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Luppino G, Wasniewska M, Casto C, Ferraloro C, Li Pomi A, Pepe G, Morabito LA, Alibrandi A, Corica D, Aversa T. Treating Children and Adolescents with Obesity: Predictors of Early Dropout in Pediatric Weight-Management Programs. CHILDREN (BASEL, SWITZERLAND) 2024; 11:205. [PMID: 38397317 PMCID: PMC10887674 DOI: 10.3390/children11020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Possible therapeutic failure of pediatric obesity is influenced by the high dropout rate. The aim of this study was to evaluate the rate of dropout and the rate of weight loss over the 24 months of follow-up. METHODS The retrospective, single-center study, involved 489 patients followed for obesity in the period 2016-2020. Patients' auxological data and blood samples were collected during the first (V1) and last visit (V2). Dropout was defined as a follow-up of less than 12 months and/or including less than one visit every 6 months. Patients were divided into two groups and compared: Group A of dropout (297 patients) and Group B of non-dropout (192 patients). RESULTS In the follow-up period, which had a mean duration of 24 months, the dropout rate was 60.7%. In Group A, the percentage of patients with BMI ≥ 3 SD at V2 was significantly higher than that in Group B. In Group B, the percentage of patients with pathological HOMA-IR and with fasting glucose >100 mg/dL was higher than group A. The probability of dropout was positively associated with pubertal stage and negatively with impaired fasting glycemia and pathological insulinemia at V1. CONCLUSION The study demonstrated a high dropout rate during follow-up, mainly among adolescents and patients with no glucometabolic alterations.
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Affiliation(s)
- Giovanni Luppino
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Celeste Casto
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Chiara Ferraloro
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Letteria Anna Morabito
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Angela Alibrandi
- Department of Economics, University of Messina, 98125 Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Pediatric Unit, AOU Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
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Cox JS, Searle A, Thornton G, Hamilton-Shield JP, Hinton EC. Integrating COM-B and the person-based approach to develop an ACT based therapy programme to raise self-determination in adolescents with obesity. BMC Health Serv Res 2023; 23:1158. [PMID: 37884913 PMCID: PMC10601199 DOI: 10.1186/s12913-023-09930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND This paper details the development of the Adolescent Intrinsic Motivation 'AIM2Change' intervention to support weight-management in young people previously unable to make changes whilst attending a tier 3 weight management service for children and young people. AIM2Change is an acceptance and commitment therapy based intervention that will be delivered one-to-one online over a seven-week period. METHODS To develop this intervention, we have triangulated results from a qualitative research study, patient and public involvement groups (PPI) and a COM-B (capability, opportunity, motivation, behaviour) analysis, in a method informed by the person-based approach. RESULTS The integrated development approach yielded a broad range of perspectives and facilitated the creation of a tailored intervention to meet the needs of the patient group whist remaining pragmatic and deliverable. CONCLUSIONS The next steps for this intervention will be in-depth co-development of the therapy sessions with service users, before implementing a proof of concept trial.
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Affiliation(s)
- Jennifer S. Cox
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
| | - Gail Thornton
- Ms Gail Thornton, Patient & Public Involvement Representative, Bristol, UK
| | - Julian P. Hamilton-Shield
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
| | - Elanor C. Hinton
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
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Ad G, Dc G, Nj J, Se W, Tr B, Slusser W, Pj C. A Hybrid Mobile Phone Feasibility Study Focusing on Latino Mothers, Fathers, and Grandmothers to Prevent Obesity in Preschoolers. Matern Child Health J 2023; 27:1621-1631. [PMID: 37347374 PMCID: PMC10359399 DOI: 10.1007/s10995-023-03700-w] [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] [Accepted: 05/20/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To pilot the feasibility of a mobile phone childhood obesity intervention for family caregivers of Latino preschool-aged children. METHODS An evidence-based early childhood obesity intervention was adapted to have cultural relevance and a shorter-length curriculum for mothers, fathers, and grandmothers of 2- to 5-year-old Latino children. Traditional in-person group sessions (four weeks) were combined with eight weeks of mobile phone content to support parenting skills and evidence-based and age-appropriate nutritional practices in either English or Spanish. A convenience sample of Latino families were recruited from WIC and Early Education Centers in East Los Angeles. Feasibility measures were collected. Child and caregiver height and weight were measured, and caregiver surveys of child dietary intake were collected at baseline, 1- and 6-month post-baseline. Changes in child's dietary intake and BMI, as well as caregiver BMI, were examined using a mixed effects linear regression model with family random intercept and nested random slope for time period of measurement. RESULTS The program was delivered to 64 low-income Latino families (46 mothers, 34 fathers, 16 grandmothers, and 48 children). Children had a reduction in raw BMI, BMI percentile, and BMI z-scores at 6-months post-baseline compared to baseline measurements. The study also demonstrated stable BMI outcomes among all caregivers. CONCLUSION The pilot study shows promise in preventing childhood obesity, and having a multi-generational impact on weight outcomes. Leveraging the high-use of mobile phones has the potential to shorten in-person interventions, and engage fathers and grandmothers who play an important role in shaping healthy weight practices in young children.
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Affiliation(s)
- Guerrero Ad
- UCLA Department of Pediatrics and Children's Discovery and Innovation Institute, Los Angeles, CA, USA.
| | - Glik Dc
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jackson Nj
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA
| | - Whaley Se
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC, Irwindale, CA, USA
| | - Belin Tr
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - W Slusser
- UCLA Department of Pediatrics and Children's Discovery and Innovation Institute, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Semel Healthy Campus Initiative Center, Los Angeles, CA, USA
| | - Chung Pj
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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4
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Rojo M, Lacruz T, Solano S, Gutiérrez A, Beltrán‐Garrayo L, Veiga OL, Graell M, Sepúlveda AR. Family-reported barriers and predictors of short-term attendance in a multidisciplinary intervention for managing childhood obesity: A psycho-family-system based randomised controlled trial (ENTREN-F). EUROPEAN EATING DISORDERS REVIEW 2022; 30:746-759. [PMID: 35644038 PMCID: PMC9796111 DOI: 10.1002/erv.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study was aimed to examine patient enrolment in the pre-intervention stage, family-reported barriers, attendance rates and underlying predictors of short-term attendance in a family-system-based randomised controlled trial for managing childhood obesity in children aged 8-12-years-old (ENTREN-F). METHOD Psychosocial and anthropometric measures were collected through primary health referral. The data were used for descriptive analyses of sample characteristics and linear regression analyses. RESULTS Low enrolment rates and several family-reported barriers were observed in the pre-intervention stage. Logistical barriers were the most frequent family-reported reason for attrition in the different stages of the study. Having a first face-to-face orientation session with the families and the use of motivational interviewing helped to improve adherence in the initial phases of the study. After 6 months of intervention, family based treatments (FBTs) under consideration achieve greater adherence compared with the standard intervention. Moreover, family involvement was a predictor of success for better treatment adherence rates. By contrast, participants who attended a brief standard intervention, mothers with primary education, greater body mass index, higher levels of depressive symptomatology and more critical comments towards their children, children with higher weight status and lower levels of self-reported depressive symptoms at baseline attended interventions less frequently. CONCLUSIONS In future programmes a comprehensive screening of modifiable factors related to family and their setting characteristics is paramount prior to intervention, identifying key barriers related to drop-out, especially in the case of less-advantaged families.
