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Mann K, Miller DiGiacomo R, Mirza N, Vaidya S. Virtual Nutrition Counseling in Pediatric Primary Care: An Integrated Approach to the Prevention and Management of Pediatric Obesity. Clin Pediatr (Phila) 2024:99228241242174. [PMID: 38563419 DOI: 10.1177/00099228241242174] [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: 04/04/2024]
Abstract
Given the rising prevalence of pediatric obesity, new approaches to the delivery of targeted nutrition counseling to not only prevent but also treat pediatric obesity are needed. The integration of a dietitian virtually was a successful quality improvement measure in this academic pediatric primary care clinic. The virtual dietitian provided age-appropriate nutrition counseling at well-child visits from 9 months to 6 years of age. Dietary counseling was also provided for children with overweight and obesity regardless of age. Vegetable, fruit, snack, and dairy intake was assessed in children who received counseling versus those who had traditional well childcare. Improved dairy habits were noted in the counseling cohort. A decrease in body mass index was not demonstrated in the patients with obesity or overweight; however, patient and provider satisfaction was quite high with this novel quality improvement measure. Virtual nutrition counseling can be easily integrated to facilitate a comprehensive pediatric medical home.
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Affiliation(s)
- Katherine Mann
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | | | - Nazrat Mirza
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- IDEAL Pediatric Weight Management Clinic, Department of General Pediatrics & Adolescent Medicine, Children's National Health System, Washington, DC, USA
| | - Susma Vaidya
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- IDEAL Pediatric Weight Management Clinic, Department of General Pediatrics & Adolescent Medicine, Children's National Health System, Washington, DC, USA
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2
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Braddock AS, Bosworth KT, Ghosh P, Proffitt R, Flowers L, Montgomery E, Wilson G, Tosh AK, Koopman RJ. Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study. Appl Clin Inform 2024; 15:368-377. [PMID: 38458233 PMCID: PMC11078569 DOI: 10.1055/a-2283-9036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. METHODS In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. RESULTS Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. CONCLUSION Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
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Affiliation(s)
- Amy S. Braddock
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - K. Taylor Bosworth
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, Missouri, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Emma Montgomery
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Gwendolyn Wilson
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Aneesh K. Tosh
- Department of Child Health, University of Missouri, Columbia, Missouri, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
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3
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Jelalian E, Darling K, Foster GD, Runyan T, Cardel MI. Effectiveness of a Scalable mHealth Intervention for Children With Overweight and Obesity. Child Obes 2023; 19:552-559. [PMID: 36576892 DOI: 10.1089/chi.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Multicomponent interventions are the first line of treatment for pediatric obesity, but are challenging to access. Mobile health (mHealth) interventions hold promise as they address commonly cited barriers for attending in person programs and have potential for wide scale dissemination. Methods: This retrospective cohort study examined data from youth who enrolled in the Kurbo program, which includes personal health coaching and a mobile app. Hierarchical linear regression was used to examine the impact of baseline percentage of the 95th% percentile for body mass index (%BMIp95), number of coaching sessions, and length of time enrolled in the program on change in %BMIp95, controlling for baseline age and sex. Results: A total of 3500 youth (mean age of 12.79 years, 71.3% female) were included. Youth experienced a 0.70 U decrease in BMI [standard deviation (SD) = 2.19] and a 4.45% decrease (SD = 8.5) in %BMIp95 over a mean of 31.5 weeks. The overall regression model was significant, R2 = 0.066, F(3,3494) = 77.18, and p < 0.001. Predictors of decrease in weight status included being female (b = -1.11, p < 0.001), higher baseline %BMIp95, (b = -0.58, p < 0.001), and greater number of coaching sessions (b = -0.12, p < 0.001), while greater time enrolled in the program (b = 0.02, p < 0.001) was associated with less change. Conclusion: Findings suggest a scalable coaching program with integrated digital tools for monitoring diet and activity can lead to significant reductions in weight status. Findings need to be replicated with more rigorous study designs, including a comparison condition and verified assessment of height and weight.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Katherine Darling
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- WW International, Inc., New York, NY, USA
| | | | - Michelle I Cardel
- WW International, Inc., New York, NY, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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4
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Ralph JE, Sezgin E, Stanek CJ, Landier W, Pai ALH, Gerhardt CA, Skeens MA. Improving medication adherence monitoring and clinical outcomes through mHealth: A randomized controlled trial protocol in pediatric stem cell transplant. PLoS One 2023; 18:e0289987. [PMID: 37590237 PMCID: PMC10434937 DOI: 10.1371/journal.pone.0289987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
Medication non-adherence rates in children range between 50% and 80% in the United States. Due to multifaceted outpatient routines, children receiving hematopoietic stem cell transplant (HCT) are at especially high risk of non-adherence, which can be life-threatening. Although digital health interventions have been effective in improving non-adherence in many pediatric conditions, limited research has examined their benefits among families of children receiving HCT. To address this gap, we created the BMT4me© mobile health app, an innovative intervention serving as a "virtual assistant" to send medication-taking reminders for caregivers and to track, in real-time, the child's medication taking, barriers to missed doses, symptoms or side effects, and other notes regarding their child's treatment. In this randomized controlled trial, caregivers will be randomized to either the control (standard of care) group or the intervention (BMT4me© app) group at initial discharge post-HCT. Both groups will receive an electronic adherence monitoring device (i.e., medication event monitoring system "MEMS" cap, Medy Remote Patient Management "MedyRPM" medication adherence box) to store their child's immunosuppressant medication. Caregivers who agree to participate will be asked to complete enrollment, weekly, and monthly parent-proxy measures of their child's medication adherence until the child reaches Day 100 or complete taper from immunosuppression. Caregivers will also participate in a 15 to 30-minute exit interview at the conclusion of the study. Descriptive statistics and correlations will be used to assess phone activity and use behavior over time. Independent samples t-tests will examine the efficacy of the intervention to improve adherence monitoring and reduce readmission rates. The primary expected outcome of this study is that the BMT4me© app will improve the real-time monitoring and medication adherence in children receiving hematopoietic stem cell transplant following discharge, thus improving clinical outcomes.
