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Cunningham PB, Naar S, Roberts JR, Powell J, Ledgerwood DM, Randall J, Lozano BE, Halliday CA, Madisetti M, Ghosh S. Study protocol for clinical trial of the FIT Families multicomponent obesity intervention for African American adolescents and their caregivers: Next step from the ORBIT initiative. BMJ Open 2024; 14:e074552. [PMID: 38355187 PMCID: PMC10868253 DOI: 10.1136/bmjopen-2023-074552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This study will test the effectiveness of FIT Families (FIT), a multicomponent family-based behavioural intervention, against a credible attention control condition, Home-Based Family Support (HBFS). This protocol paper describes the design of a randomised clinical trial testing the efficacy of the FIT intervention. The protocol will assess the efficacy of FIT to improve health status in African American adolescents with obesity (AAAO) and their primary caregivers on primary (percent body fat) and secondary (physical activity, metabolic control, weight loss) outcomes and its cost-effectiveness. METHODS 180 youth/caregiver dyads are randomised into FIT or HBFS, stratified by age, gender and baseline per cent overweight. The proposed study follows a two condition (FIT, HBFS) by four assessment time points. Tests will be conducted to identify potential relationship of baseline demographic and clinical variables to our dependent variables and see whether they are balanced between groups. It is hypothesised that youth/caregiver dyads randomised to FIT will show significantly greater reductions in percent body fat over a 12-month follow-up period compared with AAAO receiving HBFS. Preliminary findings are expected by November 2023. ETHICS This protocol received IRB approval from the Medical University of South Carolina (Pro00106021; see 'MUSC IRB 106021 Main Approval.doxc' in online supplemental materials). DISSEMINATION Dissemination activities will include summary documents designed for distribution to the broader medical community/family audience and submission of manuscripts, based on study results, to relevant peer-reviewed scientific high-impact journals. TRIAL REGISTRATION NUMBER NCT04974554.
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Affiliation(s)
- Phillippe B Cunningham
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, FSU College of Medicine, Florida State Univ, Tallahassee, Florida, USA
| | - James R Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer Powell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Jeff Randall
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian E Lozano
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen A Halliday
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samiran Ghosh
- Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston, Texas, USA
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Harshman SG, Castro I, Perkins M, Luo M, Mueller KB, Cena H, Portale S, Raspini B, Taveras E, Fiechtner L. Pediatric weight management interventions improve prevalence of overeating behaviors. Int J Obes (Lond) 2022; 46:630-636. [PMID: 34862470 PMCID: PMC8883500 DOI: 10.1038/s41366-021-00989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 09/20/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine changes in prevalence of overeating behaviors in a comparative effectiveness study of two pediatric weight management interventions. METHODS Four-hundred and seven children, ages 6-12 years, with a BMI ≥ 85th percentile were enrolled in a comparative effectiveness trial of two pediatric weight management interventions. Prevalence of "sneaking, hiding or hoarding food", and 'eating in the absence of hunger' was evaluated at baseline and 12 months. Statistical methods included McNemar's test and longitudinal logistic regression. RESULTS Prevalence of "sneak, hide, or hoard food" significantly decreased in all participants from 29.1% to 20.7% at 12 months. The prevalence of "eating in the absence of hunger" decreased in all participants from 46.7% to 22.4% at 12 months. Use of SNAP benefits, free/reduced meals at school, parental stress, housing, and food insecurity at baseline were associated with an increased likelihood of endorsing overeating behaviors at 12 months. Conversely, those who engaged in at least one session of the pediatric weight management intervention were significantly less likely to endorse "eating in the absence of hunger" at 12 months. CONCLUSIONS Participation in pediatric weight management interventions improves the prevalence of overeating behaviors and is associated with participant engagement and social determinants of health, specifically food security status. Efforts to engage populations impacted by food insecurity and other social determinants of health risk factors will be critical for success of weight management interventions. CLINICAL TRIAL REGISTRATION This trial has been registered at ClinicalTrials.gov (identifier: NCT03012126).
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Affiliation(s)
- Stephanie G. Harshman
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts;,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts
| | - Ines Castro
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Katelee B. Mueller
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
| | - Sandra Portale
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Benedetta Raspini
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Elsie Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, Massachusetts;,Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, 175 Cambridge St, Boston, Massachusetts,,Greater Boston Food Bank, 70 S. Bay Avenue, Boston, MA 02118
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San Giovanni CB, Dawley E, Pope C, Steffen M, Roberts J. The Doctor Will "Friend" You Now: A Qualitative Study on Adolescents' Preferences for Weight Management App Features. South Med J 2021; 114:373-379. [PMID: 34215886 PMCID: PMC8284848 DOI: 10.14423/smj.0000000000001273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Primary care providers report a lack of resources as a barrier to managing adolescent obesity. Mobile health applications (apps) may be helpful in weight management; however, adolescents' preferences for weight management app features are unknown. Our objectives were to provide insight into adolescents' preferred weight management app features and elicit facilitators and barriers to app use. METHODS Using the qualitative content analysis method, 14 interviews with adolescents with overweight/obesity were conducted in rural and urban pediatric offices in South Carolina. Eligibility criteria included being 13 to 17 years old, having a body mass index at or above the 85th percentile for age and sex, and having access to a smartphone or tablet. Semistructured key informant interviews were conducted from May to October 2017. Participants were presented with three popular mobile health apps and asked to complete tasks and comment on their various features and usability. Summative content analysis coding was performed on interview transcripts, and interviews were conducted until thematic saturation was reached. RESULTS Seventy-one percent of participants were from a rural practice, 64% were White, and 86% had a body mass index higher than the 95th percentile. Familiarity with similar apps and accessibility of apps on their smartphones promoted app use. The need for wireless Internet, operating difficulties, or privacy concerns were barriers. Nutritional education, physical activity tracking, and social connection were desirable app features. CONCLUSIONS Adolescents have expressed preferred app features to help them manage weight; however, further work is needed to see whether these features are effective.
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Affiliation(s)
| | - Erin Dawley
- From the University of South Carolina, Charleston
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Johansson L, Hagman E, Danielsson P. A novel interactive mobile health support system for pediatric obesity treatment: a randomized controlled feasibility trial. BMC Pediatr 2020; 20:447. [PMID: 32967638 PMCID: PMC7513491 DOI: 10.1186/s12887-020-02338-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In order to achieve improved weight status, behavioral pediatric obesity treatment is resource intensive. Mobile Health (mHealth) is more accessible than standard care but effective approaches are scarce. Therefore, the aim of this feasibility trial was to study trial design, mHealth usage, compliance, and acceptability of a novel mHealth approach in pediatric obesity treatment. METHODS This six-month parallel two-arm feasibility trial took place at three pediatric outpatient clinics in Stockholm, Sweden. Participants, 5-12 years, starting obesity treatment were randomized to using an mHealth support system as an addition to standard care (intervention) or to standard care alone (control). The intervention included daily self-monitoring of weight transferred to a mobile application (app) used by parents, a website in which clinicians could track treatment progress, prespecified treatment goals for change in degree of obesity shown in the app and on the website, and text message interactions between clinicians and parents. The main outcome was description of feasibility. Height and weight were measured at baseline, three, and 6 months to explore changes in body mass index standard deviation score (BMI SDS). RESULTS Of 40 children eligible for inclusion, 28 agreed to participate (54% girls) and were randomized to intervention (n = 15) or control (n = 13). Weight was measured at home regularly throughout the entire trial period by 12/15 children in the intervention group. Attendance at appointments were better in the intervention group (p = 0.024). Both parents and clinicians had a positive experience and found the mHealth support system accessible. At 6 months the intervention group had a greater reduction of 0.24 units in BMI SDS than standard care (- 0.23 vs. 0.01, p = 0.002). CONCLUSIONS The mHealth support system was a feasible and innovative treatment approach which, in addition to standard care, generated better treatment results than standard care alone. Future research should evaluate the treatment effects over a longer follow-up time in a larger study sample. TRIAL REGISTRATION This trial was retrospectively registered at ClinicalTrials.gov , ID: NCT03380598 , on November 8, 2017.
