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Wills-Ibarra N, Chemtob K, Hart H, Frati F, Pratt KJ, Ball GD, Van Hulst A. Family systems approaches in pediatric obesity management: a scoping review. BMC Pediatr 2024; 24:235. [PMID: 38566046 PMCID: PMC10985863 DOI: 10.1186/s12887-024-04646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) (n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) (n = 18), mental health (n = 12), FST-related outcomes (n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) (n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research.
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Affiliation(s)
- Natasha Wills-Ibarra
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keryn Chemtob
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Heather Hart
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Francesca Frati
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada
| | - Keeley J Pratt
- Department of Human Sciences, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Centre, Columbus, OH, USA
| | - Geoff Dc Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andraea Van Hulst
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West Suite 1800, Montreal, QC, Canada.
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Grey E, Griffin T, Jolly K, Pallan M, Parretti H, Retzer A, Gillison F. Extended brief interventions for weight management and obesity prevention in children: A rapid evidence review. Obes Rev 2023; 24:e13633. [PMID: 37604189 DOI: 10.1111/obr.13633] [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: 08/15/2022] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
Uptake of child weight management (CWM) support is typically low, and services are not available in all areas. Extended brief interventions (EBIs) have been proposed as an affordable way to provide enhanced support, at a level between one-off brief advice and intensive CWM programs. This rapid systematic review sought to synthesize evidence on the efficacy of EBIs for weight management and obesity prevention in children (2-18 years). Embase and Web of Science were searched from January 2012 to January 2022. Nineteen studies, reporting on 17 separate EBIs, were included. The quality of studies was variable, and the EBIs were heterogeneous. The majority of EBIs (n = 14) were based on motivational interviewing. Five of the included studies reported significant improvements in parent or child determinants of health behavior change. However, robust measures of behavioral determinants were rarely used. No studies reported significant positive effects on child weight. No clear patterns in outcomes were identified. There is currently insufficient evidence for EBIs to be adopted as part of CWM services. To improve the evidence base, EBIs that are currently being implemented by local health services, should be evaluated to establish the most effective content, how it should be delivered, and by whom.
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Affiliation(s)
- Elisabeth Grey
- NIHR Applied Research Collaboration West, Bristol Medical School, University of Bristol, Bristol, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Kate Jolly
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Miranda Pallan
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Helen Parretti
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ameeta Retzer
- Institute of Applied Health Research and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
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Bean MK, LaRose JG, Wickham EP, Raynor HA, Caccavale L, Evans RK, Thornton LM, Farthing S, Mendoza A, Mazzeo SE. The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial. BMC Public Health 2023; 23:1484. [PMID: 37537548 PMCID: PMC10401872 DOI: 10.1186/s12889-023-16421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents' inclusion in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment. METHODS Participants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up. DISCUSSION Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT03851796. Registered: February 22, 2019.
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Affiliation(s)
- Melanie K Bean
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA.
- Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Box 980308, Richmond, VA, 23298, USA.
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Box 980430, Richmond, VA, 23298, USA
| | - Edmond P Wickham
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Box 980111, Richmond, VA, 23298, USA
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, 1215 W. Cumberland Ave., Knoxville, TN, 37996, USA
| | - Laura Caccavale
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
| | - Ronald K Evans
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Box 843021, Richmond, VA, 23284, USA
| | - Laura M Thornton
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, CB#7160 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
| | - Sarah Farthing
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
| | - Ashley Mendoza
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
| | - Suzanne E Mazzeo
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, USA
- Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
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Saunders LA, Jackson B, Gibson LY, Doust J, Dimmock JA, Davis EA, Price L, Budden T. 'It's been a lifelong thing for me': parents' experiences of facilitating a healthy lifestyle for their children with severe obesity. BMC Public Health 2023; 23:1176. [PMID: 37337142 DOI: 10.1186/s12889-023-15780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/28/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE For parents and guardians, assisting children/adolescents with severe obesity to lose weight is often a key objective but a complex and difficult challenge. Our aim in this study was to explore parents' (and guardians') perspectives on the challenges they have faced in assisting their children/adolescents with severe obesity to lead a healthy lifestyle. METHODS Thirteen parents/guardians were interviewed from a pool of families who had been referred but did not engage between 2016 and 2018 (N = 103), with the Perth Children's Hospital Healthy Weight Service, a clinical obesity program for children/adolescents (parent age M = 43.2 years, children age M = 10.3 years). Using semi-structured interviews and thematic analysis, we identified 3 broad themes. RESULTS Parental weight-related factors reflected parents' own lifelong obesity narrative and its effect on their own and their families' ability to live a healthy lifestyle. Perceived inevitability of obesity in their child reflected parents' feelings that the obesity weight status of their children/adolescent was a persistent and overwhelming problem that felt 'out of control'. Lastly, parents reported challenges getting medical help stemming from co-morbid medical diagnosis in their child/adolescent, and difficulties with medical professionals. CONCLUSION This study demonstrates that parents face challenges in supporting healthy lifestyle for children/adolescents with severe obesity due to parents own internal weight biases and their negative experiences within the healthcare system when seeking help.