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Affiliation(s)
- Jessica E. Ralph
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Emre Sezgin
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Charis J. Stanek
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Wendy Landier
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Ahna L. H. Pai
- Cincinnati Children’s Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Micah A. Skeens
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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5
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Skinner AC, Xu H, Christison A, Neshteruk C, Cuda S, Santos M, Yee JK, Thomas L, King E, Kirk S. Patient Retention in Pediatric Weight Management Programs in the United States: Analyses of Data from the Pediatrics Obesity Weight Evaluation Registry. Child Obes 2022; 18:31-40. [PMID: 34415779 DOI: 10.1089/chi.2021.0092] [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: 11/13/2022]
Abstract
Objective: Meeting recommended provider contact hours in multicomponent pediatric weight management (PWM) programs is difficult when patient retention is low. Our objective was to examine associations between individual patient characteristics, program characteristics, and patient retention. Methods: Using the Pediatric Obesity Weight Evaluation Registry, a prospective longitudinal study of 32 PWM programs, we included children (≤18 years; n = 6502) enrolled for a full year. We examined associations between retention (any follow-up visit) and patient and program characteristics using multivariable models with site-clustering random effects. Results: Sixty-seven percent of children had at least one follow-up visit, whereas 12% had four or more visits. Compared with non-Hispanic white children, non-Hispanic black children were less likely to have a follow-up visit [adjusted odds ratio (aOR) = 0.79], whereas Hispanic children (any race) were more likely (aOR = 1.22). Children with Medicaid had similar retention to those with private insurance. Retention did not differ by age, gender, weight status, or comorbidities, nor by program characteristics. Conclusions: Few characteristics of PWM programs are clearly associated with retention, indicating that a variety of formats can support continued treatment and likely reflect the influence of unmeasured characteristics. Clearer ways to identify and overcome barriers for individual patients will be needed to improve retention in PWM.
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Affiliation(s)
- Asheley Cockrell Skinner
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Amy Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Suzanne Cuda
- Department of Pediatrics, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Melissa Santos
- Pediatric Obesity Center, Connecticut Children's, Hartford, CT, USA
| | - Jennifer K Yee
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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6
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Rosenbaum M, Garofano R, Liimatta K, McArthur K, Paul E, Starc T, Sopher AB, Thaker V, Baidal JW. The Families Improving Health Together (FIT) Program: Initial evaluation of retention and research in a multispecialty clinic for children with obesity. Obes Sci Pract 2021; 7:357-367. [PMID: 34401195 PMCID: PMC8346376 DOI: 10.1002/osp4.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity affects ∼17% of US children, with parallel increases in multiple comorbidities, especially among African-, Asian-, Hispanic-, and Native-Americans. Barriers to patient retention in pediatric obesity programs include lack of centralized care, and frequent subspecialty MD visits which conflict with patient school attendance and parental work attendance as well as with support service utilization. Lack of integration of multispecialty clinical care with interdisciplinary research is a major barrier to fuller exploration of the treatment, prevention, and understanding of obesity in childhood. OBJECTIVE To test the hypothesis, a novel multispecialty/interdisciplinary clinical and research infrastructure with strong emphasis on a primary obesity care physician for children with early-onset (<9 years) obesity (Families Improving health Together [FIT]) could promote lower patient attrition (primary goal) and foster productive research in pediatric obesity (secondary goal). RESULTS Data support the hypotheses. Over 15 months, FIT reported a >90% participant retention (p < 0.001 vs. expected rate based on other studies of similar programs). Though 90% of children had at least one adiposity-related comorbidity and 70% had at least two, there was no need for additional subspecialist visits with cardiologists, endocrinologists, gastroenterologists, or molecular geneticists. Three abstracts were presented at national meetings, and two manuscripts were published all with junior faculty as primary authors. CONCLUSION This pilot study suggests that an integrated multispecialty/interdisciplinary approach to children with obesity improves patient retention and can be integrated successfully with research.