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Affiliation(s)
- Marta Rojo
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Tatiana Lacruz
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Santos Solano
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Ana Gutiérrez
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Lucía Beltrán‐Garrayo
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
| | - Oscar L. Veiga
- Department of Physical Education, Sport & Human MotricityAutonomous University of MadridMadridSpain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Clinical PsychologyNiño Jesús Children's HospitalMadridSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Ana Rosa Sepúlveda
- Faculty of PsychologyDepartment of Biological and Health PsychologyAutonomous University of MadridMadridSpain
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Yaghy A, Lee AY, Keane PA, Keenan TDL, Mendonca LSM, Lee CS, Cairns AM, Carroll J, Chen H, Clark J, Cukras CA, de Sisternes L, Domalpally A, Durbin MK, Goetz KE, Grassmann F, Haines JL, Honda N, Hu ZJ, Mody C, Orozco LD, Owsley C, Poor S, Reisman C, Ribeiro R, Sadda SR, Sivaprasad S, Staurenghi G, Ting DS, Tumminia SJ, Zalunardo L, Waheed NK. Artificial intelligence-based strategies to identify patient populations and advance analysis in age-related macular degeneration clinical trials. Exp Eye Res 2022; 220:109092. [PMID: 35525297 PMCID: PMC9405680 DOI: 10.1016/j.exer.2022.109092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Antonio Yaghy
- New England Eye Center, Tufts University Medical Center, Boston, MA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA; Karalis Johnson Retina Center, Seattle, WA, USA
| | - Pearse A Keane
- Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, UK
| | - Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA; Karalis Johnson Retina Center, Seattle, WA, USA
| | | | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, 925 N 87th Street, Milwaukee, WI, 53226, USA
| | - Hao Chen
- Genentech, South San Francisco, CA, USA
| | | | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA
| | | | - Kerry E Goetz
- Office of the Director, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Institute of Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Zhihong Jewel Hu
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | | | - Luz D Orozco
- Department of Bioinformatics, Genentech, South San Francisco, CA, 94080, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen Poor
- Department of Ophthalmology, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Italy
| | - Daniel Sw Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Santa J Tumminia
- Office of the Director, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Nadia K Waheed
- New England Eye Center, Tufts University Medical Center, Boston, MA, USA.
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Appelhans BM, Martin MA, Bradley LE, French SA, Lui K, Janssen I. Weather and Household Predictors of Childhood Obesity Treatment Attendance in Low-Income Urban Families. Clin Pediatr (Phila) 2022; 61:325-329. [PMID: 35130755 PMCID: PMC9178668 DOI: 10.1177/00099228221076958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Bradley M. Appelhans
- Department of Preventive Medicine, Rush University Medical Center,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center,Corresponding Author: Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL 60612, USA.
| | - Molly A. Martin
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Lauren E. Bradley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | - Simone A. French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Karen Lui
- Department of Pediatrics, Rush University Medical Center
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center
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Ekambareshwar M, Xu H, Rissel C, Baur L, Taki S, Mihrshahi S, Wen LM. Participants' Engagement With Telephone Support Interventions to Promote Healthy Feeding Practices and Obesity-Protective Behaviours for Infant Obesity Prevention. Front Endocrinol (Lausanne) 2022; 13:868944. [PMID: 35586630 PMCID: PMC9108251 DOI: 10.3389/fendo.2022.868944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Participant engagement with program interventions is vital to support intended behaviour changes and outcomes. The aim of this research was to investigate participant engagement with the Communicating Healthy Beginnings Advice by Telephone (CHAT) program, an early childhood obesity prevention program that included interventions for promoting healthy infant feeding practices and obesity-protective behaviours via telephone, and whether engagement with the telephone support program varied by participants' sociodemographic characteristics. METHODS This study used de-identified CHAT program data of participants who received the interventions via telephone. Data analysed included 1) participant engagement in telephone support from late pregnancy to 12 months of child's age, 2) demographic characteristics collected at late pregnancy and 3) intervention providers' observations and notes (qualitative data) for 10 participants from each engagement group (low, medium, high) to explore issues discussed during telephone support. RESULTS Call completion rate by participants was above sixty percent for all six stages of the telephone support program with more than half of the participants (57%) demonstrating high level of engagement. We found that participants' country of birth, employment status and annual household income were predictors of engagement with the telephone support provided in the CHAT program. The odds of participants' engagement with the telephone support program were 1.68 times higher for Australian born (95% CI 1.07 - 2.62), 1.63 times higher for participants who were employed (95% CI 1.01 - 2.66) and 1.63 times higher for participants with annual household income ≥AUD$80,000 (95% CI 1.02 - 2.60). CONCLUSIONS Participant engagement with the program interventions was good. Participants' engagement with the telephone support program was significantly associated with certain socio-demographic characteristics. Australian born participants, and participants associated with higher household income and employment engaged significantly more with the telephone support provided in the CHAT program. Additionally, the program engaged more participants older than 30 years of age and those who spoke English at home. The program provided unintended personal benefits to some participants with high engagement level due to their various psychosocial needs such as domestic violence, mental health and sleep related issues. Although not an intended benefit of the intervention, psychosocial needs of participants were met which was a likely factor for mothers' engagement with the program. This is an important factor that needs to be considered while implementing future programs or scale up of this program.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- *Correspondence: Mahalakshmi Ekambareshwar,
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
| | - Chris Rissel
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Louise Baur
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW, Australia
- Weight Management Services, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Sarah Taki
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Li Ming Wen
- The Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