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Affiliation(s)
- Liz A Saunders
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia.
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia.
- Paediatric Consultation Liaison Program, Child and Adolescent Mental Health Service, Perth Children's Hospital, Western, Australia.
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia
| | - Lisa Y Gibson
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western, Australia
| | - Justine Doust
- Paediatric Consultation Liaison Program, Child and Adolescent Mental Health Service, Perth Children's Hospital, Western, Australia
- Healthy Weight Service, Department of Endocrinology and Diabetes, Perth Children's Hospital, Western, Australia
| | - James A Dimmock
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia
- Healthy Weight Service, Department of Endocrinology and Diabetes, Perth Children's Hospital, Western, Australia
| | - Lyndsey Price
- Healthy Weight Service, Department of Endocrinology and Diabetes, Perth Children's Hospital, Western, Australia
| | - Timothy Budden
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia
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Bean MK, Caccavale LJ, Adams EL, Burnette CB, LaRose JG, Raynor HA, Wickham EP, Mazzeo SE. Parent Involvement in Adolescent Obesity Treatment: A Systematic Review. Pediatrics 2020; 146:peds.2019-3315. [PMID: 32839242 PMCID: PMC7461263 DOI: 10.1542/peds.2019-3315] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
CONTEXT Family-based lifestyle interventions are recommended for adolescent obesity treatment, yet the optimal role of parents in treatment is unclear. OBJECTIVE To examine systematically the evidence from prospective randomized controlled and/or clinical trials (RCTs) to identify how parents have been involved in adolescent obesity treatment and to identify the optimal type of parental involvement to improve adolescent weight outcomes. DATA SOURCES Data sources included PubMed, PsychINFO, and Medline (inception to July 2019). STUDY SELECTION RCTs evaluating adolescent (12-18 years of age) obesity treatment interventions that included parents were reviewed. Studies had to include a weight-related primary outcome (BMI and BMI z score). DATA EXTRACTION Eligible studies were identified and reviewed, following the Preferred Reporting for Systematic Review and Meta-Analyses guidelines. Study quality and risk of bias were evaluated by using the Cochrane Collaboration risk of bias tool. RESULTS This search identified 32 studies, of which 23 were unique RCTs. Only 5 trials experimentally manipulated the role of parents. There was diversity in the treatment target (parent, adolescent, or both) and format (group sessions, separate sessions, or mixed) of the behavioral weight loss interventions. Many studies lacked detail and/or assessments of parent-related behavioral strategies. In ∼40% of unique trials, no parent-related outcomes were reported, whereas parent weight was reported in 26% and associations between parent and adolescent weight change were examined in 17%. LIMITATIONS Only RCTs published in English in peer-reviewed journals were eligible for inclusion. CONCLUSIONS Further research, with detailed reporting, is needed to inform clinical guidelines related to optimizing the role of parents in adolescent obesity treatment.
