Perceived child weight status, family structure and functioning, and support for health behaviors in a sample of bariatric surgery patients

Social History of Bariatric Surgery: Relationship to Patient and Associations with Postoperative Outcomes

PURPOSE

There is limited research about the prevalence of patients initiating metabolic and bariatric surgery (MBS) who also know someone who had MBS, referred to as having a social history of MBS. Evidence about the specific relationship of these individuals to the patient, how having a social history of MBS is associated with patients' choice of surgical procedure, and how having a social history of MBS is associated with patients' postoperative outcomes can be used to inform future preoperative assessments. The objective was to (a) define the number of people patients knew who had MBS and relationship to patient, (b) assess congruence between those who had MBS with patients' procedure selection, and (c) explore associations between social history of MBS and postoperative outcomes.

MATERIALS AND METHODS

The sample included 123 patients who had MBS in 2021 (83.7% female; 44.7% Sleeve Gastrectomy, 55.3% Gastric Bypass). For up to 5 people, patients provided their relationship and surgical procedure, and completed the Family Assessment Device (FAD). Bivariate analyses assessed congruence in type of procedure, and social history of MBS with complications, readmissions, and %TWL. Three mixed multilevel models were conducted with (1) close friend, (2) coworker, and (3) close family history of MBS including the FAD on change in %TWL over 12 months with surgical procedure as a covariate.

RESULTS

Ninety-one percent of patients knew someone who had MBS, average 2.66±1.45. Patients reported a close friend (56.1%), close family member (43.9%), and coworker (19.5%) who had MBS. Patients with a close family member who had MBS and reported healthy vs impaired family functioning had greater %TWL over 12 months (p=0.016). Patients with a close friend who had MBS had less %TWL (p=0.015), and patients with a coworker who had MBS had greater %TWL (p=0.012), which did not change over time.

CONCLUSION

Patients with coworkers or close family members with healthy family functioning with a history of MBS had more weight loss, whereas those with close friends with a history of MBS had less weight loss.

Family Dynamics and Functioning of Adolescents from Two-Child and One-Child Families in China

Background

To promote the balanced development with the population, China has phased out a one-child policy in 2016, and a two-child policy was launched, which has led to dramatic changes in family structure. The transition could be a huge challenge for adolescents who are in a period of psychological vulnerability.

Purpose

This study explored the differences and predictors of family dynamics and functioning between two-child and one-child families in the context of China's two-child policy.

Methods

We used the Self-rating scale of Systemic Family Dynamics (SSFD) and Family Assessment Device-General Functioning (FAD-GF) to investigate the family dynamics, family functioning, and family structure and status of 3289 adolescents under the background of China's two-child policy.

Results

Results revealed that the mean scores for family atmosphere, personalization, disease concept, overall family dynamics, and family functioning health rate of the one-child families were higher than those of the two-child families. Parental marital status, mother's education, annual household income, and family economic satisfaction in two-child and one-child families was positively correlated with family dynamics and functioning, but not significantly associated with living style, parental age and employment. Family financial satisfaction, parental marital status, and distress in the family were predictors of family dynamics and functioning, and parental preference was also an important factor in two-child families.

Conclusion

The findings suggest family atmosphere, personality, disease concept, family dynamics, and family functioning of the one-child families were better than those of the two-child families. Unlike one-child families, parental preference is an important predictor of family dynamics and functioning in two child families. This study increases our understanding of adolescents psychological problems during family structure transitions under the background of fertility policy, providing psychologists with more evidence-based evidence and intervention directions.

Improving Relational Functioning in Mother-Daughter Dyads With Obesity

Family-level interventions have the potential to address intergenerational obesity among Mexican American women. Given that poor family functioning is associated with worse weight loss outcomes, this study tested a weight management program aimed at improving relational functioning in mothers and daughters with obesity. Mexican American mothers and their adult daughters were randomly assigned to participate in a 16-week group-based standard behavioral (SB) weight loss program without or with relationship skills training (SRT). Relational functioning was assessed via observational behavioral coding using the Global Structural Family Rating Scale. General relational functioning and specifically positive alliance patterns and conflict avoidance improved significantly more in the SRT group than in the SB group. Average weight changes included percent weight loss of -5.6% in the SRT group versus -3.9% in the SB group and body mass index reduction of -2.2 kg/m2 in the SRT group versus -1.2 kg/m2 in the SB group. More participants in the SRT group (75%) than in the SB group (40%) tended to achieve at least 3% weight loss. Greater changes in positive alliance patterns increased the likelihood of losing 3% of body weight. Improving relational functioning in mother-daughter dyads may promote favorable outcomes in a behavioral weight loss intervention.