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Spring B, Stump TK, Battalio SL, McFadden HG, Fidler Pfammatter A, Alshurafa N, Hedeker D. Digitally characterizing the dynamics of multiple health behavior change. Health Psychol 2021; 40:897-908. [PMID: 33570978 PMCID: PMC8355237 DOI: 10.1037/hea0001057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We applied the ORBIT model to digitally define dynamic treatment pathways whereby intervention improves multiple risk behaviors. We hypothesized that effective intervention improves the frequency and consistency of targeted health behaviors and that both correlate with automaticity (habit) and self-efficacy (self-regulation). METHOD Study 1: Via location scale mixed modeling we compared effects when hybrid mobile intervention did versus did not target each behavior in the Make Better Choices 1 (MBC1) trial (n = 204). Participants had all of four risk behaviors: low moderate-vigorous physical activity (MVPA) and fruit and vegetable consumption (FV), and high saturated fat (FAT) and sedentary leisure screen time (SED). Models estimated the mean (location), between-subjects variance, and within-subject variance (scale). RESULTS Treatment by time interactions showed that location increased for MVPA and FV (Bs = 1.68, .61; ps < .001) and decreased for SED and FAT (Bs = -2.01, -.07; ps < .05) more when treatments targeted the behavior. Within-subject variance modeling revealed group by time interactions for scale (taus = -.19, -.75, -.17, -.11; ps < .001), indicating that all behaviors grew more consistent when targeted. METHOD Study 2: In the MBC2 trial (n = 212) we examined correlations between location, scale, self-efficacy, and automaticity for the three targeted behaviors. RESULTS For SED, higher scale (less consistency) but not location correlated with lower self-efficacy (r = -.22, p = .014) and automaticity (r = -.23, p = .013). For FV and MVPA, higher location, but not scale, correlated with higher self-efficacy (rs = .38, .34, ps < .001) and greater automaticity (rs = .46, .42, ps < .001). CONCLUSIONS Location scale mixed modeling suggests that both habit and self-regulation changes probably accompany acquisition of complex diet and activity behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Tammy K. Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Samuel L. Battalio
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - H. Gene McFadden
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | | | - Nabil Alshurafa
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago
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9
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Lopez KE, Salvy SJ, Fink C, Werner J, Wee CP, Hegedus E, Gonzalez J, Fox DS, Vidmar AP. Executive Functioning, Depressive Symptoms, and Intervention Engagement in a Sample of Adolescents Enrolled in a Weight Management Program. Child Obes 2021; 17:281-290. [PMID: 33826861 PMCID: PMC8147508 DOI: 10.1089/chi.2020.0334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose: This study examines how baseline demographics, psychosocial characteristics, and intervention delivery predict engagement among adolescents with overweight and obesity seeking treatment. Methods: Data originates from a multisite randomized control trial evaluating the efficacy of an app-based weight loss intervention, compared with standard in-clinic model in adolescents with overweight and obesity. Participants were randomized to one of the three arms: (1) AppCoach, (2) AppAlone, or (3) Control. Demographic, executive functioning (EF), and depression questionnaires were completed at baseline. Percent engagement was compared within and between groups defined by demographics and depressive symptoms. Quantile regression was used to evaluate the association between age and EF on percent engagement. Results: Baseline demographics were not associated with engagement within or between groups. Neither baseline self-reported depressive symptoms (p = 0.244) nor deficits in EF (p = 0.34) were predictors of engagement. Univariate analysis found that the control arm had the highest engagement (83%) compared with AppCoach (63.5%) and AppAlone (22.5%, p = 0.02). Hispanic ethnicity was predictive of higher engagement in the control arm (p = 0.02). On multivariate quartile regression no other baseline characteristics were significant predictors of engagement. Conclusion: Baseline demographics and individual psychosocial characteristics were not related to engagement in this cohort. The intervention arm that required parental involvement resulted in the greatest engagement suggesting that family involvement may overshadow individual behavioral phenotype and thus promote better engagement. Further investigation is needed to understand how program delivery can be leveraged to optimize treatment engagement and outcomes in adolescence. Clinical Trial Registration number: NCT03500835.
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Affiliation(s)
- Kelleen E. Lopez
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Address correspondence to: Kelleen E. Lopez, MPH, Diabetes and Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #61, Los Angeles, CA 90027, USA
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cassandra Fink
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Julie Werner
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Choo Phei Wee
- Department of Preventive Medicine, Southern California Clinical and Translational Science Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Hegedus
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Janelle Gonzalez
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - D. Steven Fox
- Department of Pharmaceutical and Health Economics, School of Pharmacy of the University of Southern California, Los Angeles, CA, USA
| | - Alaina P. Vidmar
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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10
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Raynor HA, Barroso C, Propst S, Berlin K, Robson S, Khatri P. Reach of a low-intensity, multicomponent childhood overweight and obesity intervention delivered in an integrated primary care setting. Transl Behav Med 2020; 10:760-769. [PMID: 31220326 DOI: 10.1093/tbm/ibz055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Reach (i.e., proportion and representativeness of participants) of low-intensity, multicomponent childhood overweight/obesity interventions delivered in primary care settings with low-income and/or minority families is unknown. The purpose of this research is to describe the reach of a low-intensity, multicomponent childhood overweight/obesity intervention delivered in an integrated primary care setting in a federally qualified health center (FQHC). Eligibility criteria included children aged 4-10 years with a body mass index (BMI) ≥85th percentile, with a female caregiver. Using the electronic health record (EHR) and release forms, families were broadly categorized into groupings from recruitment flow, with differing proportions calculated from these groupings. Representativeness was determined using EHR data from families who were informed about the program (n = 963). Three calculated reach rates ranged from 54.9% to 3.9%. Lower reach rates were calculated using the number of families randomized (n = 73) as the numerator and the children from families who were informed about the program (n = 963) or all eligible children in the FQHC attending appointments (n = 1,864) as denominators. The first two steps in recruitment, informing families about the program and families initiating participation, were where the largest decreases in reach occurred. Children who were randomized were older, had a higher BMI, had a greater number of medical diagnoses indicating overweight or obesity, and were Hispanic. Reach of the intervention was low. Strategies that assist with reducing time for informing families of treatment and increasing families' awareness of their child's weight status should assist with enhancing reach.