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Affiliation(s)
- Melanie K. Bean
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Laura J. Caccavale
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Elizabeth L. Adams
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Hollie A. Raynor
- Department of Nutrition, The University of Tennessee,
Knoxville, Knoxville, Tennessee
| | - Edmond P. Wickham
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Internal Medicine, School of Medicine, Virginia
Commonwealth University, Richmond, Virginia; and
| | - Suzanne E. Mazzeo
- Department of Pediatrics, Children’s Hospital
of Richmond at Virginia Commonwealth University, Richmond, Virginia;,Department of Psychology, College of Humanities and
Sciences and
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6
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Heard-Lipsmeyer ME, Hull H, Sims CR, Cleves MA, Andres A. Evaluating body composition in infancy and childhood: A comparison between 4C, QMR, DXA, and ADP. Pediatr Obes 2020; 15:e12617. [PMID: 31986239 PMCID: PMC7323309 DOI: 10.1111/ijpo.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/11/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accurate and precise methods to measure of body composition in infancy and childhood are needed. OBJECTIVES This study evaluated differences and precision of three methods when compared with the four-compartment (4C) model for estimating fat mass (FM). METHODS FM of children (age 14 days to 6 years of age, N = 346) was obtained using quantitative nuclear magnetic resonance (QMR, EchoMRI-AH), air-displacement plethysmography (ADP, PeaPod, less than or equal to 8 kg, BodPod age 6 years or older), and dual-energy X-ray absorptiometry (DXA, Hologic QDR). The 4C model was computed. Correlation, concordance, and Bland-Altman analyses were performed. RESULTS In infants, PeaPod had high individual FM accuracy, whereas DXA had high group FM accuracy compared with 4C. In children, DXA had high group and individual FM accuracies compared with 4C. QMR underestimated group FM in infants and children (300 and 510 g, respectively). The instrument FM precision was best for QMR (10 g) followed by BodPod (34 g), PeaPod (38 g), and DXA (45 g). CONCLUSIONS In infants, PeaPod was the best method to estimate individual FM whereas DXA was best to estimate group FM. In children, DXA was best to estimate individual and group FM. QMR had the highest instrument precision.
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Affiliation(s)
- Melissa E. Heard-Lipsmeyer
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Department of Pediatrics University of Arkansas for Medical Sciences, Little Rock, Arkansas,Division of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine-Louisiana Campus, Monroe, Louisiana
| | - Holly Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas
| | - Clark R. Sims
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mario A. Cleves
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Aline Andres
- Arkansas Children’s Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Department of Pediatrics University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Schroeder K, Van Allen J, Dhurandhar E, Lancaster B, Heidari Z, Cazenave K, Boone D, Erdman P. Riding into Health: A Case Study on an Equine-Assisted Childhood Obesity Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234835. [PMID: 31805713 PMCID: PMC6926900 DOI: 10.3390/ijerph16234835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 12/16/2022]
Abstract
In this article, we present an exploratory case study that describes the initial outcomes of the Equine-Assisted Positively Fit (EAPF) program. Children with obesity and their caregivers were recruited to participate in the eight-session program. Results indicated that treatment completers (n = 2) had a decrease in fat mass and fat mass percentage and an increase in fat-free mass and fat-free mass percentage. Moreover, results from accelerometer measurements of physical activity indicated that participants increased their moderate to vigorous physical activity, as well as reported increased self-efficacy for physical activity. Qualitative data from the post-intervention focus group suggested children perceived the treatment acceptable and enjoyable. Findings from this study provide support for future investigations on the feasibility and potential efficacy of pairing children and their caregivers with horses to accomplish health-related goals.