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Affiliation(s)
- Linnea Johansson
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, CLINTEC, Novum, Blickagangen 6A, 141 57 Huddinge, Sweden
- Health Professionals Function, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Emilia Hagman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, CLINTEC, Novum, Blickagangen 6A, 141 57 Huddinge, Sweden
| | - Pernilla Danielsson
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, CLINTEC, Novum, Blickagangen 6A, 141 57 Huddinge, Sweden
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Naets T, Vervoort L, Tanghe A, De Guchtenaere A, Braet C. Maladaptive Eating in Children and Adolescents With Obesity: Scrutinizing Differences in Inhibition. Front Psychiatry 2020; 11:309. [PMID: 32425824 PMCID: PMC7212434 DOI: 10.3389/fpsyt.2020.00309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/27/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In order to grasp the complex etiology of childhood obesity, we aim to clarify the relationship between external eating and weight. Based on theory and empirical evidence, we claim that inhibition is an important moderator in this association. In our first research question we expected that high external eating would be related to a higher weight status, especially for those with high inhibition problems. Secondly, we explored the moderating role of inhibition in the association between external eating and weight change after a multidisciplinary obesity treatment. METHOD We investigated n=572 participants (51% boys, aged 7-19) with moderate to extreme obesity recruited in a Belgian inpatient treatment center. At intake, parents reported on inhibition (BRIEF), while the children and adolescents reported on their eating behavior (DEBQ). Weight and length were objectively measured pre and post treatment (ADJUSTED BMI). Two hierarchical linear regression models were built to scrutinize the influence of inhibition on the association between external eating and both baseline weight and weight change. RESULTS First, predicting baseline weight, we found no significant moderating effect of inhibition problems. Second, predicting weight loss, inhibition turned out to be a substantial moderator, specifically in adolescents. Some unexpected gender differences occurred in favor of adolescent boys, in a way that those with high external eating and low inhibition problems lost most weight. CONCLUSION Inhibition problems act as a moderator explaining weight loss, but this only holds for adolescents. This suggests that external eating and inhibition play a complex role in weight loss in certain age and gender categories, and stresses the importance of identifying subgroups for tailoring interventions. For those with high inhibition problems, interventions aimed at increasing inhibition skills might be needed to optimize treatment outcomes.
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Affiliation(s)
- Tiffany Naets
- Clinical Child and Adolescent Psychology (CCAP) Lab, Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Leentje Vervoort
- Clinical Child and Adolescent Psychology (CCAP) Lab, Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Ann Tanghe
- Obesity Department, Zeepreventorium vzw, De Haan, Belgium
| | | | - Caroline Braet
- Clinical Child and Adolescent Psychology (CCAP) Lab, Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Xiong R, Spaccarotella K, Quick V, Byrd-Bredbenner C. Generational Differences: A Comparison of Weight-Related Cognitions and Behaviors of Generation X and Millennial Mothers of Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132431. [PMID: 31323912 PMCID: PMC6651214 DOI: 10.3390/ijerph16132431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 01/25/2023]
Abstract
A ‘generation’ is an identifiable group sharing birth years and significant life events at critical developmental ages. There is a paucity of literature examining how parental cognitions and lifestyle behaviors differ by generation and whether generational differences are substantial enough to warrant consideration during the development of health interventions. This study compared generational differences in weight-related cognitions and lifestyle behaviors of mothers of young children who were categorized as Generation X (born 1965–1981, n = 158) and Generation Y (aka Millennials; born 1982–1999, n = 162). Survey results indicated that Generation X had significantly higher family affluence; thus, this was controlled in subsequent analyses. Analysis of covariance indicated that Millennials had more positive expectations about the benefits of engaging in healthy eating and physical activity than comparators, but not significantly so. Millennial mothers placed significantly higher value on physical activity for themselves than Generation X mothers, but both generations were neutral on the value of personal physical activity. No generational differences were noted in self-efficacy of mothers for promoting childhood obesity-prevention practices to children and self-efficacy for personally engaging in weight-protective behaviors. Millennial mothers had significantly more family meals/week, however generations did not differ on the value placed on family meals, where family meals were eaten, or whether media devices were used at mealtime. Few differences were noted between the generations for most child feeding behaviors, except that Millennials reported placing significantly less pressure on children to eat. Mothers’ modeling of weight-related behaviors as a means for children’s observational learning about healthy eating, physical activity, and sedentary behaviors did not differ by generational group. The eating behaviors of mothers differed little between generations. Millennial mothers allowed significantly more media devices in children’s bedrooms and personally engaged in more screen time daily than comparators. Overall, the two generational groups were more similar than different in weight-related cognitions as well as for personal and parenting lifestyle behaviors. The results suggest that tailoring interventions for individuals at a similar life-stage (e.g., mothers of young children) by generation may not be warranted.
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Affiliation(s)
- Ruiying Xiong
- School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA 19104, USA
| | - Kim Spaccarotella
- Department of Biological Sciences, Kean University, 1000 Morris Avenue, Union, NJ 07082, USA
| | - Virginia Quick
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
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Jacques-Tiura AJ, Ellis DA, Idalski Carcone A, Naar S, Brogan Hartlieb K, Towner EK, N Templin T, Jen KLC. African-American Adolescents' Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial. J Adolesc Health 2019; 64:355-361. [PMID: 30392864 PMCID: PMC6996585 DOI: 10.1016/j.jadohealth.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment. METHOD One hundred and eighty six African-Americans adolescents with obesity and their caregiver were first randomly assigned to complete 3 months of cognitive-behavioral and motivational interviewing family-based weight loss treatment in their home or in the research office (Phase 1). Nonresponders (i.e., those who lost < 3% of initial weight, n = 161) were rerandomized to 3 months of continued skills training (n = 83) or contingency management (n = 78) for Phase 2; responders were allocated to 3 months of relapse prevention (n = 20). Adolescents' frequency of weight loss skills utilization was assessed via questionnaire at treatment midpoint and end. RESULTS Higher treatment attendance was associated with better skill utilization. Higher skill utilization was associated with more weight loss at treatment end, whereas higher baseline confidence was associated with more weight loss at follow-up. CONCLUSIONS This study indicates the importance of attending weight loss intervention sessions to develop and strengthen weight loss skills in African-American adolescents with obesity, and strengthening confidence to use such skills for continued weight loss.