Changes in Child Weight, Behaviors, and Family Dynamics during Parental Participation in a Medical Weight Management Program: A Longitudinal Uncontrolled Pilot Study

Background: There is limited evidence of the effects of parental participation in outpatient medical weight management (MWM) programs on children. The aims of the project were to (1) identify time effects from parental participation in the MWM program on changes in child weight trajectories, healthy and unhealthy weight control practices, physical and sedentary activity, parental restrictive feeding and pressure to eat, and family functioning and communication and (2) determine differences based on child factors. Methods: A longitudinal uncontrolled pilot study was conducted, in which parent-child (ages 7-19) dyads completed assessments at parents' MWM program initiation, 3 months (mid-program), 6 months (end of program), and 12 months to determine sustained effects. Repeated measures analysis of variance (ANOVA) was completed using a mixed multilevel modeling approach using Restricted Maximum Likelihood estimation method; each outcome was additionally analyzed with child baseline weight status, age group, and sex as between-subjects factors. Results: Fifty three dyads met inclusion criteria, 23 completed the initial assessment (enrollment: 43.3%), and 13 completed the 12-month assessment (retention: 56.5%). Significant effects over time were observed for decreased parental restrictive feeding (p < 0.038) over 12 months, and group by time effects were observed for increased restrictive feeding for female compared to male children (p = 0.025) over 12 months. Marginally significant group by time effects were found for increased impaired family functioning (p = 0.054) and communication (p = 0.054) for children with overweight/obesity compared to healthy weight children over 12 months. Conclusions: Female children and children with overweight/obesity may experience increased negative family dynamics (restriction of food, family functioning, and communication) through parental MWM programs.

Associations between family functioning during early to mid-childhood and weight status in childhood and adolescence: findings from a Quebec birth cohort

BACKGROUND

Impaired family functioning has been associated with obesity in children and adolescents, but few longitudinal studies exist. We examined whether family functioning from early to mid-childhood is associated with overweight and obesity in later childhood and adolescence.

METHODS

We examined data from the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort (N = 2120), collected between 1998 and 2011. Parent-reported family functioning was assessed at 4 time points between ages 0.5 and 8 years using the McMaster Family Assessment Device with established cut-offs for impaired family functioning. Participants were classified as having experienced: 1) early-childhood impaired functioning, 2) mid-childhood impaired functioning, 3) both early and mid-childhood impaired functioning, or 4) always healthy family functioning. Overweight and obesity were determined at 10- and 13-years using WHO criteria. Covariate adjusted multinomial logistic regressions were fitted to the data to examine associations between longitudinal family functioning groups (using the always healthy functioning as reference category) and the likelihood of having overweight and obesity (vs normal weight) at ages 10 (n = 1251) and 13 years (n = 1226).

RESULTS

In the 10- and 13-year sub-samples, respectively 10.2% and 12.5% of participants had experienced both early and mid-childhood impaired family functioning. Participants in this group had an increased likelihood of having obesity (vs normal weight) at age 10 years [OR = 2.63 (95% CI: 1.36; 5.08)] and at age 13 years [OR = 1.94 (95% CI: 0.99; 3.80] compared to those in the always healthy functioning group. No associations were found for other family functioning categories or for overweight status.

CONCLUSION

Approximately one in ten children experienced impaired family functioning throughout early and mid-childhood. Findings suggest a link between impaired functioning across childhood and the development of obesity at 10 years of age and possibly at 13 years of age.

Parents' Reports of Children's Physical and Sedentary Behavior Engagement among Parents in Weight Management

Background: The purpose of this study was to explore the associations between demographics, family exercise participation, family discouragement of exercise, and the children’s physical and sedentary behaviors to identify specific areas of physical activity intervention for children with parents engaged in medical weight management (MWM). Methods: Parents (n = 294) of children aged 2−18 years old were recruited from two university MWM programs to complete a one-time survey. Bivariate analyses tested associations. Results: Parents reported that sedentary activity was higher for children who identified as racial minorities (t(141) = −2.05, p < 0.05). Mobile phone and tablet use was higher for adolescents compared to school age and young children (H(2) = 10.96, p < 01) Exercise game use was higher for racial minority children compared to white children (U = 9440.5, z = 2.47, p ≤ 0.03). Male children (t(284) = 1.83, p < 0.07), children perceived to have a healthy weight status (t(120) = 4.68, p < 0.00), and younger children (t(289) = 1.79, p < 0.08) all engaged in more strenuous physical activity. Family exercise participation (t(162) = −2.93, p < 0.01) and family discouragement of exercise (U = 7813.50, z = −2.06, p ≤ 0.04) were significantly higher for children in racial minority families. Conclusions: Future work should determine methods to engage children and their parents participating in MWM in physical activities together to ensure that the changes the parents are making with MWM are sustainable.