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Affiliation(s)
- Katy Schroeder
- Department of Animal and Food Sciences, College of Agricultural and Natural Resources, Texas Tech University, Lubbock, TX 79409, USA;
- Correspondence:
| | - Jason Van Allen
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Emily Dhurandhar
- Department of Kinesiology and Sports Management, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA;
| | - Brittany Lancaster
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Zohal Heidari
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Kandis Cazenave
- Department of Animal and Food Sciences, College of Agricultural and Natural Resources, Texas Tech University, Lubbock, TX 79409, USA;
| | - Dianna Boone
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Phyllis Erdman
- Department of Kinesiology and Educational Psychology, College of Education, Washington State University; Pullman, WA 99164, USA;
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Freira S, Fonseca H, Williams G, Ribeiro M, Pena F, do Céu Machado M, Lemos MS. Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing. PATIENT EDUCATION AND COUNSELING 2019; 102:718-725. [PMID: 30503052 DOI: 10.1016/j.pec.2018.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/02/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare motivational interviewing (MI) with conventional care regarding the health-related quality-of-life (HRQoL) of adolescents with overweight/obesity. METHODS RCT with parallel design, involving two groups: intervention group (MI group [MIG]) and control group (conventional intervention group [CIG]). The intervention included three 30-minute interviews 3 months apart. OUTCOME Change in Pediatric Quality of Life Inventory (PedsQL) scores. A mixed repeated-measures analysis of variance was used to assess group versus time interactions. RESULTS Eighty-three participants finished the protocol (82% girls). MIG participants showed a significant average increase (+4.7) on the Psychosocial (t[41] = -2.388, p = .022, d = .37) and Emotional Subscales (+5.1) (t[41] = 5.733, p < .001, d = .88). CIG participants showed a significant average decrease on the Psychosocial (-6.1) (t[40] = 5.733, p < .001, d = .90), Emotional (-14.1) (t[40] = 7.249, p < .001, d = 1.13) and Social Subscales (-3.8) (t[40] = 3.782, p = .001, d = .59) and on the Total Score (-4.4) (t[40] = 3.535, p = .001, d = .55) CONCLUSION: MI improved HRQoL among overweight adolescents participating in a weight management program. PRACTICE IMPLICATIONS MI increases HRQoL and has the potential to benefit weight management programs for adolescents.
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Affiliation(s)
- Silvia Freira
- Department of Pediatrics, Faculty of Medicine, Hospital de Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, 1649-035 Lisboa, Lisbon, Portugal.
| | - Helena Fonseca
- Department of Pediatrics, Faculty of Medicine, Hospital de Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, 1649-035 Lisboa, Lisbon, Portugal.
| | - Geoffrey Williams
- University of Rochester Medical Center, 46 Prince St., Ste 3001, Rochester, NY 14617, United States.
| | - Marta Ribeiro
- Department of Pediatrics, Faculty of Medicine, Hospital de Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, 1649-035 Lisboa, Lisbon, Portugal.
| | - Fernanda Pena
- Unit of Continuing Care, Largo da Mundet - Bairro Novo 2840-264 Seixal, Portugal.
| | - Maria do Céu Machado
- Department of Pediatrics, Faculty of Medicine, Hospital de Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, 1649-035 Lisboa, Lisbon, Portugal.
| | - Marina Serra Lemos
- Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen 535, Porto, Portugal.
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9
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Hill SG, Phan TLT, Datto GA, Hossain J, Werk LN, Abatemarco D. Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States. J Child Health Care 2019; 23:63-78. [PMID: 29792063 PMCID: PMC6105559 DOI: 10.1177/1367493518777308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.