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Affiliation(s)
- Angela J Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan.
| | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Sylvie Naar
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | | | - Elizabeth K Towner
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Thomas N Templin
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - K-L Catherine Jen
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
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Nezami BT, Ward DS, Lytle LA, Ennett ST, Tate DF. A mHealth randomized controlled trial to reduce sugar-sweetened beverage intake in preschool-aged children. Pediatr Obes 2018; 13:668-676. [PMID: 29119719 DOI: 10.1111/ijpo.12258] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/25/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sugar-sweetened beverages and maternal weight are strong drivers of child obesity, but few studies have targeted these risk factors as an obesity prevention strategy in children. OBJECTIVE The objective of this study was to test the efficacy of a smartphone-delivered intervention to reduce parent-provided sugar-sweetened beverage and juice (SSB/juice) consumption among children ages 3-5 and maternal weight. METHODS Mothers with overweight or obesity, who had a child ages 3-5 that consumed at least 12 fl. oz./day of SSB/juice (N = 51 dyads) were randomized to the Smart Moms group that received one group session, lessons on a mobile website, and text messages, or to a waitlist control group. Mothers self-monitored their children's beverages in addition to their own beverages, high-calorie foods, and weight. Assessments at baseline, 3, and 6 months included dietary recalls to measure SSB/juice intake and objectively measured maternal weight. RESULTS Using linear mixed models controlling for baseline values, child age and race, there was a greater reduction in child SSB/juice in Smart Moms compared with control at 6 months (-9.7 oz./day vs. 1.7 oz./day, p < .01). Mothers in Smart Moms lost 2.4 kg at 6 months compared with a 0.9-kg gain in the control group (p < .01). CONCLUSIONS An intervention delivered using mHealth technologies can target mothers to change child dietary behaviours and improve maternal weight, which suggests a novel approach to family-based obesity prevention.
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Affiliation(s)
- B T Nezami
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D S Ward
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L A Lytle
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S T Ennett
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D F Tate
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Social Cognitive Reinforcement Program for Children with Social Communication Disorders. ADONGHAKOEJI 2018. [DOI: 10.5723/kjcs.2018.39.5.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zolotarjova J, Ten Velde G, Vreugdenhil ACE. Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. Obes Rev 2018; 19:931-946. [PMID: 29701298 DOI: 10.1111/obr.12680] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/28/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Morbid obesity is the fastest growing subcategory of childhood obesity, associated with an increased health risk that persists into adulthood. There is an urgent need to develop multifaceted interventions that target initial and long-term lifestyle changes. This review investigates the effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. The influence of age, gender and family participation on health outcomes and intensive treatment alternatives are explored. METHODS The review includes 16 studies conducted between 1995 and 2017. Studies examined youth with morbid obesity, 4-18 years old, undergoing multidisciplinary treatment. RESULTS All studies found a reduction in body mass index (BMI or z-score) and if measured, cardiovascular risk factors. Physical activity, nutrition education, behavioural modification and family involvement are commonly included treatment components and have improved weight loss and health-related outcomes. However, initial weight loss was often not sustainable, despite the favourable interventional effect on cardiometabolic risk markers. Weight loss was prolonged in younger children and among the male sex. CONCLUSIONS There is not a 'one-size-fits-all' treatment approach, and matched care to personal needs is preferable. The integration of a chronic care approach is critical for the successful adaption of sustainable health behaviours.
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Affiliation(s)
- J Zolotarjova
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Ten Velde
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A C E Vreugdenhil
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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Berkowitz RI, Marcus MD, Anderson BJ, Delahanty L, Grover N, Kriska A, Laffel L, Syme A, Venditti E, Van Buren DJ, Wilfley DE, Yasuda P, Hirst K. Adherence to a lifestyle program for youth with type 2 diabetes and its association with treatment outcome in the TODAY clinical trial. Pediatr Diabetes 2018; 19:191-198. [PMID: 28664624 PMCID: PMC5748014 DOI: 10.1111/pedi.12555] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/12/2017] [Accepted: 06/06/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the association of proxies of behavioral adherence to the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) lifestyle program with changes in glycemic control and obesity in a multi-ethnic sample of youth with type 2 diabetes. METHODS The TODAY clinical trial included an intensive lifestyle intervention to promote weight reduction. Adherence was assessed with measures of attendance at intervention sessions and rates of self-monitoring of diet and physical activity by participants and their caregivers. The relation between participant characteristics and consistency of proxies of adherence were examined across 3 phases of intervention. RESULTS A total of 234 TODAY youth were randomized to the lifestyle program. Overall rate of session attendance was approximately 60% of planned sessions. Participants with an adequate dose of session attendance (≥75% attended) did not differ from those who attended <75% of sessions in glycemic control, but did have significantly greater reductions in percent overweight compared with those who attended fewer than 75% of sessions. Rates of self-monitoring were low and additional analysis was not possible. CONCLUSIONS Rates of session attendance were moderate in a lifestyle program for youth with type 2 diabetes, but levels of self-monitoring, considered a key lifestyle change behavior, were low. Glycemic control was not significantly associated with session attendance but reductions in percent overweight were. Given the salience of program attendance and self-monitoring to lifestyle weight management established in other populations, future research is needed to understand, develop, and promote strategies and interventions targeting weight loss to achieve improved glycemic control in youth diagnosed with type 2 diabetes.
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Affiliation(s)
- Robert I Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Linda Delahanty
- Department of Medicine, Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, Massachusetts
| | - Nisha Grover
- George Washington University Biostatistics Center, Rockville, Maryland
| | - Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Amy Syme
- Pediatric Endocrinology, Yale University, New Haven, Connecticut
| | - Elizabeth Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dorothy J Van Buren
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Patrice Yasuda
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Kathryn Hirst
- George Washington University Biostatistics Center, Rockville, Maryland
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Perez AJ, Kebbe M, Holt NL, Gokiert R, Chanoine JP, Legault L, Morrison KM, Sharma AM, Ball GDC. Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management. J Pediatr 2018; 192:122-129. [PMID: 29246332 DOI: 10.1016/j.jpeds.2017.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/26/2017] [Accepted: 09/14/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore parents' recommendations to enhance enrollment in multidisciplinary clinical care for managing pediatric obesity. STUDY DESIGN Data for this interpretative description study were collected through individual, semistructured interviews that were audiorecorded, transcribed verbatim, and analyzed thematically. Parents (n = 79) were recruited from 4 multidisciplinary weight management clinics in Canada located in Edmonton, Hamilton, Montreal, and Vancouver. RESULTS Most interviewed parents had children with obesity (body mass index ≥95th percentile; 84.2%), were female (87.3%), had postsecondary education (69.6%), and were white (75.9%). Parents' recommendations referred to enrollment opportunities, information about obesity services, motivation for treatment, and accessibility to obesity services. Specifically, parents recommended to increase referral options and follow-up contacts with families during the enrollment process, inform referring physicians and families about the availability and characteristics of obesity services, enhance families' motivation for treatment, prevent families from getting discouraged, make services more appealing to families, and address accessibility issues (eg, offering multiple options for appointment times, providing support for transportation). CONCLUSIONS Parents' recommendations support the need for family-centered approaches to enhance enrollment; however, their feasibility, acceptability, and effectiveness remain to be tested empirically.
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Affiliation(s)
- Arnaldo J Perez
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Kebbe
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas L Holt
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Gokiert
- Community-University Partnership, Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Katherine M Morrison
- Department of Pediatrics and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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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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Darling KE, Sato AF. Systematic Review and Meta-Analysis Examining the Effectiveness of Mobile Health Technologies in Using Self-Monitoring for Pediatric Weight Management. Child Obes 2017; 13:347-355. [PMID: 28471699 DOI: 10.1089/chi.2017.0038] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pediatric obesity is a public health concern related to multiple negative physical and psychosocial problems. While behavioral weight control (BWC) interventions are generally effective in decreasing pediatric weight status, these interventions are not able to reach the third of U.S. children currently classified as overweight or obese. METHOD This review and meta-analysis examined the overall effectiveness of mobile health (mHealth) technologies employing self-monitoring, a central component of change within BWC, to decrease pediatric weight status. RESULTS Overall, a small, but significant overall effect size (d = 0.42) was found with the inclusion of nine eligible studies examining the effect on weight status. However, the quality of studies included within this weight status meta-analysis was weak, therefore limiting the interpretability of results. Analyses were also conducted examining the effect of mHealth technologies employing self-monitoring on secondary behavioral outcomes of physical activity and diet. Results indicated a small to medium, but nonsignificant effect (d = 0.41; four samples) on physical activity and a small, but significant effect on diet (d = 0.10; eight samples). CONCLUSIONS Overall, the articles included in behavioral outcomes were of generally moderate quality. More work is needed to better identify the utility of mHealth and specific treatment components (such as self-monitoring), for pediatric weight management.