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Affiliation(s)
- Michael Rosenbaum
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Robert Garofano
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Kalle Liimatta
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Kerry McArthur
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Erin Paul
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Thomas Starc
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Aviva B. Sopher
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Vidhu Thaker
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Jennifer Woo Baidal
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
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7
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Jachthuber Trub C, Balikcioglu M, Freemark M, Bain J, Muehlbauer M, Ilkayeva O, White PJ, Armstrong S, Østbye T, Grambow S, Gumus Balikcioglu P. Impact of lifestyle Intervention on branched-chain amino acid catabolism and insulin sensitivity in adolescents with obesity. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00250. [PMID: 34277974 PMCID: PMC8279626 DOI: 10.1002/edm2.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 02/16/2021] [Accepted: 03/13/2021] [Indexed: 12/30/2022]
Abstract
Insulin resistance in adolescents with obesity associates with a sex‐dependent metabolic ‘signature’ comprising branched‐chain amino acids (BCAAs), glutamate and C3/C5 acylcarnitines (C3/C5), implicating altered flux through BCAA catabolic pathways. Here, we investigated the effects of lifestyle intervention on BCAA catabolism and insulin sensitivity. We hypothesized (1) weight reduction and improved insulin sensitivity associate with enhanced BCAA catabolism; (2) baseline BCAAs and their metabolic by‐products predict changes in weight and insulin sensitivity during lifestyle intervention.
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Affiliation(s)
| | | | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes and the Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - James Bain
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Michael Muehlbauer
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Phillip J White
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Sarah Armstrong
- Division of General Pediatrics Duke University Medical Center Durham NC USA.,Department of Family Medicine and Community Health Duke University Medical Center Durham NC USA.,Department of Population Health Sciences Duke University Medical Center Durham NC USA.,Duke Clinical Research Institute Duke University Medical Center Durham NC USA
| | - Truls Østbye
- Department of Family Medicine and Community Health Duke University Medical Center Durham NC USA
| | - Steven Grambow
- Department of Biostatistics and Bioinformatics Duke University Medical Center Durham NC USA
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes and the Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
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8
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Ball GDC, Sebastianski M, Wijesundera J, Keto-Lambert D, Ho J, Zenlea I, Perez A, Nobles J, Skelton JA. Strategies to reduce attrition in managing paediatric obesity: A systematic review. Pediatr Obes 2021; 16:e12733. [PMID: 32959990 DOI: 10.1111/ijpo.12733] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature for strategies designed to reduce attrition in managing paediatric obesity. METHODS We searched Ovid Medline (1946 to May 6, 2020), Ovid Embase (1974 to May 6, 2020), EBSCO CINAHL (inception to May 6, 2020), Elsevier Scopus (inception to April 14, 2020), and ProQuest Dissertations & Theses (inception to April 14, 2020). Reports were eligible if they included any obesity management intervention, included 2 to 18 year olds with overweight or obesity (or if the mean age of participants fell within this age range), were in English, included experimental study designs, and had attrition reduction as a main outcome. Two team members screened studies, abstracted data, and appraised study quality. RESULTS Our search yielded 5,415 original reports; six met inclusion criteria. In three studies, orientation sessions (n = 2) and motivational interviewing (MI) (n = 1) were used as attrition-reduction strategies before treatment enrollment; in three others, text messaging (n = 2) and MI (n = 1) supplemented existing obesity management interventions. Attrition-reduction strategies led to decreased attrition in two studies, increased in one, and no difference in three. For the two strategies that reduced attrition, (a) pre-treatment orientation and (b) text messaging between children and intervention providers were beneficial. The quality of the six included studies varied (good [n = 4]; poor [n = 2]). CONCLUSION Some evidence suggests that attrition can be reduced. The heterogeneity of approaches applied and small number of studies included highlight the need for well-designed, experimental research to test the efficacy and effectiveness of strategies to reduce attrition in managing paediatric obesity.