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Affiliation(s)
- Samareh G Hill
- Department of Pediatric Weight Management, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Thao-Ly T Phan
- Division of Weight Management, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - George A Datto
- Division of Weight Management, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Jobayer Hossain
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Lloyd N Werk
- Division of General Academic Pediatrics, Nemours Children’s Hospital, Orlando, FL, USA
| | - Diane Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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10
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Simon SL, Behn CD, Cree-Green M, Kaar JL, Pyle L, Hawkins SMM, Rahat H, Garcia-Reyes Y, Wright KP, Nadeau KJ. Too Late and Not Enough: School Year Sleep Duration, Timing, and Circadian Misalignment Are Associated with Reduced Insulin Sensitivity in Adolescents with Overweight/Obesity. J Pediatr 2019; 205:257-264.e1. [PMID: 30497764 PMCID: PMC6357957 DOI: 10.1016/j.jpeds.2018.10.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/04/2018] [Accepted: 10/11/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To examine the relationship between insulin resistance (IR) and sleep/circadian health in overweight/obese adolescents. We hypothesized that insufficient and delayed sleep would be associated with IR in this population. STUDY DESIGN Thirty-one adolescents (mean age, 16.0 ± 1.4 years; 77% female) with body mass index ≥90th percentile for age/sex were recruited from outpatient clinics at a children's hospital. Participants underwent 1 week of objective home sleep monitoring with wrist actigraphy during the academic year. A 3-hour oral glucose tolerance test was conducted, followed by in-laboratory salivary dim-light melatonin sampling every 30-60 minutes from 5 p.m. to noon the next day. Regression analyses between sleep and circadian variables with IR were examined. RESULTS Longer sleep time and time in bed on weekends and weekdays and earlier weekday bedtime were significantly associated with better insulin sensitivity. Participants who obtained less than the median duration of sleep per night (6.6 hours) had evidence of IR with compensatory insulin secretion compared with those obtaining ≥6.6 hours of sleep. A wider phase angle between bedtime and melatonin onset, indicating a later circadian timing of sleep onset, was significantly associated with IR. CONCLUSIONS Short sleep duration, later weekday bedtime, and later circadian timing of sleep were associated with IR in a cohort of adolescents with overweight/obesity during the school year. Further research is needed to better understand the physiology underlying these observations and to evaluate the impact of improved sleep and circadian health on metabolic health in this at-risk population.
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Affiliation(s)
- Stacey L Simon
- Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children's Hospital Colorado, Aurora, CO.
| | - Cecilia Diniz Behn
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO; Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jill L Kaar
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Stephen M M Hawkins
- Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children's Hospital Colorado, Aurora, CO
| | - Haseeb Rahat
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Yesenia Garcia-Reyes
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Kenneth P Wright
- Sleep & Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO; Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kristen J Nadeau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
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11
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Murray M, Pearson JL, Dordevic AL, Bonham MP. The impact of multicomponent weight management interventions on quality of life in adolescents affected by overweight or obesity: a meta-analysis of randomized controlled trials. Obes Rev 2018; 20:278-289. [PMID: 30358046 DOI: 10.1111/obr.12774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Abstract
Adolescents affected by overweight or obesity report similar quality of life to adolescents with cancer. While weight management is important for physiological outcomes, it is unclear whether weight management improves quality of life in this age group. This meta-analysis assessed the impact of multicomponent weight management interventions on quality of life in adolescents affected by overweight or obesity. Ovid PsycINFO, Ovid Medline, Ovid Embase, Cochrane Library, Scopus and CINAHL Plus databases were searched up to July 2017. Eight eligible studies were randomized controlled trials of multicomponent weight management interventions for adolescents (10 to 19 years) affected by overweight or obesity, with quality of life and weight measurements. Meta-analyses determined a positive effect on quality of life (mean difference 0.20 [0.11, 0.29]; p < 0.01) and weight (mean difference 0.30 [0.12, 0.47]; p < 0.01) following intervention. There was no correlation between weight loss and improvements in quality of life (R2 = 0.103). Rather than weight loss, intervention factors such as parental involvement, group settings and a focus on psychosocial well-being appeared linked to improvements in quality of life. The reduced quality of life reported by this group may be due to social consequences of obesity, rather than actual weight.
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Affiliation(s)
- M Murray
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - J L Pearson
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - A L Dordevic
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - M P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
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12
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Winkler MR, Moore ED, Bennett GG, Armstrong SC, Brandon DH. Parent-adolescent influences on everyday dietary practices: Perceptions of adolescent females with obesity and their mothers. MATERNAL AND CHILD NUTRITION 2017; 13. [PMID: 28097807 DOI: 10.1111/mcn.12416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
Parents demonstrate an important influence on adolescent obesity and dietary behavior; yet, family-based obesity interventions continue to exhibit limited success among adolescents. To further inform family-based approaches for adolescent obesity treatment, we examined the perceptions of adolescent females with obesity and their mothers of the influences experienced within the parent-adolescent relationship that affect everyday dietary practices. We conducted six focus group interviews (three adolescent female and three mother) among 15 adolescent (12-17 years old) females with obesity and 12 of their mothers. Content analysis techniques were used to analyze the transcribed interviews. Adolescent females with obesity discussed a diverse set of parental influences (controlling, supporting and cultivating, overlooking and tempting, acquiescing, providing, attending, and not providing and avoiding) on their daily dietary practices. Among mother focus groups, mothers discussed specific intentional and unintentional types of influences from children that affected the food and drink they consumed, prepared, and acquired. Findings provide a fuller view of the varied social influences on everyday dietary practices within the parent-adolescent relationship. They indicate the importance of examining both parent-to-child and child-to-parent influences and begin to illuminate the value of attending to the social circumstances surrounding dietary behaviors to strengthen family-based obesity treatment approaches.