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Affiliation(s)
| | - Amy F Sato
- Department of Psychological Sciences, Kent State University , Kent, OH
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Alulis S, Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: A qualitative meta-synthesis. Obes Res Clin Pract 2017; 11:627-639. [PMID: 28844833 DOI: 10.1016/j.orcp.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child and adolescent obesity trends are rising throughout the world, revealing treatment difficulties and a lack of consensus about treatment. The family system is broadly viewed as a potential setting for facilitation of behaviour change. Therefore, family-based interventions have come into focus. However, the use of theoretical frameworks to strengthen these interventions is rare and very uneven. OBJECTIVE AND METHOD To conduct a qualitative meta-synthesis of family-based interventions for child and adolescent obesity to identify the theoretical frameworks applied, thus understanding how theory is used in practice. A literature review was conducted between January and March 2016. A total of 35 family-based interventions were selected for analysis. RESULTS Eleven interventions explicitly stated that theory guided the development and were classified as theory-inspired. The social cognitive, self-efficacy and Family Systems Theory appeared most frequently. The remaining 24 were classified as theory-related as theoretical elements of self-monitoring; stimulus control, reinforcement and modelling were used. CONCLUSION The designs of family-based interventions reveal numerous inconsistencies and a significant void between research results and health care practice. Based on the analysis, this article proposes three themes to be used as focus points when designing future interventions and when selecting theories for the development of solid, theory-based frameworks for application. The themes are: (1) age of target group, (2) intervention objective, and (3) self-efficacy and readiness for change.
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Affiliation(s)
- Sarah Alulis
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark; Lund University, Paradisgatan 2, 221 00 Lund, Sweden.
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion Research, Niels Steensens Vej 8, 2820 Gentofte, Denmark.
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Warschburger P, Kröller K. Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC). BMC Pediatr 2016; 16:184. [PMID: 27842526 PMCID: PMC5109701 DOI: 10.1186/s12887-016-0727-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/08/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. METHODS Five hundred twenty-three parents and their 7-13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. RESULTS Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child's quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant. CONCLUSIONS The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background. TRIAL REGISTRATION Current Controlled Trials ISRCTN24655766 . Registered 06 September 2008, updated 16 May 2012.
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Affiliation(s)
- Petra Warschburger
- Department of Psychology, University of Potsdam, Counseling Psychology, Potsdam University, Karl- Liebknecht- Str. 24/25, 14476 Potsdam, Germany
| | - Katja Kröller
- Department of Psychology, University of Potsdam, Counseling Psychology, Potsdam University, Karl- Liebknecht- Str. 24/25, 14476 Potsdam, Germany
- Department of Health Psychology, H:G Hochschule für Gesundheit & Sport, Technik & Kunst, Vulkanstraße 1, 10367 Berlin, Germany
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Graziano PA. How well do preschoolers identify healthy foods? Development and preliminary validation of the Dietary Interview Assessing Nutritional Awareness (DIANA). Appetite 2015; 92:110-7. [DOI: 10.1016/j.appet.2015.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/04/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
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Silva C, Fassnacht DB, Ali K, Gonçalves S, Conceição E, Vaz A, Crosby RD, Machado PPP. Promoting health behaviour in Portuguese children via Short Message Service: The efficacy of a text-messaging programme. J Health Psychol 2015; 20:806-15. [DOI: 10.1177/1359105315577301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A Short Message Service programme was adapted to monitor three health behaviours and provide supportive feedback. The study aimed to evaluate the effectiveness of the programme to increase fruit/vegetable consumption and physical activity and to decrease screen time. A total of 139 Portuguese children, aged 8–10 years, grouped by classroom, were randomly assigned to an intervention (8 weeks of monitoring/feedback) or a control condition. Participants had their key behaviours assessed at baseline, post-intervention and follow-up. A three-level hierarchical linear model was developed. Results showed that the monitoring and feedback programme significantly increased fruit and vegetable consumption over time.
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Affiliation(s)
- Cátia Silva
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
| | - Daniel B Fassnacht
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
- James Cook University, Australia
| | - Kathina Ali
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
| | - Sónia Gonçalves
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
| | - Eva Conceição
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
| | - Ana Vaz
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
| | - Ross D Crosby
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Paulo PP Machado
- Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
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Dietary Self-Monitoring in Weight Management: Current Evidence on Efficacy and Adherence. J Acad Nutr Diet 2015; 115:1931-8. [PMID: 26028176 DOI: 10.1016/j.jand.2015.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Indexed: 11/20/2022]
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Martins LCCDO, Ferreira EAP, Silva LCCD, Almeida FP. Seguimento de Regras Nutricionais em Crianças com Excesso de Peso. PSICOLOGIA: TEORIA E PESQUISA 2015. [DOI: 10.1590/0102-37722015011465033041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Foram avaliados efeitos de instruções, treino de relato verbal (TRV) e treino de automonitoração (TA), com e sem a presença do cuidador principal, sobre o seguimento de regras nutricionais em crianças com excesso de peso. Participaram duas crianças (P1: menino de 9 anos; P2: menina de 11 anos) e suas cuidadoras, por meio de entrevistas em ambulatório. Após instruções, P1 manteve e P2 melhorou o conhecimento das orientações nutricionais. Os Índices de adesão à dieta obtidos por P2 foram mais elevados do que os obtidos por P1 em todas as fases. Houve mudança com significância clínica após introdução de TRV em ambos os participantes. Discute-se a eficácia dos procedimentos de intervenção utilizados e a importância da presença do cuidador.
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Jelalian E, Hadley W, Sato A, Kuhl E, Rancourt D, Oster D, Lloyd-Richardson E. Adolescent weight control: an intervention targeting parent communication and modeling compared with minimal parental involvement. J Pediatr Psychol 2014; 40:203-13. [PMID: 25294840 DOI: 10.1093/jpepsy/jsu082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Adolescent weight control interventions demonstrate variable findings, with inconsistent data regarding the appropriate role for parents. The current study examined the efficacy of a standard adolescent behavioral weight control (BWC) intervention that also targeted parent-adolescent communication and parental modeling of healthy behaviors (Standard Behavioral Treatment + Enhanced Parenting; SBT + EP) compared with a standard BWC intervention (SBT). METHODS 49 obese adolescents (M age = 15.10; SD = 1.33; 76% female; 67.3% non-Hispanic White) and a caregiver were randomly assigned to SBT or SBT + EP. Adolescent and caregiver weight and height, parental modeling, and weight-related communication were obtained at baseline and end of the 16-week intervention. RESULTS Significant decreases in adolescent weight and increases in parental self-monitoring were observed across both conditions. Analyses of covariance revealed a trend for greater reduction in weight and negative maternal commentary among SBT condition participants. CONCLUSIONS Contrary to hypotheses, targeting parent-adolescent communication and parental modeling did not lead to better outcomes in adolescent weight control.