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Jessica Wijesundera
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Josephine Ho
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - James Nobles
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina, USA
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Bowen-Jallow K, Nunez-Lopez O, Wright A, Fuchs E, Ahn M, Lyons E, Jupiter D, Berry L, Suman O, Radhakrishnan RS, Glaser AM, Thompson DI. Wearable Activity Tracking Device Use in an Adolescent Weight Management Clinic: A Randomized Controlled Pilot Trial. J Obes 2021; 2021:7625034. [PMID: 33505717 PMCID: PMC7811568 DOI: 10.1155/2021/7625034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The use of physical activity tracker devices has increased within the general population. However, there is limited medical literature studying the efficacy of such devices in adolescents with obesity. In this study, we explored the feasibility of using wearable activity tracking devices as an adjunct intervention on adolescents with obesity. METHODS Randomized controlled pilot trial evaluated the feasibility (attrition ≤50%) of an activity tracking intervention (ATI) and its effects on weight loss in adolescents with obesity enrolled in an adolescent weight management clinic (AWMC). Outcomes included feasibility (attrition rate) and absolute change in BMI. Differences between groups at 6, 12, and 18 weeks were examined. RESULTS Forty-eight participants were enrolled in the study. Eighteen subjects were randomly assigned to the ATI group and 30 to control. The average age was 14.5 years. Overall, the majority of participants were Hispanic (56%). Sexes were equally distributed. The average baseline BMI was 37.5 kg/m2. At the study conclusion, the overall attrition rate was 52.1%, 44.4% in the ATI group versus 56.6% in the control group, with a differential attrition of 12.2%. The ATI and control groups each showed an absolute decrease in BMI of -0.25 and -2.77, respectively, with no significant differences between the groups. CONCLUSION The attrition rate in our study was >50%. Participation in the AWMC by the ATI and control groups resulted in maintenance of BMI and body weight for the study duration. However, the use of an activity tracking device was not associated with greater weight loss. This trial is registered with NCT03004378.
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Affiliation(s)
- Kanika Bowen-Jallow
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Omar Nunez-Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Alex Wright
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Erika Fuchs
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mollie Ahn
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Elizabeth Lyons
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Lindsey Berry
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Oscar Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ravi S. Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea M. Glaser
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Deborah I. Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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10
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Slowik V, Wasserkrug H, Fischer RT, Connelly M, Deacy AD, Hampl S, Daniel JF. Readiness to Change and Prospective Effects of Weight Management Programs in Pediatric Nonalcoholic Fatty Liver Disease. Clin Transl Sci 2020; 14:582-588. [PMID: 33142354 PMCID: PMC7993262 DOI: 10.1111/cts.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
Non‐alcoholic fatty liver disease (NAFLD) is an increasing problem in pediatrics with limited treatment options. We prospectively assessed outcomes in patients managed in a hepatology clinic (HC) alone vs. those managed in combination with a multidisciplinary weight management program (MWMP). We describe each group’s readiness to change at the time of NAFLD diagnosis. Patients diagnosed with NAFLD were given a modified Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) at enrollment (T1) to assess readiness to change. They were then followed at 3–9 months (T2) and at 10–15 months (T3). Linear mixed models were used to evaluate changes in body mass index (BMI), BMI z‐score, and transaminases over time and between the two groups. There were no significant treatment group main effects or treatment × time interactions for our primary end points for HC alone (n = 75) or with MWMP (n = 18). There was a significant main effect for time for BMI z‐score, with BMI z‐scores declining on average by 0.0568 (P = 0.004) from visit to visit. Low SOCRATES subscales scores in HC alone (n = 33) or with MWMP (n = 4) suggested a patient population with low recognition of disease and likelihood of taking steps for change. Patients with obesity and NAFLD had low scores on all three SOCRATES subscales. Despite this, both groups had improvement in BMI z‐score without significant difference between the two treatment groups in other primary end points. Further study is needed to identify the most effective patient selection and treatment strategies for pediatric patients with NAFLD, including pharmacotherapy and surgery.
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Affiliation(s)
- Voytek Slowik
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Heather Wasserkrug
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Ryan T Fischer
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Mark Connelly
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Amanda D Deacy
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Developmental and Behavioral Health, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Sarah Hampl
- Division of General Academic Pediatrics and Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
| | - James F Daniel
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri, USA
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11