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Affiliation(s)
- Hollie A Raynor
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Cristina Barroso
- Department of Public Health, University of Tennessee Knoxville, Knoxville, TN, USA
| | | | | | - Shannon Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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Bala N, Price SN, Horan CM, Gerber MW, Taveras EM. Use of Telehealth to Enhance Care in a Family-Centered Childhood Obesity Intervention. Clin Pediatr (Phila) 2019; 58:789-797. [PMID: 30894004 DOI: 10.1177/0009922819837371] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Family-centered childhood obesity interventions have been found to be effective. We describe the use of telehealth for tailored behavior change support in a family-centered randomized trial. Children of 2 to 12 years with body mass index ≥85th percentile were randomized to Enhanced Primary Care (EPC) or Enhanced Primary Care + Coaching (EPC + C). EPC + C received 6 health coach visits (in-person or by video or phone call) over 1 year. Telehealth modalities included interactive text messaging, video calls, and an online community resource map. There were 360 children randomized to the EPC + C arm; 87% of parents completed ≥1 health coaching contacts. Overall, 93% parents were sent text messages of which 99% responded at least once. About 72% parents were very satisfied with the message content and 97% were satisfied with information provided about community health resources. The high level of participant engagement and satisfaction suggests that telehealth is feasible and acceptable in family-centered childhood obesity programs.
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Affiliation(s)
- Natasha Bala
- 1 Massachusetts General Hospital, Boston, MA, USA
| | - Sarah N Price
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Chrissy M Horan
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Monica W Gerber
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Elsie M Taveras
- 2 Massachusetts General Hospital for Children, Boston, MA, USA.,3 Harvard University, Boston, MA, USA
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12
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St George SM, Petrova M, Kyoung Lee T, Sardinas KM, Kobayashi MA, Messiah SE, Prado G. Predictors of Participant Attendance Patterns in a Family-Based Intervention for Overweight and Obese Hispanic Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1482. [PMID: 30011798 PMCID: PMC6068939 DOI: 10.3390/ijerph15071482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 02/01/2023]
Abstract
This study examined participant attendance patterns and individual (e.g., income), family dynamics (e.g., communication), and cultural (i.e., Americanism, Hispanicism) predictors of these patterns among Hispanic families enrolled in a 12-week family-based intervention, Familias Unidas for Health and Wellness. Hispanic adolescents (n = 140, 49% female, 13.04 ± 0.87 years old, 36% overweight, 64% obese, 39% immigrants) and their parents (87% female, 42.09 ± 6.30 years old, BMI 30.99 ± 6.14 kg/m², 90% immigrants) were randomized to the intervention condition. A repeated measures latent class analysis that included 12 binary variables (yes/no) of attendance identified three subgroups of attendance patterns: consistently high, moderate and decreasing, and consistently low. An ANOVA was then conducted to examine whether the identified attendance patterns differed by individual, family dynamics, and cultural characteristics at baseline. Parents in the consistently high attendance group had lower Americanism than those in either of the other attendance groups. Adolescents in the consistently high attendance group had lower Hispanicism than those in either of the other attendance groups. No other variables significantly discriminated between attendance groups. Sustained attendance in the Familias Unidas for Health and Wellness intervention may be driven by Hispanic parents' desire to better understand their host culture, connect with other culturally similar parents, and reconnect adolescents with their heritage culture.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Mariya Petrova
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Krystal M Sardinas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Sarah E Messiah
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Schmied EA, Chuang E, Madanat H, Moody J, Ibarra L, Ortiz K, Macias K, Ayala GX. A Qualitative Examination of Parent Engagement in a Family-Based Childhood Obesity Program. Health Promot Pract 2018; 19:905-914. [PMID: 29448812 DOI: 10.1177/1524839918757487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.
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Affiliation(s)
- Emily A Schmied
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Hala Madanat
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Jamie Moody
- 4 University of California, San Diego, La Jolla, CA, USA
| | | | - Kenia Ortiz
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Karla Macias
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Guadalupe X Ayala
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
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The Team to Address Bariatric Care in Canadian Children (Team ABC3): Team Grant Research Proposal. BMC Res Notes 2017; 10:301. [PMID: 28992812 PMCID: PMC6389219 DOI: 10.1186/s13104-017-2506-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/16/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years). METHODS/DESIGN From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits. DISCUSSION Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.
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Ligthart KA, Buitendijk L, Koes BW, van Middelkoop M. The association between ethnicity, socioeconomic status and compliance to pediatric weight-management interventions – A systematic review. Obes Res Clin Pract 2017; 11:1-51. [DOI: 10.1016/j.orcp.2016.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 11/26/2022]
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Frontini R, Canavarro MC, Moreira H. Family cohesion and psychopathological symptoms in pediatric obesity: Is there an indirect effect? CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1316199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Roberta Frontini
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | - Helena Moreira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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17
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A Systematic Review of Obesity Disparities Research. Am J Prev Med 2017; 53:113-122. [PMID: 28341221 DOI: 10.1016/j.amepre.2017.01.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 11/22/2022]
Abstract
CONTEXT A review of interventions addressing obesity disparities could reveal gaps in the literature and provide guidance on future research, particularly for populations with a high prevalence of obesity and obesity-related cardiometabolic risk. EVIDENCE ACQUISITION A systematic review of clinical trials in obesity disparities research that were published in 2011-2016 in PubMed/MEDLINE resulted in 328 peer-reviewed articles. Articles were excluded if they had no BMI, weight, or body composition measure as primary outcome or were foreign (n=201); were epidemiologic or secondary data analyses of clinical trials (n=12); design or protocol papers (n=54); systematic reviews (n=3); or retracted or duplicates (n=9). Forty-nine published trials were summarized and supplemented with a review of ongoing obesity disparities grants being funded by the National, Heart, Lung and Blood Institute. EVIDENCE SYNTHESIS Of the 49 peer-reviewed trials, 27 targeted adults and 22 children only or parent-child dyads (5 of 22). Interventions were individually focused; mostly in single settings (e.g., school or community); of short duration (mostly ≤12 months); and primarily used behavioral modification (e.g., self-monitoring) strategies. Many of the trials had small sample sizes and moderate to high attrition rates. A meta-analysis of 13 adult trials obtained a pooled intervention effect of BMI -1.31 (95% CI=-2.11, -0.52, p=0.0012). Institutional review identified 140 ongoing obesity-related health disparities grants, but only 19% (n=27) were clinical trials. CONCLUSIONS The reviews call for cardiovascular-related obesity disparities research that is long term and includes population research, and multilevel, policy, and environmental, or "whole of community," interventions.