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Affiliation(s)
- Elissa Jelalian
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Wendy Hadley
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Amy Sato
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Elizabeth Kuhl
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Diana Rancourt
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Danielle Oster
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Elizabeth Lloyd-Richardson
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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Hadley W, McCullough MB, Rancourt D, Barker D, Jelalian E. Shaking up the system: the role of change in maternal-adolescent communication quality and adolescent weight loss. J Pediatr Psychol 2014; 40:121-31. [PMID: 25214645 DOI: 10.1093/jpepsy/jsu073] [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: 12/31/2022] Open
Abstract
OBJECTIVE The association between directly observed mother-adolescent weight-related communication quality and adolescent percent overweight within the context of an adolescent weight control study was examined. METHODS As part of a larger study examining the impact of a behavioral weight control intervention that included attention to parent-adolescent communication (Standard Behavioral Treatment + Enhanced Parenting, SBT + EP) compared with an efficacious Standard Behavioral Treatment (SBT), 38 mother-adolescent dyads participated in a weight-related videotaped discussion. Discussions were taped and collected pre- and postintervention. RESULTS No significant differences emerged in the quality of mother-adolescent communication between SBT (n = 19) and SBT + EP (n = 19) participants, nor was baseline mother-adolescent communication quality associated with adolescents' weight loss in either condition. However, a decline in communication quality was associated with better outcomes for adolescents participating in the SBT group. CONCLUSIONS This study provides preliminary evidence that a change in mother-adolescent communication is associated with successful weight loss among adolescents.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - Mary Beth McCullough
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - Diana Rancourt
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - David Barker
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - Elissa Jelalian
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
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Morrison KM, Damanhoury S, Buchholz A, Chanoine JP, Lambert M, Tremblay MS, Berall G, Hamilton J, Laberge AM, Legault L, Thabane L, Jakymyshyn M, Ambler KA, Ball GDC. The CANadian Pediatric Weight management Registry (CANPWR): study protocol. BMC Pediatr 2014; 14:161. [PMID: 24957705 PMCID: PMC4082676 DOI: 10.1186/1471-2431-14-161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/16/2014] [Indexed: 11/15/2022] Open
Abstract
Background Over recent decades, the prevalence of pediatric obesity has increased markedly in developed and developing countries, and the impact of obesity on health throughout the lifespan has led to urgent calls for action. Family-based weight management interventions that emphasize healthy lifestyle changes can lead to modest improvements in weight status of children with obesity. However, these interventions are generally short in duration, reported in the context of randomized controlled trials and there are few reports of outcomes of these treatment approaches in the clinical setting. Answering these questions is critical for improving the care of children with obesity accessing outpatient health services for weight management. In response, the CANadian Pediatric Weight management Registry (CANPWR) was designed with the following three primary aims: 1. Document changes in anthropometric, lifestyle, behavioural, and obesity-related co-morbidities in children enrolled in Canadian pediatric weight management programs over a three-year period; 2. Characterize the individual-, family-, and program-level determinants of change in anthropometric and obesity-related co-morbidities; 3. Examine the individual-, family-, and program-level determinants of program attrition. Methods/Design This prospective cohort, multi-centre study will include children (2–17 years old; body mass index ≥85th percentile) enrolled in one of eight Canadian pediatric weight management centres. We will recruit 1,600 study participants over a three-year period. Data collection will occur at presentation and 6-, 12-, 24-, and 36-months follow-up. The primary study outcomes are BMI z-score and change in BMI z-score over time. Secondary outcomes include anthropometric (e.g., height, waist circumference,), cardiometabolic (e.g., blood pressure, lipid profile, glycemia), lifestyle (e.g., dietary intake, physical activity, sedentary activity), and psychosocial (e.g., health-related quality of life) variables. Potential determinants of change and program attrition will include individual-, family-, and program-level variables. Discussion This study will enable our interdisciplinary team of clinicians, researchers, and trainees to address foundational issues regarding the management of pediatric obesity in Canada. It will also serve as a harmonized, evidence-based registry and platform for conducting future intervention research, which will ultimately enhance the weight management care provided to children with obesity and their families.
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Affiliation(s)
- Katherine M Morrison
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
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Cohen JS, Edmunds JM, Brodman DM, Benjamin CL, Kendall PC. Using Self-Monitoring: Implementation of Collaborative Empiricism in Cognitive-Behavioral Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2012.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents' motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counterchange talk (CCT; amotivational statements against change and commitment). METHODS Thirty-seven black adolescents with obesity received a single motivational interviewing session targeting weight-related behaviors. The video-recorded transcribed sessions were coded using the Minority Youth Sequential Coding for Observing Process Exchanges generating a sequential chain of communication. Data were then subjected to sequential analysis to determine causal relationships between counselor and adolescent communication. RESULTS Asking open-ended questions to elicit adolescent CT and emphasizing adolescents' autonomy most often led to CT. Open-ended questions to elicit CML, reflecting adolescent CML, and emphasizing autonomy most often led to CML. In contrast, open-ended questions to elicit CCT, reflecting CCT, reflecting ambivalence, and neutral open-ended questions about the target behavior led to CCT. CONCLUSIONS This study provides clinicians with insight into the most effective way to communicate with black adolescents with obesity about weight loss. Specifically, reflective statements and open questions focusing on their own desires, abilities, reasons, need, and commitment to weight loss recommendations are more likely to increase motivational statements, whereas other types of reflections and questions may be counterproductive. Finally, because adolescents have a strong need for autonomous decision making, emphasizing their autonomy may be particularly effective in evoking motivational statements.
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Xanthopoulos MS, Moore RH, Wadden TA, Bishop-Gilyard CT, Gehrman CA, Berkowitz RI. The association between weight loss in caregivers and adolescents in a treatment trial of adolescents with obesity. J Pediatr Psychol 2013; 38:766-74. [PMID: 23629145 PMCID: PMC3721188 DOI: 10.1093/jpepsy/jst024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 03/04/2013] [Accepted: 03/18/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The relationship between weight change in caregivers and their adolescents was evaluated following a randomized trial of lifestyle modification for adolescents, which included either a conventional diet or meal replacements. METHODS Adolescents (N = 113) had an M ± SD age of 15.0 ± 1.3 years (62% African American; 26% Caucasian, 12% other; 81% female) and body mass index of 37.1 ± 5.1 kg/m(2). RESULTS Mixed effects models yielded a significant association between percentage change in body mass index of caregivers and adolescents from baseline to months 4 and 12 (p = .01). When caregivers lost above the median (-1.67%) at month 4, their adolescents achieved a significantly greater loss at month 12 (-9.1 ± 1.3%) compared with adolescents whose caregivers lost less than the median (-4.3 ± 1.3%) (p = .003). CONCLUSION Engaging caregivers in their own weight loss efforts during adolescent weight loss treatment may improve adolescent weight loss.
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Affiliation(s)
- Melissa S Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Abstract
Although intuitively appealing, teacher self-report of treatment integrity is not currently recommended as a method for collecting treatment integrity data. Education researchers have not, however, evaluated features of a treatment integrity self-reporting system that may facilitate accurate self-report. In this preliminary investigation, four treatment integrity assessment conditions were investigated: (a) weekly verbal self-report, (b) weekly written self-report, (c) daily verbal self-report, and (d) daily written self-report. Results indicated that teachers who reported treatment integrity daily had the highest overall treatment integrity levels, but neither the frequency nor method of treatment integrity assessment significantly influenced the teachers’ level of treatment integrity. However, results suggested that frequency and method of treatment integrity self-report may be related to accuracy of teacher report.