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Brown CL, Dovico J, Garner-Edwards D, Moses M, Skelton JA. Predictors of Engagement in a Pediatric Weight Management Clinic after Referral. Child Obes 2020; 16:238-243. [PMID: 32484761 PMCID: PMC7262647 DOI: 10.1089/chi.2020.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Little is known about factors that affect a family's ability to engage in pediatric weight management clinics (PWMCs). We aimed at comparing child and family characteristics of patients referred to a PWMC by participants' attendance at orientation, attendance at intake, or completing the program. Methods: We performed a retrospective study of patients ages 2-18 years referred to a PWMC between 2014 and 2017. We extracted data from electronic medical records and clinic databases, including age, sex, race/ethnicity, language, referral year, address, and insurance. We performed t-tests and chi-square tests to examine the association of engagement outcomes with covariates. We used separate multivariate logistic regression models to assess the predictors of engagement outcomes, including significant covariates from bivariate analyses. Results: Participants (N = 2020 referred) had a mean age of 11.5 ± 3.5 years; 72% had Medicaid, and 34% lived in city limits. Participants were 39% white, 30% black, and 27% Hispanic. Of those referred, 41% attended orientation, 14% attended intake, and 9% completed. Significant predictors of attending orientation were age [odds ratio (OR): 0.93, 95% confidence interval (CI): 0.91-0.96], male sex (OR: 0.74, 95% CI: 0.60-0.91), Hispanic ethnicity (OR: 1.69, 95% CI: 1.26-2.26), living in city limits (OR: 1.39, 95% CI: 1.11-1.75), and Medicaid (OR: 0.77, 95% CI: 0.60-0.98). Significant predictors of attending intake were age (OR: 0.93, 95% CI: 0.90-0.96), Medicaid (OR: 0.61, 95% CI: 0.46-0.81), and 2017 referral year (OR: 0.21, 95% CI: 0.12-0.35). Hispanic ethnicity was associated with twice the odds of completion (OR: 2.07, 95% CI: 1.10-3.91). Conclusions: Child and family characteristics more strongly predicted initial engagement with a PWMC than completion. Future research should examine how targeting these predictors (e.g., referring at younger age) can improve PWMC engagement.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Address correspondence to: Callie L. Brown, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jaclyn Dovico
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dara Garner-Edwards
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Melissa Moses
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
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12
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DeSilva S, Vaidya SS. The Application of Telemedicine to Pediatric Obesity: Lessons from the Past Decade. Telemed J E Health 2020; 27:159-166. [PMID: 32293986 DOI: 10.1089/tmj.2019.0314] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Telemedicine has been utilized to deliver pediatric weight management care in both rural and urban communities. This method of health care delivery may provide a solution to the many logistical obstacles to pediatric obesity management, including time, finances, and distance to programs. Objectives: This review examines all studies in the past decade that employed telehealth communication directly between families and obesity specialists to treat pediatric obesity. To assess the practical use of such programs, studies that surveyed family satisfaction with this method of health care are also included. Methods: A comprehensive electronic database search was conducted in PubMed/MEDLINE, Scopus, CINAHL, and Cochrane Library databases. Results: All studies demonstrated noninferiority in clinical efficacy as measured by weight status improvement in participants of either the telehealth cohort or the in-person cohort. Attrition rates were also not statistically significant between groups. Patient satisfaction with telemedicine delivery was high across studies. Lack of statistical significance in outcomes of these studies can be attributed to infrequent visits, limited duration of programs, and study size. Conclusions: Future research is needed to evaluate the effect on health outcomes as well as compliance when direct to consumer telemedicine visits are integrated in pediatric weight management clinics with more frequency and for longer duration. This method of telemedicine would allow for increased contact with patients and families in between face-to-face encounters. Telehealth provides the potential to create more robust, accessible, and effective pediatric weight management programs.
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Affiliation(s)
- Samantha DeSilva
- The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Susma Shanti Vaidya
- Obesity Program, Children's National Medical Center, Washington, District of Columbia, USA
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13
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Morrow AS, Sandridge S, Herring W, King K, Lanciers S, Lim CS. Characterizing attendance patterns at a multidisciplinary pediatric obesity clinic. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1740884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anne S. Morrow
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
- Center for Children and Families, Florida International University, Miami, FL, USA
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Shanda Sandridge
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Whitney Herring
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Krista King
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sophie Lanciers
- Pediatric Gastroenterology, Tulane University, New Orleans, LA, USA
| | - Crystal Stack Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
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14
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Stephens TN, Joerin A, Rauws M, Werk LN. Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot. Transl Behav Med 2020; 9:440-447. [PMID: 31094445 DOI: 10.1093/tbm/ibz043] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Behavioral intervention technologies (BITs) are unique ways to incorporate the benefits of technology and psychology to address differing health needs through various media, including Internet interventions, mobile apps, and video games. BITs present several possible benefits, including increased dissemination and accessibility, cost-effectiveness, increased engagement, and decreased stigma, especially among youth. A behavioral coaching chatbot, Tess, addresses different facets of behavioral health, such as depression and anxiety. Available 24/7, Tess delivers customized integrative support, psychoeducation, and interventions through brief conversations via existing communication channels (i.e., SMS text messaging and Facebook Messenger). This study assessed the feasibility of integrating Tess in behavioral counseling of adolescent patients (n = 23; Mage = 15.20 years; Rangeage = 9.78-18.54 years; 57% female) coping with weight management and prediabetes symptoms. Tess engaged patients via a preferred method of communication (SMS text messaging) in individualized conversations to promote treatment adherence, behavior change, and overall wellness. Adolescent patients reported experiencing positive progress toward their goals 81% of the time. The 4,123 messages exchanged and patients' reported usefulness ratings (96% of the time) illustrate that adolescents engaged with and viewed this chatbot as helpful. These results highlight the feasibility and benefit of support through artificial intelligence, specifically in a pediatric setting, which could be scaled to serve larger groups of patients. As a partner to clinicians, Tess can continue the therapeutic interaction outside office hours while maintaining patient satisfaction. Due to Tess's capacity for continuous learning, future iterations may have additional features to increase the user experience.