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Williams SL, Van Lippevelde W, Magarey A, Moores CJ, Croyden D, Esdaile E, Daniels L. Parent engagement and attendance in PEACH™ QLD - an up-scaled parent-led childhood obesity program. BMC Public Health 2017; 17:559. [PMID: 28599644 PMCID: PMC5466714 DOI: 10.1186/s12889-017-4466-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/25/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parenting, Eating and Activity for Child Health (PEACH™) is a multicomponent treatment program delivered over ten group sessions to parents of overweight/obese primary school-aged children. It has been shown to be efficacious in an RCT and was recently translated to a large-scale community intervention funded by the Queensland (Australia) Government. Engagement (enrolment and attendance) was critical to achieving program outcomes and was challenging. The purpose of the present study was to examine sample characteristics and mediating factors that potentially influenced program attendance. METHODS Data collected from parents who attended at least one PEACH™ Queensland session delivered between October 2013 and October 2015 (47 programs implemented in 29 discrete sites), was used in preliminary descriptive analyses of sample characteristics and multilevel single linear regression analyses. Mediation analysis examined associations between socio-demographic and parent characteristics and attendance at group sessions and potential mediation by child and parent factors. RESULTS 365/467 (78%) enrolled families (92% mothers) including 411/519 (79%) children (55% girls, mean age 9 ± 2 years) attended at least one session (mean 5.6 ± 3.2). A majority of families (69%) self-referred to the program. Program attendance was greater in: advantaged (5.9 ± 3.1 sessions) vs disadvantaged families (5.4 ± 3.4 sessions) (p < 0.05); partnered (6.1 ± 3.1 sessions) vs un-partnered parents (5.0 ± 3.1 sessions) (p < 0.01); higher educated (6.1 ± 3.0 sessions) vs lower educated parents (5.1 ± 3.3 sessions) (p = 0.02); and self-referral (6.1 ± 3.1) vs professional referral (4.7 ± 3.3) (p < 0.001). Child (age, gender, pre-program healthy eating) and parent (perceptions of child weight, self-efficacy) factors did not mediate these relationships. CONCLUSIONS To promote reach and effectiveness of up-scaled programs, it is important to identify ways to engage less advantaged families who carry higher child obesity risk. Understanding differences in referral source and parent readiness for change may assist in tailoring program content. The influence of program-level factors (e.g. facilitator and setting characteristics) should be investigated as possible alternative mediators to program engagement.
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Affiliation(s)
- Susan L. Williams
- Central Queensland University, School of Health, Medical and Applied Sciences, Building 6, Bruce Highway, Rockhampton, QLD 4702 Australia
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, De Pintelaan 185 – 4K3 room 036, 9000 Ghent, Belgium
| | - Anthea Magarey
- Flinders University, Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Carly J. Moores
- Flinders University, Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Debbie Croyden
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
| | - Emma Esdaile
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
| | - Lynne Daniels
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
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Castelnuovo G, Pietrabissa G, Manzoni GM, Cattivelli R, Rossi A, Novelli M, Varallo G, Molinari E. Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives. Psychol Res Behav Manag 2017; 10:165-173. [PMID: 28652832 PMCID: PMC5476722 DOI: 10.2147/prbm.s113278] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care.
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Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
- Department of Psychology, Catholic University of Milan, Milan
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
- Department of Psychology, Catholic University of Milan, Milan
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
- Department of Psychology, Catholic University of Milan, Milan
| | - Alessandro Rossi
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
| | - Margherita Novelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
| | - Giorgia Varallo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania
- Department of Psychology, Catholic University of Milan, Milan
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Khanal S, Welsby D, Lloyd B, Innes-Hughes C, Lukeis S, Rissel C. Effectiveness of a once per week delivery of a family-based childhood obesity intervention: a cluster randomised controlled trial. Pediatr Obes 2016; 11:475-483. [PMID: 26695932 DOI: 10.1111/ijpo.12089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effectiveness of once per week (OPW) delivery of a family-based childhood obesity programme was compared with twice per week (TPW) delivery in achieving health and behavioural outcomes at a population level and in improving programme attendance. Both programmes were delivered over 10-weeks, and the contact hours in the OPW and TPW programmes were 20 and 35-h, respectively. METHODS A cluster-randomised controlled trial with stratification by local health district was conducted. Height, weight and global self esteem of participants and parent-reported diet and physical activity were measured at programme commencement and completion and at 6-month follow-up. Attendance was defined as the proportion of total sessions attended. RESULTS There were no differences between the OPW and TPW arms in changes from pre-programme baseline for body mass index (BMI) z-score and other health and behaviourial measures at programme completion and at follow-up, except for the increase in physical activity outside of the programme at programme completion (OPW, 3.5 h/week; TPW, 1.9 h/week; p = 0.03). OPW and TPW participants attended 71.2% and 69.2% of the total sessions, respectively. Attendance was the only contributing factor to a positive BMI z-score outcome (β = -2.45, p < 0.01) with no effects of child age and gender, language spoken at home or highest qualification of mother. CONCLUSIONS A family-based childhood obesity programme can be delivered OPW with no compromise to health or behavioural outcomes compared with TPW. Higher attendance, as a proportion of available sessions, leads to better outcomes for children.
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Affiliation(s)
- S Khanal
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - D Welsby
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - B Lloyd
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - C Innes-Hughes
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
| | - S Lukeis
- Better Health Company, Ashwood, Victoria, Australia
| | - C Rissel
- NSW Office of Preventive Health, Liverpool, New South Wales, Australia
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Beard M, Chuang E, Haughton J, Arredondo EM. Determinants of Implementation Effectiveness in a Physical Activity Program for Church-Going Latinas. FAMILY & COMMUNITY HEALTH 2016; 39:225-233. [PMID: 27536927 PMCID: PMC4991556 DOI: 10.1097/fch.0000000000000122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Faith-based interventions show promise for reducing health disparities among ethnic minority populations. However, churches vary significantly in their readiness and willingness to support these programs. Semistructured interviews were conducted with priests, other church leaders, and lay health advisors in churches implementing a physical activity intervention targeting Latinas. Implementation effectiveness was operationalized as average 6-month participation rates in physical activity classes at each church. Factors facilitating implementation include church leader support and strength of parishioners' connection to the church. Accounting for these church-level factors may be critical in determining church readiness to participate in health promotion activities.
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Affiliation(s)
- Megan Beard
- Center for Community Health, Department of Pediatrics, University of California, San Diego, La Jolla (Ms Beard); Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (Dr Chuang); and Institute of Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California (Ms Haughton and Dr Arredondo)
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23
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Zenlea IS, Milliren C, Herel S, Thomaseo Burton E, Askins N, Ludwig DS, Rhodes ET. Outcomes from an orientation model to reduce attrition in paediatric weight management. Clin Obes 2016; 6:313-20. [PMID: 27487780 PMCID: PMC5023470 DOI: 10.1111/cob.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/16/2016] [Accepted: 06/17/2016] [Indexed: 12/01/2022]
Abstract
We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.