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Affiliation(s)
- Megan R Winkler
- School of Nursing, Duke University, Durham, North Carolina, USA
| | | | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Debra H Brandon
- School of Nursing, Duke University, Durham, North Carolina, USA.,School of Medicine, Duke University, Durham, North Carolina, USA
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Elvsaas IKØ, Giske L, Fure B, Juvet LK. Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses. J Obes 2017; 2017:5021902. [PMID: 29391949 PMCID: PMC5748119 DOI: 10.1155/2017/5021902] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Treatment of childhood obesity is important in preventing development of obesity-related diseases later in life. This systematic review evaluates the effect of multicomponent lifestyle interventions for children and adolescents from 2 to 18 years. METHODS AND RESULTS We performed systematic searches in nine databases. Thirty-nine studies met the criteria for meta-analyses. We found a significant difference in body mass index (BMI) after 6 months (MD -0.99 (95% CI -1.36 to -0.61)), 12 months (MD -0.67 (95% CI -1.01 to -0.32)), and 24 months (MD -0.96 (95% CI -1.63 to -0.29)) in favour of multicomponent lifestyle interventions compared to standard, minimal, and no treatment. We also found a significant difference in BMI Z scores after 6 months (MD -0.12 (95% CI -0.17 to -0.06)), 12 months (MD -0.16 (95% CI -0.21 to -0.11)), and 24 months (MD -0.16 (95% CI -0.21 to -0.10)) in favour of multicomponent lifestyle interventions. Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention. CONCLUSION Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMI Z score after 6, 12, and 24 months compared with standard, minimal, and no treatment.
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Affiliation(s)
| | - L. Giske
- Norwegian Institute of Public Health, Oslo, Norway
| | - B. Fure
- Norwegian Institute of Public Health, Oslo, Norway
- The Arctic University of Norway, Tromsø, Norway
| | - L. K. Juvet
- Norwegian Institute of Public Health, Oslo, Norway
- University College of Southeast Norway, Notodden, Norway
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15
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Hausman NL, Borrero JC, Fisher A, Kahng S. Teaching young children to make accurate portion size estimations using a stimulus equivalence paradigm. BEHAVIORAL INTERVENTIONS 2016. [DOI: 10.1002/bin.1466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nicole L. Hausman
- Department of Behavioral Psychology; University of Maryland, Baltimore County and the Kennedy Krieger Institute; Baltimore MD USA
| | - John C. Borrero
- Department of Psychology; University of Maryland, Baltimore County; Baltimore MD USA
| | - Alyssa Fisher
- Department of Behavioral Psychology; University of Maryland, Baltimore County and the Kennedy Krieger Institute; Baltimore MD USA
| | - SungWoo Kahng
- Department of Health Psychology; University of Missouri; Columbia MO USA
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Danielsson P, Bohlin A, Bendito A, Svensson A, Klaesson S. Five-year outpatient programme that provided children with continuous behavioural obesity treatment enjoyed high success rate. Acta Paediatr 2016; 105:1181-90. [PMID: 26859578 DOI: 10.1111/apa.13360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/03/2015] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
AIM Results from long-time follow-up of obesity treatment in early childhood are lacking. We investigate long-term continuous behavioural childhood obesity treatment and factors of importance for treatment effect. METHOD A five-year longitudinal retrospective controlled study of children aged five to 13 years in obesity treatment, divided into three groups depending on age at start of treatment. Outcome is presented as change in degree of obesity, body mass index standard deviation score (BMI SDS), change in weight status and decrease of ≥0.5 BMI SDS units, in relation to a age-matched obese comparison group. RESULTS In total, 220 children (46% females) were included. After five years of treatment, the decrease in BMI SDS was significant in all age groups with the largest effect in age group 4-6 years. Compared to the comparison group (n = 369), the decline in BMI SDS was greater (p = 0.001). After five years of treatment, 48% of the patients were cured from their obesity and 72% reached a decline of 0.5 BMI SDS units. Age at start of treatment was the only factor affecting treatment efficacy. CONCLUSION The ability to reach a significant weight loss in a paediatric outpatient clinic is promising through a long-term behavioural obesity treatment.