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Affiliation(s)
- Taylor N Stephens
- Children and Adolescents Psychotherapy and Technology (CAPT) Research Lab, Palo Alto University, Palo Alto, CA, USA
| | | | | | - Lloyd N Werk
- Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA.,College of Medicine, University of Central Florida, Orlando, FL, USA
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15
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Gorecki MC, Feinglass JM, Binns HJ. Characteristics Associated with Successful Weight Management in Youth with Obesity. J Pediatr 2019; 212:35-43. [PMID: 31230887 DOI: 10.1016/j.jpeds.2019.05.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify the medical, demographic, and behavioral factors associated with a reduction of body mass index percent of the 95th percentile (BMIp95) after 1 year for patients receiving care at a tertiary care obesity management clinic. STUDY DESIGN A retrospective review of data from first and 12 ± 3-month follow-up visits of subjects aged 8-17 years with obesity. Data included anthropometrics, demographics, medical/psychological history, reported diet patterns, and participation in moderate/vigorous physical activity. After analyzing factors associated with 1-year follow-up, we used a forward conditional logistic regression model, controlling for subject's sex, to examine associations with a BMIp95 ≥5-point decrease at 1 year. RESULTS Of 769 subjects, 184 (23.9%) had 1-year follow-up. Boys more often had follow-up (28.4% vs girls, 19.1%; P = .003). The follow-up sample was 62.0% male, 65.8% Hispanic, and 77.7% with public insurance; 33.2% achieved a ≥5-point decrease in BMIp95. In regression results, the ≥5-point decrease group was more likely to have completed an initial visit in April-September (OR 2.0, 95% CI 1.1-3.9); have increased physical activity by 1-2 d/wk (OR 3.4, 95% CI 1.4-7.8) or increased physical activity by ≥ 3 d/wk at 1 year (OR 2.7, 95% CI 1.1-6.3); and less likely to have been depressed at presentation (OR 0.4, 95% CI 0.2-0.9). Demographic and dietary factors were not significantly associated with BMIp95 group status. CONCLUSIONS Strategies improving follow-up rates, addressing mental health concerns, and promoting year-round physical activity are needed to increase the effectiveness of obesity management clinics.
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Affiliation(s)
| | - Joseph M Feinglass
- Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Helen J Binns
- Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University, Chicago, IL; Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Chicago, IL.
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16
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Hill SG, Phan TLT, Datto GA, Hossain J, Werk LN, Abatemarco D. Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States. J Child Health Care 2019; 23:63-78. [PMID: 29792063 PMCID: PMC6105559 DOI: 10.1177/1367493518777308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.
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Affiliation(s)
- Samareh G Hill
- Department of Pediatric Weight Management, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Thao-Ly T Phan
- Division of Weight Management, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - George A Datto
- Division of Weight Management, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Jobayer Hossain
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Lloyd N Werk
- Division of General Academic Pediatrics, Nemours Children’s Hospital, Orlando, FL, USA
| | - Diane Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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17
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Phan TLT, Barnini N, Xie S, Martinez A, Falini L, Abatemarco A, Waldron M, Benton JM, Frankenberry S, Coleman C, Nguyen L, Bo C, Datto GA, Werk LN. Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial. JMIR Mhealth Uhealth 2018; 6:e10523. [PMID: 30482743 PMCID: PMC6290267 DOI: 10.2196/10523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 12/31/2022] Open
Abstract
Background Fitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. Objective We conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. Methods Adolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. Results A total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). Conclusions Despite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions.
