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Wills-Ibarra N, Chemtob K, Hart H, Frati F, Pratt KJ, Ball GD, Van Hulst A. Family systems approaches in pediatric obesity management: a scoping review. BMC Pediatr 2024; 24:235. [PMID: 38566046 PMCID: PMC10985863 DOI: 10.1186/s12887-024-04646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) (n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) (n = 18), mental health (n = 12), FST-related outcomes (n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) (n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research.
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Affiliation(s)
- Natasha Wills-Ibarra
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keryn Chemtob
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Heather Hart
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Francesca Frati
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Centre, Columbus, OH, USA
| | - Geoff Dc Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andraea Van Hulst
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada.
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Jacques-Tiura AJ, Carcone AI, Naar S, Brogan Hartlieb K, Albrecht TL, Barton E. Building Motivation in African American Caregivers of Adolescents With Obesity: Application of Sequential Analysis. J Pediatr Psychol 2017; 42:131-141. [PMID: 27246865 DOI: 10.1093/jpepsy/jsw044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types of counselor behaviors increased caregivers' motivational statements regarding supporting their child's weight loss. Methods We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12-16-year-olds using the Minority Youth Sequential Coding for Observing Process Exchanges. We used sequential analysis to determine which counselor communication codes predicted caregiver motivational statements. Results Counselors' questions to elicit motivational statements and emphasis on autonomy increased the likelihood of both caregiver change talk and commitment language statements. Counselors' reflections of change talk predicted further change talk, and reflections of commitment language predicted more commitment language. Conclusions When working to increase motivation among caregivers of adolescents with overweight or obesity, providers should strive to reflect motivational statements, ask questions to elicit motivational statements, and emphasize caregivers' autonomy.
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Affiliation(s)
- Angela J Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, MI, USA
| | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, MI, USA
| | - Sylvie Naar
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, MI, USA
| | - Kathryn Brogan Hartlieb
- Department of Dietetics and Nutrition, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Terrance L Albrecht
- Karmanos Cancer Institute, School of Medicine, Wayne State University, MI, USA
| | - Ellen Barton
- Linguistics Program, Department of English, Wayne State University, MI, USA
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Nichols M, Nemeth LS, Magwood G, Odulana A, Newman S. Exploring the Contextual Factors of Adolescent Obesity in an Underserved Population Through Photovoice. FAMILY & COMMUNITY HEALTH 2016; 39:301-309. [PMID: 27536935 DOI: 10.1097/fch.0000000000000118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obesity, a global health epidemic, requires targeted interventions to promote sustainable health behavior change; yet, prior efforts have not yielded significant improvements in obesity rates. Using Photovoice as a data collection approach, this community-engaged research study partnered with a weight management program to understand participants' perspectives on access to physical activity and nutritious food. Twelve adolescent-parent dyads participated. Barriers, facilitators, and opportunities for change were identified and categorized through adolescent photographs, interviews, and participant focus groups, according to the social ecological model. A community-engaged research approach can identify areas to increase health promotion and prevention efforts regarding physical activity and nutrition.
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Affiliation(s)
- Michelle Nichols
- Colleges of Nursing (Drs Nichols, Nemeth, Magwood, and Newman) and Medicine (Dr Odulana), Medical University of South Carolina, Charleston
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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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Nichols M, Newman S, Nemeth LS, Magwood G. The influence of parental participation on obesity interventions in african american adolescent females: an integrative review. J Pediatr Nurs 2015; 30:485-93. [PMID: 25648656 DOI: 10.1016/j.pedn.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022]
Abstract
African American adolescent females have the highest prevalence rates of obesity among those age 18 and under. The long-term health effects and associated comorbidities of obesity within this cohort threaten the health and well-being of a major section of the U.S. population. There is a need to understand the influence of parental support in reducing obesity related health disparities. Using a social ecological framework to explore parental influence on adolescent obesity interventions allows for greater insight into the complex and dynamic influences affecting the lives of African American adolescent females who are obese.
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Affiliation(s)
- Michelle Nichols
- Medical University of South Carolina, Charleston, SC; Hunter Holmes McGuire VA Medical Center, Richmond, VA.
| | - Susan Newman
- Medical University of South Carolina, Charleston, SC
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