Couple and family interventions for high mortality health conditions: A strategic review (2010-2019)

The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.

All in the Family: Child and Adolescent Weight Loss Surgery in the Context of Parental Weight Loss Surgery

Background: Bariatric surgery is the most effective current treatment option for patients with severe obesity. More children and adolescents are having surgery, many whose parents have also had surgery. The current study examines whether parental surgery status moderates the association between perceived social support, emotional eating, food addiction and weight loss following surgery, with those whose parents have had surgery evidencing a stronger relationship between the psychosocial factors and weight loss as compared to their peers. Methods: Participants were 228 children and adolescents undergoing sleeve gastrectomy between 2014 and 2019 at one institution. Children and adolescents completed self-report measures of perceived family social support, emotional eating, and food addiction at their pre-surgical psychological evaluation. Change in body mass index (BMI) from pre-surgery to 3, 6, and 12 months post-surgery was assessed at follow-up clinic visits. Parents reported their surgical status as having had surgery or not. Results: There were no differences in perceived family support, emotional eating, or food addiction symptoms between those whose parents had bariatric surgery and those whose parents did not. There were some moderating effects of parent surgery status on the relationship between social support, emotional eating/food addiction, and weight loss following surgery. Specifically, at 3 months post-surgery, higher change in BMI was associated with lower perceived family support only in those whose parents had not had surgery. More pre-surgical food addiction symptoms were associated with greater weight loss at 3 months for those whose parents had not had surgery, whereas this finding was true only for those whose parents had surgery at 12 months post-surgery. Conclusions: Children and adolescents whose parents have had bariatric surgery may have unique associations of psychosocial factors and weight loss. More research is needed to determine mechanisms of these relationships.

Changes in Parent and Child Skin Carotenoids, Weight, and Dietary Behaviors over Parental Weight Management

(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.

Impaired Family Functioning Affects 6-Month and 12-Month Postoperative Weight Loss

PURPOSE

Prior cross-sectional research details the high rate of impaired family functioning, a measure of the overall family environment, among adult bariatric surgery patients; however, family functioning has not been explored in relation to adult patient's postoperative outcomes. The objective of this study was to determine how family functioning affects postoperative patient outcomes including readmission rates, early complications, and 6- and 12-month percent total weight loss (%TWL).

MATERIALS AND METHODS

An observational design at a single-academic medical center was employed. The sample comprised 98 patients, living with ≥1 family member, who enrolled in one of two concurrent studies at the Center. Patients were followed from their surgical intake through 12 months postsurgery; family functioning was assessed within 2 months of their date of surgery. Chi-square and independent t tests determined significant associations between family functioning with readmission and complication rates. Average family functioning was an independent variable in multivariate linear regression models to determine significant correlates of %TWL at 6 and 12 months postsurgery. Patient age, race, and insurance status were included as covariates.

RESULTS

Patients with higher impaired family functioning had significantly less %TWL at 6 (p=.004) and 12 months (p=.030). Black patients also had significantly lower %TWL at 6 (p=.003) and 12 months (p=.009).

CONCLUSION

Family functioning and patient race were both correlates of weight loss at 6 months and 12 months. Future research should explore additional family factors as correlates of patient outcomes following bariatric surgery.

Dyadic reports of weight control practices, sedentary behaviors, and family functioning and communication between adult weight management patients and their children

Background

Parents are increasingly pursuing weight loss in medical weight management programs, yet little is known about the presenting behaviors and practices of children who have parents initiating these programs.

Objective

To describe congruence in weight control practices, sedentary and screen time behaviors, and family functioning and communication between parents initiating a medical weight management program and their children (ages 7-18).

Methods

Twenty-three dyads were enrolled and had measured height/weight and research packets completed including perceived weight status, weight control practices, sedentary and screen-time behaviors, and family functioning and communication. Paired t-tests and intraclass correlations assessed congruence; independent t-tests determined differences based on child demographics (age, sex, and weight status).

Results

Parents underestimated children's use of weight control practices compared to child reports. Children with overweight, males, and older in age had increased weight control practices and sedentary and screen-time behaviors. Children who perceived themselves to have overweight reported more impaired family communication than children perceived to be a healthy weight.

Conclusions

This study highlights the discrepancy between dyads' reports of children's behaviors, and identifies that specific child populations with overweight, older in age, and males are at-risk of experiencing less healthy behaviors and impaired family communication. Future research should monitor changes over time in parental weight management programs to determine effects based on parental weight loss.

Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment

PURPOSE OF REVIEW

The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity.

RECENT FINDINGS

Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.

Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children

OBJECTIVE

To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children.

DESIGN

Cross-sectional survey.

SETTING

Two US weight management centers.