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Affiliation(s)
- I S Zenlea
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - C Milliren
- Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - S Herel
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- New Balance Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
| | - E Thomaseo Burton
- New Balance Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - N Askins
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - D S Ludwig
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- New Balance Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
| | - E T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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24
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Kwitowski M, Bean MK, Mazzeo SE. An exploration of factors influencing attrition from a pediatric weight management intervention. Obes Res Clin Pract 2016; 11:233-240. [PMID: 27544283 DOI: 10.1016/j.orcp.2016.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 10/19/2022]
Abstract
Pediatric obesity is a public health concern. High attrition from treatment negatively impacts outcomes, particularly among lower income and ethnic minority populations. NOURISH+ is a parent-exclusive childhood weight management treatment targeting at-risk children aged 5-11 years who are overweight or obese. The current study sought to enhance understanding of attrition among at-risk families. NOURISH+ participants completed a survey assessing barriers to treatment adherence. Among low-income, racially diverse families, practical barriers are pressing concerns. The NOURISH+ parent-exclusive approach, although empirically supported, appears inconsistent with caregivers' expectations. Minimizing practical barriers and enhancing child engagement might reduce attrition and improve outcomes.
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Affiliation(s)
- Melissa Kwitowski
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23298-0140, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA; Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23298-0140, USA
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25
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Naar-King S, Ellis DA, Carcone AI, Templin T, Jacques-Tiura AJ, Brogan Hartlieb K, Cunningham P, Jen KLC. Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 45:428-41. [PMID: 25668386 PMCID: PMC4658314 DOI: 10.1080/15374416.2014.971459] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to develop an adaptive behavioral treatment for African American adolescents with obesity. In a sequential multiple assignment randomized trial, 181 youth ages 12-16 years with primary obesity and their caregiver were first randomized to 3 months of home-based versus office-based delivery of motivational interviewing plus skills building. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based skills or contingency management. Primary outcome was percent overweight and hypothesized moderators were adolescent executive functioning and depression. There were no significant differences in primary outcome between home-based or office-based delivery or between continued home-based skills or contingency management for nonresponders to first-phase treatment. However, families receiving home-based treatment initially attended significantly more sessions in both phases of the trial, and families receiving contingency management attended more sessions in the second phase. Overall, participants demonstrated decreases in percent overweight over the course of the trial (3%), and adolescent executive functioning moderated this effect such that those with higher functioning lost more weight. More potent behavioral treatments to address the obesity epidemic are necessary, targeting new areas such as executive functioning. Delivering treatment in the home with contingency management may increase session attendance for this population.
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26
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Larsen KT, Huang T, Ried-Larsen M, Andersen LB, Heidemann M, Møller NC. A Multi-Component Day-Camp Weight-Loss Program Is Effective in Reducing BMI in Children after One Year: A Randomized Controlled Trial. PLoS One 2016; 11:e0157182. [PMID: 27362497 PMCID: PMC4928840 DOI: 10.1371/journal.pone.0157182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/25/2016] [Indexed: 12/14/2022] Open
Abstract
The objective of the present study was to evaluate the effectiveness of a one-year multi-component immersive day-camp weight-loss intervention for children with overweight and obesity. The study design was a parallel-group randomized controlled trial. One hundred fifteen 11-13-year-old children with overweight and obesity were randomized into either: A six-week day-camp intervention arm focusing on increased physical activity, and healthy diet followed by a subsequent one-year family-based intervention, or a standard intervention arm consisting of one weekly exercise session for six weeks. Body mass index (BMI) was the primary outcome. BMI z-score, clustered cardiovascular risk z-score, and body composition were secondary outcomes. All outcomes were measured at baseline, six week-, and 52 week follow-up. After six weeks, children from the day-camp intervention arm had improved their BMI (-2.2 kg/m2 (95% CI -2.6 to -1.7, P<0.001)) and all secondary outcomes when compared to the children from the standard intervention arm. After 52 weeks, the day-camp intervention arm had a lower BMI (-1.2 kg/m2 (95% CI -1.8 to -0.5, P = 0.001)), and BMI z-score (-0.20 (95% CI -0.35 to -0.05, P = 0.008)), and clustered cardiovascular risk z-score (-0.23 (95% CI -0.37 to -0.08, P = 0.002)) compared to the standard intervention arm. No group differences were detected in body composition after 52 weeks. This study shows that the day-camp intervention arm is effective in reducing BMI and improving the metabolic health of children with overweight and obesity. However, the effects seem to be diminishing over time.
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Affiliation(s)
- Kristian Traberg Larsen
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Tao Huang
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mathias Ried-Larsen
- The Centre of Inflammation and Metabolism (CIM) and The Centre for Physical Activity Research (CFAS), The Danish Diabetes Academy, Rigshospitalet, Copenhagen, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Lars Bo Andersen
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Niels Christian Møller
- Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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27
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Meagher SM, Leidig M, Price LL, Biever E. The relationship between depressive symptoms and BMI in adolescents enrolled in a weight management program. CHILDRENS HEALTH CARE 2016. [DOI: 10.1080/02739615.2016.1163491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Susan M. Meagher
- Department of Psychiatry, Tufts Medical Center, Boston, MA
- Department of Pediatrics, The Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Michael Leidig
- Department of Pediatrics, The Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Emily Biever
- Department of Nutrition Services, Dana-Farber Cancer Institute, Boston, MA
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28
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Castelnuovo G, Pietrabissa G, Manzoni GM, Corti S, Ceccarini M, Borrello M, Giusti EM, Novelli M, Cattivelli R, Middleton NA, Simpson SG, Molinari E. Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings. Front Psychol 2015; 6:1557. [PMID: 26528215 PMCID: PMC4606044 DOI: 10.3389/fpsyg.2015.01557] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/25/2015] [Indexed: 11/29/2022] Open
Abstract
Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives.
