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Davison GM, Monocello LT, Lipsey K, Wilfley DE. Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:589-603. [PMID: 37683261 PMCID: PMC10586458 DOI: 10.1080/15374416.2023.2251164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents. METHOD Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022. RESULTS Family-based treatment (FBT) remains a well-established treatment for overweight and obesity in children and is now well-established in adolescents and toddlers. Parent-only behavioral treatment remains well-established in children and is now well-established among adolescents and children. Possibly effective treatments continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered possibly effective including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for possibly effective treatments. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth). CONCLUSIONS Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.
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Affiliation(s)
- Genevieve M. Davison
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lawrence T. Monocello
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Ling J, Wen F, Robbins LB, Pageau L. Motivational interviewing to reduce anthropometrics among children: A meta-analysis, moderation analysis and Grading of Recommendations Assessment, Development and Evaluation assessment. Pediatr Obes 2022; 17:e12896. [PMID: 35092188 DOI: 10.1111/ijpo.12896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Limited systematic reviews exist to evaluate the effects of motivational interviewing (MI) on children's anthropometric factors. OBJECTIVE This review examined the effects of MI interventions for children and/or parents on children's anthropometric factors and included moderation analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched Cochrane Library, PubMed, CINAHL, EMBASE, PsycINFO, Sociological Abstracts, SPORTDiscus, Education Resources Information Center, and Web of Science in December 2020. A two-step double screening approach was applied: (1) screening titles and abstracts, and (2) screening full-text articles obtained in step 1. At each step, discussion occurred until reaching consensus. The Cochrane risk-of-bias tool was used to evaluate risk of bias, and GRADE system was applied to assess overall quality of evidence. We performed meta-analyses using the Comprehensive Meta-Analysis software. RESULTS A total of 2209 records were found, and 45 eligible articles were retained. MI interventions had a pooled effect of -0.15 on body mass index (BMI; 95% confidence interval [CI]: -0.24 to -0.06), -0.36 on waist circumference (WC; 95% CI: -0.71 to -0.01) and -0.22 on percent body fat (95% CI: -0.41 to -0.03). Child baseline weight status and percent low-income families were identified as significant intervention moderators. According to the GRADE assessment, the quality of evidence on BMI percentile, BMI z-score and percent body fat was moderate, while quality on BMI and WC was low. CONCLUSIONS In conclusion, culturally appropriate clinic- or home-based MI interventions with adequate duration, dose and active parental involvement are promising in reducing anthropometrics among children.
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Affiliation(s)
- Jiying Ling
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Fujun Wen
- Center for Family Health, Jackson, Michigan, USA
| | - Lorraine B Robbins
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Lauren Pageau
- Michigan State University College of Nursing, East Lansing, Michigan, USA
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Laroche HH, Park-Mroch J, O'Shea A, Rice S, Cintron Y, Engebretsen B. Resource mobilization combined with motivational interviewing to promote healthy behaviors and healthy weight in low-income families: An intervention feasibility study. SAGE Open Med 2022; 10:20503121221102706. [PMID: 35707344 PMCID: PMC9189556 DOI: 10.1177/20503121221102706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: This non-randomized pilot trial examined the feasibility and acceptability of an intervention for low-income families with one parent with obesity, glucose intolerance and/or diabetes. Methods: The 12-month intervention combined health coaching using motivational interviewing to promote lifestyle behavior change and community resource mobilization to assist with basic needs plus diet quality and physical activity. Outcome measures included process measures, open-ended questions, and the Family Nutrition and Physical Activity scale. Results: Forty-five families completed an average of 2.1 health coach in-person visits, including 15 families lost to follow-up. Parents who stayed in the intervention reported the intervention was helpful. Some families and the health coach had difficulties contacting one another, and some of these families reported they would have liked more sessions with the coach. The Family Nutrition and Physical Activity scores improved significantly for all children (6 months: 2.9; p < .01; 12 months: 3.2; p < .05) and at 6 months for index children (6 months: 3.5; p < .01; 12 months: 2.9; p = .09). There was variation in the FNPA and other outcome changes between families. Conclusion: This intervention was feasible in terms of recruitment and delivery of family sessions and community referrals and acceptable to participants, but maintaining contact with participants was difficult. Findings warrant improvements to help retention and logistical aspects of communication between families and coaches and testing in a randomized, controlled trial.