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Sallinen BJ, Schaffer S, Woolford SJ. In their own words: learning from families attending a multidisciplinary pediatric weight management program at the YMCA. Child Obes 2013; 9:200-7. [PMID: 23631344 DOI: 10.1089/chi.2012.0106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A family-based multidisciplinary weight management program for obese children 7-11 years old was implemented by a pediatric weight management center and local YMCA. The purpose of this study was to explore parents' and children's perceptions of the program to gain insight about factors that may enhance engagement and retention of families in weight management treatment. METHODS Families were invited to participate in a telephone interview after their participation in the program. The interviews assessed satisfaction with program components, acceptability of the intervention, barriers to treatment participation, and suggestions for improvement. RESULTS A total of 34 semistructured telephone interviews were performed, including 19 parents and 15 children. The majority of children (mean age=9.2±1.5 years) interviewed were female (74%) and recipients of Medicaid (79%). The population was racially diverse (63% black, 26% white, 11% other). Results suggest families were generally very positive about the program and viewed the major components of the program as helpful (i.e., nutrition, exercise, behavior). Families particularly enjoyed exercise and cooking demonstrations, whereas self-monitoring activities and learning about behavior change strategies were less enjoyable. Parents noted that increasing the length of individual sessions would likely be beneficial. Families who did not complete the program cited factors such as transportation barriers (e.g., gas money, distance), scheduling conflicts, and unmet expectations as contributing to their decision to discontinue participation. CONCLUSIONS This study may have implications for how to enhance family-based pediatric weight management programs for children ages 7-11 years.
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Affiliation(s)
- Bethany J Sallinen
- Pediatric Comprehensive Weight Management Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA.
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Rengasamy M, Mansoor BM, Hilton R, Porta G, He J, Emslie GJ, Mayes T, Clarke GN, Wagner KD, Keller MB, Ryan ND, Birmaher B, Shamseddeen W, Asarnow JR, Brent DA. The bi-directional relationship between parent-child conflict and treatment outcome in treatment-resistant adolescent depression. J Am Acad Child Adolesc Psychiatry 2013; 52:370-7. [PMID: 23582868 PMCID: PMC3737571 DOI: 10.1016/j.jaac.2013.01.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/27/2012] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the bidirectional relationship between parent-child discord and treatment outcome for adolescent treatment-resistant depression. METHOD Depressed youth who had not responded to an adequate course of a selective serotonin reuptake inhibitor (SSRI) were randomized to either a switch to another SSRI or venlafaxine, with or without the addition of cognitive behavior therapy (CBT) in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. The Conflict Behavior Questionnaire was used to assess adolescent (CBQ-A) and parent-reported (CBQ-P) parent-child discord. The impact of remission on parent-child conflict, and the differential impact of medication and CBT on the CBQ-A and CBQ-P, were assessed using generalized linear models. RESULTS Although there were no differential treatment effects on parent or adolescent-report of conflict, remission was associated with improvement in the CBQ-P. In general, intake family conflict did not predict remission, except in the sub-group of participants whose parents reported clinically significant parent-child conflict at intake, for whom high levels of parent-reported conflict predicted a lower likelihood of remission. Conflict also did not moderate treatment response. CONCLUSIONS Remission of depression may be sufficient to reduce parent-reported parent-child conflict. However, higher parent-reported conflict, in the clinically significant range, predicts a lower likelihood of remission from depression. Clinical trial registration information-Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://clinicaltrials.gov/; NCT00018902.
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Theim KR, Sinton MM, Goldschmidt AB, Van Buren DJ, Doyle AC, Saelens BE, Stein RI, Epstein LH, Wilfley DE. Adherence to behavioral targets and treatment attendance during a pediatric weight control trial. Obesity (Silver Spring) 2013; 21:394-7. [PMID: 23532993 PMCID: PMC3410964 DOI: 10.1002/oby.20281] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 04/02/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children's adherence to a range of behaviors relevant for weight maintenance over long-term follow-up. DESIGN AND METHODS Overweight children (N = 101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up. RESULTS Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally focused MT group. CONCLUSIONS Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children's sustained weight control.
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Affiliation(s)
- Kelly R. Theim
- Department of Psychology, Washington University, St. Louis, Missouri
| | - Meghan M. Sinton
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Department of Psychology, The College of William and Mary, Williamsburg, Virginia
| | - Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Dorothy J. Van Buren
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Angela Celio Doyle
- Eating and Weight Disorders Center of Seattle, Seattle, Washington
- Department of Psychology, University of Washington, Seattle, Washington
| | - Brian E. Saelens
- Department of Pediatrics, Seattle Children’s Research Institute and University of Washington, Seattle, Washington
| | - Richard I. Stein
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Leonard H. Epstein
- Department of Pediatrics, State University of New York at Buffalo School of Medicine, Buffalo, New York
| | - Denise E. Wilfley
- Department of Psychology, Washington University, St. Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Anton SD, LeBlanc E, Allen HR, Karabetian C, Sacks F, Bray G, Williamson DA. Use of a computerized tracking system to monitor and provide feedback on dietary goals for calorie-restricted diets: the POUNDS LOST study. J Diabetes Sci Technol 2012; 6:1216-25. [PMID: 23063049 PMCID: PMC3570857 DOI: 10.1177/193229681200600527] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of self-monitoring as a tool to facilitate behavioral modification is common in many lifestyle-based weight loss interventions. Electronic tracking programs, including computer-based systems and smart phone applications, have been developed to allow individuals to self-monitor their behavior digitally. These programs offer an advantage over traditional self-report modalities in that they can provide users with direct feedback about dietary and/or physical activity adherence levels and thereby assist them in real-time decision making. This article describes the use of an Internet-based computerized tracking system (CTS) that was developed specifically for the POUNDS LOST study, a 2-year randomized controlled trial designed to test the efficacy of four macronutrient diets for weight and fat reduction in healthy, overweight men and women (body mass index range = 25.0-39.9 kg/m(2)). The CTS served many functions in this study, including data collection, dietary and exercise assessment and feedback, messaging system, and report generation. Across all groups, participants with high usage of the CTS during the initial 8 weeks lost greater amounts of weight than participants with low usage (8.7% versus 5.5% of initial body weight, respectively; p < .001) at week 32. Rates of CTS utilization were highest during the first year of this 2-year intervention, and utilization of the CTS declined steadily over time. The unique features of the CTS combined with technological developments, such as smart phone applications, offer significant potential to improve the user's self-monitoring experience and adherence to health promotion programs designed specifically for individuals with obesity and type 2 diabetes.
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Affiliation(s)
- Stephen D Anton
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, Florida, USA.
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de Niet J, Timman R, Bauer S, van den Akker E, Buijks H, de Klerk C, Kordy H, Passchier J. The effect of a short message service maintenance treatment on body mass index and psychological well-being in overweight and obese children: a randomized controlled trial. Pediatr Obes 2012; 7:205-19. [PMID: 22492669 DOI: 10.1111/j.2047-6310.2012.00048.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 12/19/2011] [Accepted: 01/03/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Maintaining weight loss results in childhood obesity treatment is difficult to achieve. Self-management techniques such as self-monitoring are associated with increased weight loss and maintenance. This study analyzes whether self-monitoring of lifestyle behaviours through a short message service maintenance treatment (SMSMT) via mobile phones with personalized feedback positively effects weight, lifestyle behaviours and psychological well-being in obese children. METHODS After 3 months of behavioural lifestyle treatment, 141 overweight and obese children (7-12 years) were randomly assigned to an intervention group receiving SMSMT for 9 months (n = 73) or to the control group (n = 68). The intervention group sent weekly self-monitoring data on exercise and eating behaviour and their mood via mobile phones. In return, they received tailored feedback messages. Primary treatment outcomes were weight, eating behaviour and psychological well-being, i.e. competence, self-esteem and quality of life. Secondary outcome was adherence to the SMSMT. Data were analyzed with mixed modelling. RESULTS SMSMT did not improve treatment outcomes. Controls gained temporarily in physical health scores (P = 0.01). SMSMT completers sent on average every 2 weeks an SMS. Children who had greater weight loss during the first 3 months of lifestyle treatment sent more SMSs (P = 0.04). CONCLUSIONS We did not find a positive effect of SMSMT on weight, eating behaviour or psychological well-being in obese children. SMSMT seems to be a feasible method of treatment delivery. Future research should study variations of SMSMT to investigate how SMSMT can be more effective.