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Affiliation(s)
- Thao-Ly Tam Phan
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, United States.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Division of Weight Management, Nemours Children's Health System, Wilmington, DE, United States
| | - Nadia Barnini
- Cardiac Center, Nemours Children's Hospital, Orlando, FL, United States
| | - Sherlly Xie
- Biostatistics Core, Department of Biomedical Research, Nemours Children's Health System, Wilmington, DE, United States
| | - Angelica Martinez
- Division of General Academic Pediatrics, Nemours Children's Hospital, Orlando, FL, United States
| | - Lauren Falini
- Division of Weight Management, Nemours Children's Health System, Wilmington, DE, United States
| | - Atiera Abatemarco
- Division of General Academic Pediatrics, Nemours Children's Hospital, Orlando, FL, United States
| | - Maura Waldron
- Department of Kinesiology, West Chester University, West Chester, PA, United States
| | - Jane M Benton
- Division of General Academic Pediatrics, Nemours Children's Hospital, Orlando, FL, United States
| | - Steve Frankenberry
- Division of General Academic Pediatrics, Nemours Children's Hospital, Orlando, FL, United States
| | - Cassandra Coleman
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Linhda Nguyen
- Division of Weight Management, Nemours Children's Health System, Wilmington, DE, United States
| | - Cindy Bo
- Strategy and Business Development, Nemours Children's Health System, Wilmington, DE, United States
| | - George A Datto
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Division of Weight Management, Nemours Children's Health System, Wilmington, DE, United States
| | - Lloyd N Werk
- Division of General Academic Pediatrics, Nemours Children's Hospital, Orlando, FL, United States.,College of Medicine, University of Central Florida, Orlando, FL, United States
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18
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Hawkins MJ, Wiggins SA, Struwe L. A retrospective review of patient outcomes in the pediatric HEROES weight management program. Appl Nurs Res 2018; 43:18-23. [PMID: 30220358 DOI: 10.1016/j.apnr.2018.06.017] [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: 01/02/2018] [Revised: 06/14/2018] [Accepted: 06/23/2018] [Indexed: 11/26/2022]
Abstract
Pediatric obesity is a public health concern in the U.S. The purpose of this study was to describe the impact of a pediatric stage 3 and 4 weight management program. Program aims measured: change in biometric values using BMI z-scores; intervention attrition rate; and health-related quality of life (HRQOL) from admission through the initial six months of the program. The program evaluation included a retrospective review of 884 electronic records. Of the 698 children that met the inclusion criteria, 468 completed at least one follow-up visit within the baseline to 6 month time period. Overall 66.38% of the 468 maintained program involvement at the 6 month evaluation. Of the 468 who completed the 6 months, 192 children/families participated in the clinic only program and 276 participated both in the clinic and a 12 week contract education/fitness and exercise intervention. The completion rate for the contract intervention was 7.3%. All children demonstrated a decrease in BMI z-scores. There were no statistically significant differences (p = 0.276) in the BMI z-change scores from baseline to 6 months in the clinic only program; those who did not complete the education/fitness and exercise intervention, and those who completed the education/fitness and exercise intervention. Children demonstrated a statistically significant improvement in their overall HRQOL scale score (p = 0.001) from baseline to the 6 month evaluation. The results indicate the impact of attrition and HRQOL in weight management programs. Further research is needed to develop and strengthen the effectiveness of weight management interventions.
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Affiliation(s)
- Mary Jane Hawkins
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA.
| | - Shirley A Wiggins
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA; University of Nebraska Medical Center, College of Nursing, 1230 O Street, Suite 131 P.O. 880220, Lincoln, NE, 68588-0220, USA.
| | - Leeza Struwe
- Niedfelt Nursing Research Center, University of Nebraska Medical Center, 1230 O Street, Suite 131, P.O. 880220, College of Nursing, Lincoln, NE, 68588-0220, USA.
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19
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Phan TLT, Chen FF, Pinto AT, Cox C, Robbins J, Kazak AE. Impact of Psychosocial Risk on Outcomes among Families Seeking Treatment for Obesity. J Pediatr 2018; 198:110-116. [PMID: 29628410 PMCID: PMC6019163 DOI: 10.1016/j.jpeds.2018.02.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/19/2018] [Accepted: 02/28/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To test the hypothesis that children with elevated psychosocial risk would have increased attrition and worse weight outcomes in weight management treatment. STUDY DESIGN This was a prospective cohort study of 100 new patients, aged 4-12 years, in a weight management clinic. Parents completed the Psychosocial Assessment Tool. Logistic regression analyses were conducted to calculate the odds of attrition from the clinic and a nonmeaningful change in body mass index (BMI) z-score (ie, <0.1 unit decrease in BMI z-score) over a 6-month period based on psychosocial risk category, adjusting for child demographics and baseline weight category. RESULTS The majority of patients were male (59%), black (36%) or white (43%), and had severe obesity (55%), and 59% of families were categorized as having moderate or high psychosocial risk. Over the 6-month period, 53% of families were lost to follow-up, and 67% did not have a clinically meaningful decrease in BMI z-score. Compared with children of families with low psychosocial risk, children of families with moderate or high psychosocial risk were 3.1 times (95% CI, 1.3-7.2 times) more likely to be lost to follow-up and 2.9 times (95% CI, 1.1-7.9 times) more likely to have a non-clinically meaningful change in BMI z-score. CONCLUSIONS Children presenting with increased psychosocial risk have higher attrition and poorer weight outcomes, supporting the need for psychosocial screening as a standard component of pediatric weight management treatment.