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Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan , Milan, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan , Milan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy ; Faculty of Psychology, eCampus University , Milan, Italy
| | - Stefania Corti
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, University of Bergamo , Bergamo, Italy
| | - Martina Ceccarini
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, University of Bergamo , Bergamo, Italy
| | - Maria Borrello
- Department of Psychology, University of Bergamo , Bergamo, Italy
| | - Emanuele M Giusti
- Department of Psychology, Catholic University of Milan , Milan, Italy
| | - Margherita Novelli
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy
| | - Nicole A Middleton
- School of Psychology, Social Work and Social Policy, University of South Australia , Adelaide, SA, Australia
| | - Susan G Simpson
- School of Psychology, Social Work and Social Policy, University of South Australia , Adelaide, SA, Australia
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano, Istituti di Ricovero e Cura a Carattere Scientifico , Ospedale San Giuseppe, Verbania, Italy ; Department of Psychology, Catholic University of Milan , Milan, Italy
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29
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Braden AL, Madowitz J, Matheson BE, Bergmann K, Crow SJ, Boutelle KN. Parent binge eating and depressive symptoms as predictors of attrition in a family-based treatment for pediatric obesity. Child Obes 2015; 11:165-9. [PMID: 25715322 PMCID: PMC4382825 DOI: 10.1089/chi.2014.0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attrition is a significant problem in family-based treatment (FBT) for childhood obesity. Despite this, very few studies have examined factors associated with attrition. The current study examined parent symptoms of depression and binge eating as predictors of attrition in FBT. METHODS Participants included 77 parents of overweight children enrolled in FBT for childhood obesity. Data were collected at baseline and post-treatment. Binary logistic regression was used to assess associations between parent binge eating symptoms, depressive symptoms, and attrition. RESULTS Results showed that parent binge eating symptoms (p=0.02), but not depressive symptoms (p=0.07), were significantly associated with attrition, after controlling for parent BMI, treatment group assignment, and family income. CONCLUSIONS Higher reported parent binge eating symptoms were significantly related to attrition in FBT. Assessment of parent binge eating may be important in identifying families at risk for dropping out of FBT. Further, FBT may need to be adapted for families with parents who have a high level of psychopathology.
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Affiliation(s)
- Abby L. Braden
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Jennifer Madowitz
- Department of Pediatrics, University of California San Diego, La Jolla, CA.,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA
| | - Brittany E. Matheson
- Department of Pediatrics, University of California San Diego, La Jolla, CA.,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA
| | - Kristie Bergmann
- Department of Pediatrics, University of California San Diego, La Jolla, CA.,Alliant International University, San Diego, CA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN.,Emily Program, Minneapolis, MN
| | - Kerri N. Boutelle
- Department of Pediatrics, University of California San Diego, La Jolla, CA.,Department of Psychiatry, University of California San Diego, La Jolla, CA
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30
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Alia KA, Wilson DK, McDaniel T, St George SM, Kitzman-Ulrich H, Smith K, Heatley V, Wise C. Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents. EVALUATION AND PROGRAM PLANNING 2015; 49:106-16. [PMID: 25614139 PMCID: PMC4372476 DOI: 10.1016/j.evalprogplan.2014.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 05/12/2023]
Abstract
UNLABELLED This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure. RESULTS Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum. DISCUSSION Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.
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Affiliation(s)
- Kassandra A Alia
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Tyler McDaniel
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heather Kitzman-Ulrich
- Department of Behavioral and Community Health, University of North Texas, Fort Worth, TX, USA
| | - Kelsey Smith
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - VaShawn Heatley
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Courtney Wise
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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31
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Cesa CC, Barbiero SM, Petkowicz RDO, Martins CC, Marques RDV, Andreolla AAM, Pellanda LC. Effectiveness of physical exercise to reduce cardiovascular risk factors in youths: a randomized clinical trial. J Clin Med Res 2015; 7:348-55. [PMID: 25780484 PMCID: PMC4356096 DOI: 10.14740/jocmr1700w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents. Methods A randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home. Results A total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14. Conclusion A low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors.
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Affiliation(s)
- Claudia Ciceri Cesa
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil
| | - Sandra Mari Barbiero
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil
| | - Rosemary de Oliveira Petkowicz
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil
| | - Carla Correa Martins
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil ; Universidade Federal de Ciencias da Saude de Porto Alegre, Avenida Osvaldo Aranha, 245, Porto Alegre, Rio Grande do Sul 90050-170, Brazil
| | - Renata das Virgens Marques
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil ; Universidade Federal de Ciencias da Saude de Porto Alegre, Avenida Osvaldo Aranha, 245, Porto Alegre, Rio Grande do Sul 90050-170, Brazil
| | - Allana Abreu Martins Andreolla
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil ; Universidade Federal de Ciencias da Saude de Porto Alegre, Avenida Osvaldo Aranha, 245, Porto Alegre, Rio Grande do Sul 90050-170, Brazil
| | - Lucia Campos Pellanda
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Avenida Princesa Isabel, 370, 3º andar, Porto Alegre, Rio Grande do Sul 90620-000, Brazil ; Universidade Federal de Ciencias da Saude de Porto Alegre, Avenida Osvaldo Aranha, 245, Porto Alegre, Rio Grande do Sul 90050-170, Brazil
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32
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Sacheck JM, Van Rompay MI, Olson EM, Chomitz VR, Goodman E, Gordon CM, Eliasziw M, Holick MF, Economos CD. Recruitment and retention of urban schoolchildren into a randomized double-blind vitamin D supplementation trial. Clin Trials 2014; 12:45-53. [PMID: 25349179 DOI: 10.1177/1740774514556551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While rarely used for supplementation trials in the United States, schools present a practical alternative to a clinical setting. PURPOSE We describe the successful recruitment and retention of urban schoolchildren into a 6-month randomized, double-blind vitamin D3 supplementation trial. METHODS Boston-area urban schoolchildren, aged 8-15 years, were recruited in 2011-2012 through classroom and auditorium presentations. Informed consent forms in five languages were sent home to parents. Retention methods included regular telephone calls and gift cards for completed study visits. RESULTS In total, 691 schoolchildren enrolled. Their mean (standard deviation) age was 11.7 (1.4) years; 59% were racial/ethnic minorities and 68% qualified for free or reduced-price school meals. Multi-level, culturally sensitive, creative approaches contributed to success in recruitment and retention. Of 691 participants, 81% completed the 6-month intervention period. Reasons for attrition included missed appointments and fear of a blood draw. More children from households with higher incomes were retained than those from households with lower incomes (85% vs 79%, respectively, P = 0.04). LIMITATIONS The need for three fasting blood draws over the 6-month supplementation period was a limiting factor in the recruitment and retention of children in this study. CONCLUSION Recruitment of urban children into a school-based randomized controlled trial represents a feasible approach for a supplementation study. Particular attention to children of lower socioeconomic status may enhance participation and retention when conducting intervention studies among diverse populations.