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Affiliation(s)
- J de Niet
- Department of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
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Faith MS, Van Horn L, Appel LJ, Burke LE, Carson JAS, Franch HA, Jakicic JM, Kral TV, Odoms-Young A, Wansink B, Wylie-Rosett J. Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps. Circulation 2012; 125:1186-207. [DOI: 10.1161/cir.0b013e31824607ee] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This scientific statement addresses parents and adult caregivers (PACs) as “agents of change” for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental “involvement” in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.
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Sandilands M, Brennan L, Walkley J, Fraser SF, Greenway K. Self-Monitoring in the Treatment of Overweight Adolescents. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.28.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe aim of this study was to explore the relationship between the quantity and quality of self-monitoring and per cent fat loss in overweight and obese adolescents participating in a weight-loss intervention. Participants were 55 (33F) over-weight and obese adolescents taking part in a 20-week cognitive–behavioural intervention aimed at improving eating and physical activity behaviours. Food and physical activity self-monitoring from the first 9 weeks of the intervention was coded using 24 components assessing the quantity (20) and quality (4) of self-monitoring. Those who completed treatment (n= 42) were split into groups: Losers (n= 30) and Gainers (n= 12) of per cent body fat as measured by DXA. Group analyses showed that Losers and Gainers could be differentiated by both quantitative and qualitative measures of self-monitoring. The strongest associations were with the classifications of food and drink items into food groups. The number of days monitored and the average number of items recorded did not differentiate the groups. Quantity and quality measures of self-monitoring completed early in treatment could also differentiate those who completed treatment and those who did not complete treatment (n= 13), and the strongest associations were with the amounts of food and drink items recorded, an association not found with treatment outcome. The results indicate that both quantity and quality of self-monitoring may be important predictors of both treatment completion and outcome. Based on these findings a framework of self-monitoring requirements is offered to reduce homework burden while maximising treatment efficacy.
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35
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[Psychological aspects of obesity. Consquences for content, indication, and success of therapy]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:562-9. [PMID: 21547647 DOI: 10.1007/s00103-011-1264-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To simply reduce obesity to the medical set of problems falls short due to the complexity of the disorder. The focus of the affected children and adolescents is less on acute and future somatic health impairments but on the psychosocial aspects of obesity. The high degree of stigmatization especially accounts for the psychosocial burdens of the persons concerned. Constraints in the quality of life and a higher prevalence of mental disorders are reported by overweight and obese children and adolescents. In the sense of a vicious psychosocial circle, these variables in turn influence our eating and exercise behavior and hence central influences of weight control actions. Therefore, complex multimodal programs, which take into account these relationships, have long since been established in therapy. Numerous studies have underscored the efficacy of such lifestyle interventions resulting in moderate weight loss effects. Parent involvement and including behavioral strategies is associated with better results. Future studies should focus more on various psychosocial outcomes and addressing the question of psychosocial predictors of short- and long-term treatment success.
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Gunnarsdottir T, Njardvik U, Olafsdottir AS, Craighead LW, Bjarnason R. The role of parental motivation in family-based treatment for childhood obesity. Obesity (Silver Spring) 2011; 19:1654-62. [PMID: 21455125 DOI: 10.1038/oby.2011.59] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigated the role of parental motivation (importance, confidence and readiness) for predicting dropout and outcome from family-based behavioral treatment for childhood obesity. Parent and child demographics, adherence to treatment, and weight loss parameters were also explored as potential predictors. Eighty-four obese children (BMI-standard deviation scores (SDS) >2.14) and a participating parent with each child started treatment consisting of 12 weeks of group and individual treatment sessions (24 sessions total) delivered over a period of 18 weeks. Sixty-one families (73%) completed treatment and attended follow-up at 1 year after treatment. Child session attendance and completion of self-monitoring records served as measures of adherence. In regression analyses, parent reports (pretreatment) of confidence for doing well in treatment was the strongest predictor of treatment completion (P = 0.003) as well as early treatment response (weight loss at week 5) (P = 0.003). This variable remained a significant predictor of child weight loss at post-treatment (P = 0.014), but was not associated with child outcome at 1-year follow-up (P > 0.05). The only significant predictor of child weight loss at that point was child baseline weight (P = 0.001). However, pretreatment parent ratings of importance of and readiness for treatment did not predict dropout or weight loss at any point. The results underscore the importance of addressing parental motivation, specifically parental confidence for changing lifestyle related behaviors, early in the treatment process. Doing so may reduce treatment dropout and enhance treatment outcome.
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37
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Idalski Carcone A, MacDonell KE, Naar-King S, Ellis DA, Cunningham PB, Kaljee L. Treatment Engagement in a Weight Loss Intervention for African American Adolescents and Their Families. CHILDRENS HEALTH CARE 2011. [DOI: 10.1080/02739615.2011.590398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sato AF, Jelalian E, Hart CN, Lloyd-Richardson EE, Mehlenbeck RS, Neill M, Wing RR. Associations between parent behavior and adolescent weight control. J Pediatr Psychol 2011; 36:451-60. [PMID: 21112925 PMCID: PMC3079126 DOI: 10.1093/jpepsy/jsq105] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 10/19/2010] [Accepted: 10/22/2010] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate associations between parent behaviors (i.e., parent weight change, self-monitoring of their behavior, and feeding practices and attitudes) and changes in adolescent BMI and weight following 16-weeks of behavioral weight control (BWC) intervention. METHOD Adolescents (N = 86) 13-16 years old and 30-90% overweight (M = 60.54%, SD = 15.10%) who completed BWC intervention and their parents. Adolescents were randomized to 1 of 2 interventions involving 16 consecutive weeks of active treatment with 4 biweekly maintenance sessions. Adolescent weight and BMI were measured at baseline and 16-weeks. Feeding practices were measured at baseline. Parent self-monitoring was measured during the intervention. RESULTS The only independently significant predictor of adolescent BMI change (p < .01) was parent BMI change. Greater parent self-monitoring (p < .01) predicted greater adolescent weight loss. Greater parent pressure to eat predicted less adolescent weight loss (p < .01). CONCLUSIONS Findings highlight the potential importance of parent weight-related behaviors and feeding practices in the context of adolescent BWC.
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Affiliation(s)
- Amy F Sato
- Department of Psychiatry, Rhode Island Hospital, Alpert Medical School of Brown University, 1, Hoppin Street, Providence, RI 02903, USA.
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Abstract
BACKGROUND With the rising prevalence of childhood obesity over the last several decades, and the call for more family-based intervention research to combat childhood obesity, it is important to examine the extant research on family-based interventions in order to make recommendations and improve future research. OBJECTIVE To conduct a meta-analysis of family-based interventions targeting childhood obesity in the last decade in order to inform the research in the next decade. METHODS A literature review was conducted between December 2009-April 2010. Studies published between the years 2000-2009 that used family-based interventions to treat childhood obesity were included. A total of 20 studies met inclusionary criteria. RESULTS Although results varied by study design, the majority of studies had a moderate to large effect size for change in the target child's BMI (BMI percentile, zBMI, percent overweight) after participating in a family-based intervention. Long-term change varied by study, but the majority of studies produced sustainable change in child BMI, although smaller effect sizes. Change in secondary variables (dietary intake, sugar-sweetened beverage intake, physical activity) were substantially different between studies and are reported as trends. CONCLUSION To date, there is preliminary evidence suggesting that family-based interventions targeting childhood obesity are successful in producing weight loss in the short and long-term. Including families in weight loss treatment of obese children warrants further implementation and study. Limitations with the research, recommendations for future research, and implications for practitioners working with overweight/obese children are discussed.