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Affiliation(s)
- Helena H Laroche
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Children's Mercy Hospital and Clinics, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jennifer Park-Mroch
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Health & Well-Being, University of Wisconsin-Extension, Madison, WI, USA
| | - Amy O'Shea
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA.,Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Sarai Rice
- Des Moines Area Religious Council (DMARC), Des Moines, IA, USA
| | - Yolanda Cintron
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
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A randomized controlled trial of a community-based obesity intervention utilizing motivational interviewing and community resource mobilization for low-income families: Study protocol and baseline characteristics. Contemp Clin Trials 2022; 112:106626. [PMID: 34801731 PMCID: PMC8805455 DOI: 10.1016/j.cct.2021.106626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023]
Abstract
Low-income, racially diverse families with one parent with obesity are at high risk for child obesity. Effective approaches to promote healthy behaviors and prevent additional weight gain in family members are needed. Motivational interviewing (MI) may assist families to engage, identify motivations for change and establish goals. However, families with limited resources face other barriers to goal achievement that may be addressed through connection with community organizations. This paper describes a unique protocol combining MI and community connection. This randomized controlled trial includes low-income families with one parent with obesity and at least one child aged 6 to 12 years. Families in the intervention group receive an innovative, 12-month intervention combining health coaching using MI to promote lifestyle behavior change goals and community resource mobilization to assist with basic needs and resources to aid goals. The study protocol is modeled on community-based participatory research principles. Data is collected at baseline, 6 months, 12 months, and 18 months include questionnaires, body measurements, and accelerometer data. For adults, primary outcomes are Body Mass Index (BMI), minutes of moderate to vigorous physical activity (MVPA), and hours of sedentary time per day. For children, primary outcomes are sedentary time, MVPA, and the Family Nutrition and Physical Activity Score. From this hard-to-reach population, 236 diverse families were recruited. If the study is deemed effective, it has the potential to demonstrate that the combination of MI, resource mobilization, and utilization of existing community organizations is a sustainable model to assist families at risk for obesity.
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Lee MS, Carcone AI, Ko L, Kulik N, Ellis DA, Naar S. Managing Outliers in Adolescent Food Frequency Questionnaire Data. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:28-35. [PMID: 33012663 PMCID: PMC7855646 DOI: 10.1016/j.jneb.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data. DESIGN This secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial. PARTICIPANTS African American adolescents (n = 181) were recruited from outpatient clinics and community health fairs. VARIABLES MEASURED Data collected included self-reported FFQ and mediators of weight (food addiction, depressive symptoms, and relative reinforcing value of food), caregiver-reported executive functioning, and objectively measured weight status (percentage overweight). ANALYSIS Descriptive statistics examined patterns in study variables at baseline and follow-up. Correlational analyses explored the relationships between FFQ data and key study variables at baseline and follow-up. RESULTS Compared with not removing outliers, using decision rules reduced the number of cases and restricted the range of data. The magnitude of baseline FFQ-mediator relationships was attenuated under all decision rules but varied (increasing, decreasing, and reversing direction) at follow-up. Decision rule use increased the magnitude of change in FFQ estimated energy intake and significantly strengthened its relationship with weight change under 2 fixed range decision rules. CONCLUSIONS AND IMPLICATIONS Results suggest careful evaluation of outliers and testing and reporting the effects of different outlier decision rules through sensitivity analyses.
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Affiliation(s)
| | - April Idalski Carcone
- Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI.
| | - Linda Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Noel Kulik
- Division of Kinesiology, Health and Sport Studies and the Center for Health and Community Impact, College of Education, Wayne State University, Detroit, MI
| | - Deborah A Ellis
- Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL
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Bean MK, Caccavale LJ, Adams EL, Burnette CB, LaRose JG, Raynor HA, Wickham EP, Mazzeo SE. Parent Involvement in Adolescent Obesity Treatment: A Systematic Review. Pediatrics 2020; 146:peds.2019-3315. [PMID: 32839242 PMCID: PMC7461263 DOI: 10.1542/peds.2019-3315] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Family-based lifestyle interventions are recommended for adolescent obesity treatment, yet the optimal role of parents in treatment is unclear. OBJECTIVE To examine systematically the evidence from prospective randomized controlled and/or clinical trials (RCTs) to identify how parents have been involved in adolescent obesity treatment and to identify the optimal type of parental involvement to improve adolescent weight outcomes. DATA SOURCES Data sources included PubMed, PsychINFO, and Medline (inception to July 2019). STUDY SELECTION RCTs evaluating adolescent (12-18 years of age) obesity treatment interventions that included parents were reviewed. Studies had to include a weight-related primary outcome (BMI and BMI z score). DATA EXTRACTION Eligible studies were identified and reviewed, following the Preferred Reporting for Systematic Review and Meta-Analyses guidelines. Study quality and risk of bias were evaluated by using the Cochrane Collaboration risk of bias tool. RESULTS This search identified 32 studies, of which 23 were unique RCTs. Only 5 trials experimentally manipulated the role of parents. There was diversity in the treatment target (parent, adolescent, or both) and format (group sessions, separate sessions, or mixed) of the behavioral weight loss interventions. Many studies lacked detail and/or assessments of parent-related behavioral strategies. In ∼40% of unique trials, no parent-related outcomes were reported, whereas parent weight was reported in 26% and associations between parent and adolescent weight change were examined in 17%. LIMITATIONS Only RCTs published in English in peer-reviewed journals were eligible for inclusion. CONCLUSIONS Further research, with detailed reporting, is needed to inform clinical guidelines related to optimizing the role of parents in adolescent obesity treatment.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Laura J. Caccavale
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth L. Adams
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Hollie A. Raynor
- Department of Nutrition, The University of Tennessee,
Knoxville, Knoxville, Tennessee
| | - Edmond P. Wickham
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Internal Medicine, School of Medicine, Virginia
Commonwealth University, Richmond, Virginia; and
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Department of Psychology, College of Humanities and
Sciences and
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