-15.14, p=0.010). No relationship was found between other forms of exercise and program completion. CONCLUSIONS Self-reported pretreatment weekly SA, but not standard readiness scales, predicted pediatric weight management program completion.
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Lehnert T, Sonntag D, Konnopka A, Riedel-Heller S, König HH. Economic costs of overweight and obesity. Best Pract Res Clin Endocrinol Metab 2013; 27:105-15. [PMID: 23731873 DOI: 10.1016/j.beem.2013.01.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obesity has substantially increased in recent decades and is now one of the major global health problems. The large obesity-related health burden negatively impacts many relevant health outcomes (e.g. quality of life, disability, mortality) and leads to increased healthcare utilization. This excess service use is the main driver behind high healthcare costs of obese individuals. Findings indicate that costs rise curvilinearly with increasing body mass index, especially among the obese. As more individuals of a country's population become obese, a larger share of total annual national healthcare expenditure is spent on obesity and obesity-related health problems. In addition to escalating healthcare costs, obesity goes along with indirect costs through decreases in workforce productivity. The empirical evidence has shown beyond doubt that obesity negatively impacts individuals, healthcare systems, employers, and the economy as a whole. This article provides a brief overview of selected economic consequences associated with excess-weight.
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Affiliation(s)
- Thomas Lehnert
- Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
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Yi-Frazier JP, Larison C, Neff JM, Grow HMG, Liu LL. Obesity in pediatric specialty clinics: an underestimated comorbidity. Clin Pediatr (Phila) 2012; 51:1056-62. [PMID: 22930781 DOI: 10.1177/0009922812458353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (a) To examine the prevalence of obesity across 31 subspecialties in a tertiary care children's hospital and (b) to examine the percentage of obesity-specified diagnosis codes used for obese patient visits. METHODS We analyzed 48 479 youth aged 2 to 18 years in 31 outpatient subspecialty clinics at Seattle Children's Hospital between 2005 and 2007. Body mass index (BMI) percentiles were determined by age- and gender-adjusted BMI calculated from height/weight obtained at clinic visits. For obese patients, the percentage of diagnoses coded as obesity-specific (278.11, 278.01, 272.02, 783.1) were determined by evaluation of standard diagnostic codes. RESULTS Twenty-two of the 31 clinics had patient obesity rates greater than 15%. Analysis of International Classification of Diseases, 9th Revision, codes for obese patient visits as defined by BMI revealed only 2 clinics used obesity-specific codes for >5% of all diagnoses. CONCLUSIONS Given the prevalence of obesity across all subspecialties, more recognition and resources are needed to screen, diagnosis, and provide coordinated services for healthy weight management.
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Abstract
BACKGROUND Studies of school-based anti-obesity interventions have yielded inconsistent results. Using growth screening data from a school administrative database, we re-evaluated an obesity prevention strategy that was previously reported to have a beneficial effect on weight status of a sample of students in grades 5-7. METHODS Ten K-8 schools (five control and five intervention) participated in a 2-year cluster-randomized trial of a multi-component nutrition education intervention. We obtained student height and weight data for 6 consecutive school years and imputed missing baseline and follow-up measurements (53% and 55%, respectively) and defined the target population based on the intent-to-treat principle. We analyzed changes in body mass index (BMI) Z-scores via mixed-effects linear regression and in the prevalence of overweight/obesity via conditional logistic regression. We also assessed incidence and remission of overweight/obesity and long-term effects. RESULTS We analyzed data for 8186 (96%) K-8 students in the 10 schools (4511 in intervention; 3675 in control). From baseline to the end of the intervention period, mean increases in BMI Z-score were 0.10 and 0.09 in the control and intervention groups, respectively (P=0.671). The prevalence of overweight/obesity increased by 3% in both groups (P=0.926). There was no significant intervention effect on the incidence or remission of overweight/obesity. Among 5469 students who attended study schools during both years of the intervention, there was no significant intervention effect. Furthermore, there was no long-term effect among students with up to 2 years of data beyond the end of the intervention. CONCLUSION Using routinely collected data for the entire target population, we failed to confirm earlier findings of an intervention effect observed in a subset of students in grades 5-7. Volunteer bias in the prior evaluation and/or measurement error in the routinely collected data are potential reasons for the discrepant findings.