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Affiliation(s)
- Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Jessie C. Everts
- Department of Family Social Science, University of Minnesota, Minneapolis, MN
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Jelalian E, Lloyd-Richardson EE, Mehlenbeck RS, Hart CN, Flynn-O’Brien K, Kaplan J, Neill M, Wing RR. Behavioral weight control treatment with supervised exercise or peer-enhanced adventure for overweight adolescents. J Pediatr 2010; 157:923-928.e1. [PMID: 20655544 PMCID: PMC2988988 DOI: 10.1016/j.jpeds.2010.05.047] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 03/26/2010] [Accepted: 05/26/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the efficacy of behavioral weight control intervention with a peer-enhanced activity intervention versus structured aerobic exercise in decreasing body mass index (BMI) and z-BMI in overweight adolescents. STUDY DESIGN Participants were randomized to 1 of 2 group-based treatment conditions: (1) cognitive behavioral treatment with peer-enhanced adventure therapy or (2) cognitive behavioral weight control treatment with supervised aerobic exercise. Participants included 118 overweight adolescents, ages 13 to 16 years, and a primary caregiver. Changes in BMI, standardized BMI, percent over BMI, and waist circumference were examined. RESULTS Analysis of variance on the basis of intent-to-treat indicated significant decreases in all weight change outcomes at the end of treatment, with significant decreases maintained at the 12-month follow-up. No differences in treatment conditions were observed. Secondary analyses indicated that adherence with attendance and completion of weekly diet records contributed significantly to reductions in BMI. CONCLUSIONS A cognitive behavioral weight control intervention combined with supervised aerobic exercise or peer-enhanced adventure therapy is equally effective in short-term reduction of BMI and z-BMI in overweight adolescents. Adherence, as measured with session attendance and self-monitoring, is a key dimension of weight change.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elizabeth E. Lloyd-Richardson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA
| | - Robyn S. Mehlenbeck
- Department of Psychiatry, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Chantelle N. Hart
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Katherine Flynn-O’Brien
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Jamie Kaplan
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Meghan Neill
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI
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Kilanowski JF, Moore LC. Food security and dietary intake in midwest migrant farmworker children. J Pediatr Nurs 2010; 25:360-6. [PMID: 20816558 PMCID: PMC2935913 DOI: 10.1016/j.pedn.2009.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 04/08/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
Abstract
This article is a descriptive cross-sectional study with Latino migrant farmworker (MFW) families in Ohio. A demographic questionnaire, the U.S. Household Food Security Survey (USHFSS), and the Food Frequency Questionnaire were self-administered. Participants (N = 50) were primarily mothers of children with ages 2 to 13 years. USHFSS was 30% high, 18% marginal, 44% low, and 8% very low. Only 22% of the children met the minimum MyPyramid daily recommended food-group servings for age and gender. Knowledge gained from these data will influence development of culturally appropriate nutrition interventions to help Latino MFW families achieve healthier nutrition and weight in their children.
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Affiliation(s)
- Jill F Kilanowski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
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Cushing CC, Jensen CD, Steele RG. An evaluation of a personal electronic device to enhance self-monitoring adherence in a pediatric weight management program using a multiple baseline design. J Pediatr Psychol 2010; 36:301-7. [PMID: 20719751 DOI: 10.1093/jpepsy/jsq074] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of a personal electronic device (PED) in order to improve adherence to self-monitoring of dietary intake and physical activity. METHOD The impact of a PED on adherence to self-monitoring goals was examined in a multiple baseline design across three overweight adolescents. During baseline, a traditional paper-and-pencil method of self-monitoring was utilized. The subsequent study phase introduced a PED for self-monitoring. Percent self-monitoring goal attainment was the outcome of interest. RESULTS During baseline, attainment of self-monitoring goals was low for all three participants (3-4%). Each subject's percent attainment of self-monitoring goal increased upon the introduction of the PED. For two of the three subjects this increase was stable (~75 and 100%) post-intervention. For the third subject the increase in percent attainment of self-monitoring goal was more variable but remained above baseline levels. CONCLUSION PEDs have potential for improving self-monitoring in the context of behavioral weight management treatment for adolescents.
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Affiliation(s)
- Christopher C Cushing
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555, USA
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Bauer S, de Niet J, Timman R, Kordy H. Enhancement of care through self-monitoring and tailored feedback via text messaging and their use in the treatment of childhood overweight. PATIENT EDUCATION AND COUNSELING 2010; 79:315-319. [PMID: 20418046 DOI: 10.1016/j.pec.2010.03.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This paper first illustrates the general potential of the short message service (SMS) for symptom and behavior monitoring and the provision of tailored feedback. Second, an SMS-based maintenance treatment (SMSMT) is introduced aimed at enhancing the treatment of childhood overweight. METHODS After a 12-week cognitive behavioral group treatment (CBGT), 40 children were assigned to the SMSMT for a period of 36 weeks. Children were asked to send weekly self-monitoring data on eating behavior, exercise behavior, and emotions and received tailored feedback. The adherence to SMSMT and changes in Body Mass Index Standard Deviation Scores (BMI-SDS) during the first and second treatment phase were analysed. RESULTS Children (mean age=10.05, SD=1.28) submitted 67% of the weekly SMS that they were expected to send in. During CBGT a significant reduction by 0.20 BMI-SDS was observed. The reduction by 0.07 BMI-SDS during the SMSMT did not reach statistical significance. CONCLUSION The results support the feasibility of SMSMT in the treatment of childhood overweight. The efficacy of the intervention needs to be demonstrated in an RCT. PRACTICE IMPLICATIONS SMSMT is a promising intervention that may extend the reach of treatment centers for childhood overweight at reasonable cost and effort.
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Shapiro JR, Bauer S, Hamer RM, Kordy H, Ward D, Bulik CM. Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: a pilot study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:385-391. [PMID: 18984496 PMCID: PMC2592683 DOI: 10.1016/j.jneb.2007.09.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 09/28/2007] [Accepted: 09/30/2007] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine acceptability, attrition, adherence, and preliminary efficacy of mobile phone short message service (SMS; text messaging) for monitoring healthful behaviors in children. DESIGN All randomized children received a brief psychoeducational intervention. They then either monitored target behaviors via SMS with feedback or via paper diaries (PD) or participated in a no-monitoring control (C) for 8 weeks. SETTING University of North Carolina at Chapel Hill. PARTICIPANTS Fifty-eight children (age 5-13) and parents participated; 31 completed (SMS: 13/18, PD: 7/18, C: 11/22). INTERVENTION Children and parents participated in a total of 3 group education sessions (1 session weekly for 3 weeks) to encourage increasing physical activity and decreasing screen time and sugar-sweetened beverage consumption. MAIN OUTCOME MEASURES Treatment acceptability, attrition, and adherence to self-monitoring. ANALYSIS Descriptive statistics and nonparametric tests were used to analyze differences across time and group. RESULTS Children in SMS had somewhat lower attrition (28%) than both PD (61%) and C (50%), and significantly greater adherence to self-monitoring than PD (43% vs 19%, P < .02). CONCLUSIONS AND IMPLICATIONS Short message service may be a useful tool for self-monitoring healthful behaviors in children, although the efficacy of this approach needs further study. Implications suggest that novel technologies may play a role in improving health.
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Affiliation(s)
- Jennifer R Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC 27599, USA.
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Bibliography. Current world literature. Growth and development. Curr Opin Endocrinol Diabetes Obes 2008; 15:79-101. [PMID: 18185067 DOI: 10.1097/med.0b013e3282f4f084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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