PARTICIPANTS

259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2-18 years) MAIN OUTCOME MEASURE(S): Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation.

ANALYSIS

Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates.

RESULTS

Patients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021).

CONCLUSIONS AND IMPLICATIONS

Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.

Adolescent Bariatric Surgery: Effects of Socioeconomic, Demographic, and Hospital Characteristics on Cost, Length of Stay, and Type of Procedure Performed

BACKGROUND

Despite the efficacy of bariatric surgery in adolescents and the increasing rates of adolescent obesity, the use of bariatric surgery remains low. Treatment cost and length of stay (LOS) could be influencing the utilization of bariatric surgery.

METHODS

We used the Kids' Inpatient Database (KID) from 2006, 2009, and 2012. Adolescents with a primary diagnosis of obesity who underwent bariatric surgery were included. Multinomial logistic and linear regression modeling was used to determine the association of the predictor variables with type of procedure and treatment cost and LOS, respectively.

RESULTS

We identified 1799 adolescents who underwent bariatric surgery. The majority of the subjects were female (77%) and White (60%). The most commonly performed procedure was Roux-en-Y gastric bypass (56%). Race, region, hospital teaching status, and hospital ownership affected the type of procedure performed. Self-pay patients were less likely to undergo Roux-en-Y gastric bypass (RYGB) than sleeve gastrectomy (SG) when compared to patients with private insurance. Teaching hospitals were less likely to perform RYGB or AGB than SG when compared to non-teaching hospitals. Treatment cost was significantly affected by income, teaching hospital status, hospital size, and surgery type. LOS was affected by income quartile, region, and surgery type.

CONCLUSION

Socioeconomic and demographic factors as well as hospital characteristics affect not only the LOS and treatment cost, but also the type of bariatric surgery performed in adolescents. Identifying and understanding the factors influencing procedure choice, treatment cost, and LOS can improve care and healthcare resource utilization.

Adult weight management patients' perceptions of family dynamics and weight status

Our overall objective was to describe the parent-child, romantic, and family dynamics of adult weight management program (WMP) patients, and associations with children's and partners' weight status. First, we determined if family functioning mediated the effect between parent-child feeding practices and perceived child weight status, and romantic relationship anxiety and avoidance and perceived partner weight status. Second, we assessed if perceived child and partner weight status moderated the associations between family functioning and parent-child feeding practices and romantic relationship anxiety and avoidance, respectively. Patients (N=203) who resided with a child and partner from two WMPs completed assessments of parent-child feeding practices (Child Feeding Questionnaire), romantic relationship anxiety and avoidance (Relationship Structures Questionnaire), family functioning (Family Assessment Device General Functioning Scale), and perceived child and partner weight status. Bivariate analyses determined differences in weight status and relationship dynamics and family functioning, and mediation and moderation analyses were conducted to answer the two research questions. Family functioning was not a mediator between romantic relationship dynamics and partner weight status or parent-child dynamics and child weight status. Lower family functioning was associated with higher parent-child restrictive feeding practices, only among children with overweight/obesity. Similarly, lower family functioning was associated with higher anxiety and avoidance in romantic relationships, only for partners with overweight/obesity. Patients with children and/or partners with overweight/obesity reported more impaired family dynamics and functioning, compared to patients with children and/or partners with a healthy weight status.

Rationale and design of a feasibility and acceptability RCT of romantic partner and support figure attendance during bariatric surgery visits

As US obesity rates increase, more patients, particularly females, are seeking out bariatric surgery. As bariatric surgery patients' social supports have been vastly understudied, clinicians and researchers have limited information about how to include support figures, including romantic partners, in the surgery process. To address this gap in knowledge, we are conducting a four-arm randomized controlled trial to assess the feasibility, acceptability and preliminary efficacy for the inclusion of romantic partners and support figures throughout the bariatric surgery process for a group of 110 women age 18 years or older. Patients will be randomized based upon their cohabitating romantic relationships at baseline. Female patients who have a cohabitating romantic partner will be randomized to one of two arms: partner attended (PA), and partner attended treatment as usual (PA-TU). To provide greater detail about social support during the bariatric process, interested patients (female or male) not in cohabitating romantic relationships will be randomized into support figure attended (SFA) and SFA-TU arms. Four data collection points are planned, including 4-months pre-surgery, 2 weeks pre-surgery, 2 weeks and 2-months post-surgery. Feasibility and acceptability of support figure/partner attendance collected at the final data point. Patients and support figures/partners will complete weight status, health behaviors, support for behavior change and relationship quality assessments at each time point. The rationale, design, theoretical framework, and methodology for the study are described. The results of this study will identify how support figures/partners influence patients’ health behavior change and weight loss, and how relationships change over the surgery process.

Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach

Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.