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Skelton JA, Irby MB, Beech BM, Rhodes SD. Attrition and family participation in obesity treatment programs: clinicians' perceptions. Acad Pediatr 2012; 12:420-8. [PMID: 22795203 PMCID: PMC3456989 DOI: 10.1016/j.acap.2012.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/25/2012] [Accepted: 05/03/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The majority of participants drop out of pediatric obesity treatment programs; however, clinicians have little knowledge of how to address this problem. The objective of this study was to explore obesity treatment clinicians' perceptions of contributors to attrition, as well as methods to maintain family participation. METHODS Semistructured interviews were conducted with 29 pediatric obesity clinicians representing primary care (PC), community based (CB), and tertiary care (TC) treatment programs in North Carolina. Interviews were recorded, transcribed verbatim, and coded with a multistage inductive approach. Grounded theory was used to analyze responses. RESULTS Eleven themes emerged from analysis, including: the influence of program elements, family characteristics, and the variety of approaches used to address retention. Only TC programs reported attempts to address attrition. Patients' past experiences with obesity treatment, desire for immediate outcomes, and relationships with clinicians were perceived as important factors related to attrition. Other important themes were: families' understanding of obesity treatment, importance of realistic expectations, and families' value of treatment. Important differences and similarities among programs were identified. All clinicians reported families came to treatment through physician referral, not self referral. CONCLUSIONS Clinicians perceive attrition to be a significant problem in pediatric obesity treatment. As a result of clinical interviews, several potential avenues to address attrition were identified, including: the need for clinicians to develop relationships with families, assist in building appropriate expectations, and address families' value of treatment. Findings of this study can inform larger investigations of attrition, and guide exploration of family impressions of and experiences in treatment.
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Woolford SJ, Sallinen BJ, Schaffer S, Clark SJ. Eat, play, love: adolescent and parent perceptions of the components of a multidisciplinary weight management program. Clin Pediatr (Phila) 2012; 51:678-84. [PMID: 22492836 PMCID: PMC3598577 DOI: 10.1177/0009922812440839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Participants' perceptions may be associated with the high attrition rates reported by weight management programs. OBJECTIVE To explore participants' perceptions of a weight management program. METHODS Semistructured interviews were performed (spring 2010) with past participants of the Michigan Pediatric Outpatient Weight Evaluation and Reduction program. Transcripts were reviewed and themes identified. RESULTS Parents (38) and adolescents (25) were interviewed separately; similar themes emerged. Theme 1: Support/encouragement-Participants emphasized the importance of a supportive environment with a positive, compassionate approach from providers. Theme 2: Exercise-Fun, achievable activities were a valued means of making exercise enjoyable and building self-efficacy. Theme 3: Nutrition-Hands on demonstrations and tangible suggestions were preferred over activities such as self-monitoring. Theme 4: Behavioral factors-Participants valued the opportunity to hear their peers' experiences. However, individual/family sessions addressing their personal concerns were also viewed as important. CONCLUSION Beyond program content, participants valued a supportive environment emphasizing health over habitus.
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Skelton JA, Buehler C, Irby MB, Grzywacz JG. Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management. Int J Obes (Lond) 2012; 36:891-900. [PMID: 22531090 PMCID: PMC3977510 DOI: 10.1038/ijo.2012.56] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Family-based approaches to pediatric obesity treatment are considered the 'gold-standard,' and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment.
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Affiliation(s)
- J A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27 157, USA.
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Larrier Y, Kijai J, Bakerson MA, Walker L, Linton J, Woolford-Hunt C, Sallinen BJ, Woolford SJ. School Counselors Perspectives of the Barriers and Facilitators Associated with their Involvement in the Childhood Obesity Epidemic. AMERICAN JOURNAL OF HEALTH EDUCATION 2012. [DOI: 10.1080/19325037.2012.10599238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Jimmy Kijai
- b Andrews University , Berrien Springs , MI , 49104
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Trasande L, Elbel B. The economic burden placed on healthcare systems by childhood obesity. Expert Rev Pharmacoecon Outcomes Res 2012; 12:39-45. [PMID: 22280195 DOI: 10.1586/erp.11.93] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The obesity epidemic has transformed children's healthcare, such that diabetes, hypertension and the metabolic syndrome are phrases more commonly used by child health providers than ever before. This article reviews the economic consequences of this epidemic for healthcare delivery systems, both in the short term when obesity has been associated with increased utilization, and in the long term where increased likelihood of adult obesity and cardiovascular disease is well documented. Large investments through research and prevention are needed and are likely to provide strong returns in cost savings, and would optimally emerge through a cooperative effort between private and government payers alike.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University, 227 East 30th Street, Room 711, NY 10016, USA.
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