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Affiliation(s)
- Thao-Ly T. Phan
- Department of Pediatrics, Nemours Children's Health System, Wilmington, DE,Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE
| | - Fang Fang Chen
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE
| | - Alison Taggi Pinto
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE
| | - Courtney Cox
- Department of Pediatrics, Nemours Children's Health System, Wilmington, DE
| | - Jennifer Robbins
- Department of Pediatrics, Nemours Children's Health System, Wilmington, DE
| | - Anne E. Kazak
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE
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20
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van der Heijden LB, Feskens EJM, Janse AJ. Maintenance interventions for overweight or obesity in children: a systematic review and meta-analysis. Obes Rev 2018; 19:798-809. [PMID: 29363283 DOI: 10.1111/obr.12664] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
Childhood obesity is associated with significant health consequences. Although several intervention programmes for children result in weight loss or stabilization in the short-term, preventing relapse after treatment remains an important challenge. This systematic review summarizes the evidence about maintenance interventions after treatment in childhood obesity. Studies were identified by searching PubMed, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, CINAHL and SocINDEX. The primary outcome measure for this review was body mass index standard deviation score (BMI-Z-score). Data were pooled using quality effect models. Eleven studies (1,532 participants, age 2-18 years) were included, covering a wide range of maintenance approaches. Included studies varied widely in methodological quality. Pooled analysis showed that the BMI-Z-score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for 'face-to-face' versus 'on distance' interventions was shown. In summary, this review shows that, although there is limited quality data to recommend one maintenance intervention over another, continued treatment does have a stabilizing effect on BMI-Z-score. Considering the magnitude of the problem of childhood obesity, this is an important finding that highlights the need for further research on weight loss maintenance.
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Affiliation(s)
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - A J Janse
- Department of Pediatrics, Hospital Gelderse Vallei, Ede, The Netherlands
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21
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Shoemaker A, Cheng P, Gal RL, Kollman C, Tamborlane WV, Klingensmith GJ, Clements MA, Hannon TS, Heptulla R, Less J, Wood J. Predictors of Loss to Follow-Up among Children with Type 2 Diabetes. Horm Res Paediatr 2018; 87:377-384. [PMID: 28505610 DOI: 10.1159/000475595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Youth with type 2 diabetes (T2D) have poor compliance with medical care. This study aimed to determine which demographic and clinical factors differ between youth with T2D who receive care in a pediatric diabetes center versus youth lost to follow-up for >18 months. METHODS Data were analyzed from 496 subjects in the Pe-diatric Diabetes Consortium registry. Enrollment variables were selected a priori and analyzed with univariable and multivariable logistic regression models. RESULTS After a median of 1.3 years from enrollment, 55% of patients were lost to follow-up. The final model included age, race/ethnicity, parent education, and estimated distance to study site. The odds ratio (99% confidence interval) of loss to follow-up was 2.87 (1.34, 6.16) for those aged 15 to <18 years versus those aged 10 to <13 years and 6.57 (2.67, 16.15) for those aged ≥18 years versus those aged 10 to <13 years. Among patients living more than 50 miles from the clinic, the odds ra tio of loss to follow-up was 3.11 (1.14, 8.49) versus those living within 5 miles of the site. CONCLUSION Older adolescents with T2D are more likely to be lost to follow-up, but other socioeconomic factors were not significant predictors of clinic follow-up.
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Affiliation(s)
- Ashley Shoemaker
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peiyao Cheng
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - William V Tamborlane
- Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | | | - Tamara S Hannon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Joane Less
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Jamie Wood
- University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | -
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Jaeb Center for Health Research, Tampa, Florida, USA.,Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut, USA.,Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA.,Children's Mercy Kansas City, Kansas City, Missouri, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Albert Einstein College of Medicine, Bronx, New York, USA.,University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.,University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
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Ward WL, Shaffer LA, Testa EG. Pediatric Psychologists' Collaboration in a National Pediatric Obesity Initiative: A Case Study in Interprofessional Collaboration. J Clin Psychol Med Settings 2018; 25:367-389. [PMID: 29468566 DOI: 10.1007/s10880-018-9540-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Health Care reform calls for collaborative team-based care; psychologists must therefore strengthen their competencies for work in interprofessional clinical care settings. Toward that end, a group of psychologists participated with physicians, dieticians, physical activity specialists, nurses, and others in a national interprofessional workgroup focused on pediatric obesity. The interprofessional group was designed to identify areas in need of national advocacy, key assessment and treatment concerns, and gaps in internal policies and procedures in children's hospitals. This article provides a case report of psychologists' roles and experience in this workgroup, and focuses on factors that underlie successful collaboration among diverse health professionals, as well as potential barriers to success. The participating psychologists developed a working model for collaboration with other disciplines. Additionally, they formed a Psychology Subcommittee to identify and address discipline-specific issues regarding collaborative practice in pediatric psychology. Lessons learned in this interprofessional collaborative undertaking have relevance for future collaborative endeavors.
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Affiliation(s)
- Wendy L Ward
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-21, Little Rock, AR, 72202-3591, USA.
| | - Laura A Shaffer
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Elizabeth Getzoff Testa
- Division of Pediatric Psychology/Neuropsychology, Mt Washington Pediatric Hospital, Baltimore, MD, USA
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Dieris B, Reinehr T. Treatment programs in overweight and obese children: How to achieve lifestyle changes? ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.obmed.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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