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Affiliation(s)
- Jennifer M Sacheck
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Maria I Van Rompay
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Elizabeth M Olson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Virginia R Chomitz
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | - Elizabeth Goodman
- MassGeneral Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Catherine M Gordon
- Divisions of Adolescent Medicine and Endocrinology, Hasbro Children's Hospital, Providence, RI, USA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | | | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Klitzman P, Armstrong B, Janicke DM. Distance as a Predictor of Treatment Attendance in a Family Based Pediatric Weight Management Program in Rural Areas. J Rural Health 2014; 31:19-26. [DOI: 10.1111/jrh.12078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Page Klitzman
- Department of Clinical and Health Psychology; University of Florida; Gainesville Florida
| | - Bridget Armstrong
- Department of Clinical and Health Psychology; University of Florida; Gainesville Florida
| | - David M. Janicke
- Department of Clinical and Health Psychology; University of Florida; Gainesville Florida
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Castelnuovo G, Manzoni GM, Pietrabissa G, Corti S, Giusti EM, Molinari E, Simpson S. Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach. Front Psychol 2014; 5:559. [PMID: 24959157 PMCID: PMC4051130 DOI: 10.3389/fpsyg.2014.00559] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/20/2014] [Indexed: 11/22/2022] Open
Abstract
Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area.
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Affiliation(s)
- Gianluca Castelnuovo
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Gian Mauro Manzoni
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
- Faculty of Psychology, eCampus UniversityComo, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Stefania Corti
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
- Department of Psychology, University of BergamoBergamo, Italy
| | | | - Enrico Molinari
- Department of Psychology, Catholic University of MilanMilan, Italy
- Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Psychology Research LaboratoryOspedale San Giuseppe, Verbania, Italy
| | - Susan Simpson
- School of Psychology, Social Work and Social Policy, University of South AustraliaAdelaide, SA, Australia
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Brook E, Cohen L, Hakendorf P, Wittert G, Thompson C. Predictors of attendance at an obesity clinic and subsequent weight change. BMC Health Serv Res 2014; 14:78. [PMID: 24552252 PMCID: PMC3933369 DOI: 10.1186/1472-6963-14-78] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/13/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is conflicting evidence regarding characteristics of patients most likely to have poor outcomes after referral to a multidisciplinary weight loss clinic. The aim of this study was to identify patient characteristics associated with poor attendance and poor weight outcomes at a weight management clinic based in an Australian tertiary hospital. METHODS Patient characteristics including age, sex, referral source, postcode of residence, weight, body mass index (BMI) and the presence of specific comorbidities were recorded. Outcome measures included questionnaire return following referral (a requirement prior to a first appointment being scheduled), percentage of appointments attended and rate of weight change (kg/month). Continuous variables were expressed as mean ± standard deviation and compared using a t-test. Categorical data were presented as proportions and a chi-squared test was used to test significance. Statistical significance was set as p < 0.05. RESULTS Of 502 patients referred to the Comprehensive Metabolic Care Centre (CMCC), 231 (46%) did not return their questionnaire. Patients referred by their GP, compared to those with only internal hospital referrals, were more likely to return their questionnaire (86.0% cf. 77.9%; p = 0.02) as were those who had their BMI recorded in their referral letter (58% cf 45% p = 0.011). 28.1% of patients attended half or less of their scheduled appointments at the CMCC but none of the parameters analysed was associated with attendance. Weight loss was associated with residence in a rural location (p = 0.016) and hypercholesterolaemia (p = 0.03) and weight gain was associated with obstructive sleep apnoea (p = 0.04). CONCLUSIONS A large proportion of the patients referred to a weight management clinic never had an appointment scheduled. Clinicians should not anticipate greater compliance in one patient demographic than another; all groups need focus, particularly at the referral stage, and likely poor compliance must be anticipated and better managed.
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Affiliation(s)
- Emma Brook
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lauren Cohen
- University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Clinical Epidemiology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Gary Wittert
- Department of Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Campbell Thompson
- Department of Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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Steele RG, Janicke DM. Changing times call for changing methods: introduction to the special issue on innovative treatments and prevention programs for pediatric obesity. J Pediatr Psychol 2013; 38:927-31. [PMID: 24006274 DOI: 10.1093/jpepsy/jst066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ric G Steele
- PhD, Clinical Child Psychology Program, University of Kansas, 2010 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555, USA.
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Abstract
BACKGROUND/OBJECTIVES Cigarette smoking remains the leading cause of preventable death in the United States with the vast majority of adult smokers starting prior to the age of 18. Despite the public health relevance and implications of studying smoking in adolescents, little is known about the initiation of quit attempts, the process of relapse, and the most efficacious treatment interventions in this high-risk and underserved population. Issues such as retention in research studies and accuracy of self-reports have prompted investigators to explore innovative technology-based systems to integrate into treatment studies and services delivery. METHODS This paper will review the remote monitoring of smoking through means of ecological momentary assessment, biochemical verification of smoking verified through video capture, physiological monitoring, and mobile-delivered interventions using self-reported smoking outcomes in adolescents, when applicable. RESULTS Use of remote monitoring methods in adolescent smokers has been limited thus far, though monitoring technology in adults has shown promise for understanding relapse and delivering treatment interventions. CONCLUSIONS Comprehensive technology-based systems that do not rely primarily on self-report to monitor smoking would be a highly fruitful and innovative avenue to explore with adolescent smokers. Technology integration holds great promise to improve health-related research, treatment delivery, cost-effectiveness, and just-in-time interventions, but its novelty comes with unique problems and concerns to be carefully considered.
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Affiliation(s)
- Erin A McClure
- Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M Gray
- Medical University of South Carolina, Charleston, SC, USA
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Kuo F, Goebel LA, Satkamp N, Beauchamp R, Kurrasch JM, Smith AR, Maguire JM. Service learning in a pediatric weight management program to address childhood obesity. Occup Ther Health Care 2013; 27:142-162. [PMID: 23855572 DOI: 10.3109/07380577.2013.780318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper describes an inter-professional service learning collaboration and reflects benefits and considerations when incorporating a family-oriented approach in the community-based pediatric weight management program. Because obesity has tremendous consequences on a nation's health and economy, a pediatrician in a community health network has utilized an inter-professional team to implement a pediatric weight management program targeting children between the ages of 8 and 15 years. The team incorporates a culturally sensitive curriculum using a family-oriented approach for obesity prevention and intervention. Physicians, registered dietitians, occupational therapists, nurse practitioners, and mental health professionals assist participants in adopting a healthier lifestyle by addressing physical and psychosocial issues related to obesity, developing a nutrition plan, making healthier food choices, and finding fun ways to be more physically active. Graduate occupational therapy students work closely with the team members to assist delivery of interactive activities and behavior intervention.
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Affiliation(s)
- Fengyi Kuo
- Department of Occupational Therapy, Indiana University School of Health and Rehabilitation Sciences, Indianapolis, IN 46202, USA.
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