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Affiliation(s)
- Pernilla Danielsson
- Department of Clinical Science; Division of Pediatrics; Karolinska Institutet; Intervention and Technology (CLINTEC); Stockholm Sweden
| | - Anna Bohlin
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
| | - Ana Bendito
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
| | - Annie Svensson
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
| | - Sven Klaesson
- Department of Women's and Children's Health; Södertälje Hospital; Södertälje Sweden
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17
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Effect of water- versus land-based exercise training as a component of a multidisciplinary intervention program for overweight and obese adolescents. Physiol Behav 2016; 165:365-73. [DOI: 10.1016/j.physbeh.2016.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 11/19/2022]
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18
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Fenner AA, Howie EK, Davis MC, Straker LM. Relationships between psychosocial outcomes in adolescents who are obese and their parents during a multi-disciplinary family-based healthy lifestyle intervention: One-year follow-up of a waitlist controlled trial (Curtin University's Activity, Food and Attitudes Program). Health Qual Life Outcomes 2016; 14:100. [PMID: 27389034 PMCID: PMC4936224 DOI: 10.1186/s12955-016-0501-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Limited studies have investigated relationships in psychosocial outcomes between adolescents who are obese and their parents and how psychosocial outcomes change during participation in a physical activity and healthy eating intervention. This study examined both adolescent and parent psychosocial outcomes while participating in a one - year multi-disciplinary family-based intervention: Curtin University's Activity, Food, and Attitudes Program (CAFAP). METHODS Following a waitlist control period, the intervention was delivered to adolescent (n = 56, ages 11-16) and parent participants over 8 weeks, with one-year maintenance follow-up. Adolescent depression and quality of life, family functioning, and parent depression, anxiety, and stress were assessed at six time points: baseline and prior to intervention (e.g., waitlist control period), immediately following intervention, and at 3, 6, and 12 months post-intervention. Relationships between adolescent and parent psychosocial outcomes were assessed using Spearman correlations and changes in both adolescent and parent outcomes were assessed using linear mixed models. Changes in adolescent psychosocial outcomes were compared to changes in behavioural (physical activity and healthy eating) and physical (weight) outcomes using independent samples t-tests. RESULTS The majority of psychosocial outcomes were significantly correlated between adolescents and parents across the one-year follow-up. Adolescent depression, psychosocial and physical quality of life outcomes significantly improved before or following intervention and were maintained at 6-months or one-year follow-up. Parent symptoms of depression, anxiety, and stress were reduced during waitlist and primarily remained improved. Changes in adolescent psychosocial outcomes were shown to be partially associated with behavioural changes and independent of physical changes. CONCLUSIONS Adolescents in CAFAP improved psychosocial and physical quality of life and reversed the typical trajectory of depressive symptoms in adolescents who are obese during a one-year maintenance period. CAFAP was also effective at maintaining reductions in parent symptoms of depression, anxiety, and stress demonstrated during the waitlist period. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry (No. 12611001187932 ).
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Affiliation(s)
- Ashley A. Fenner
- />School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Erin K. Howie
- />School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Melissa C. Davis
- />School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Leon M. Straker
- />School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
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Van Allen J, Seegan PL, Haslam A, Steele RG. Hope mediates the relationship between depression and quality of life among youths enrolled in a family-based pediatric obesity intervention. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2015.1065744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Do Overweight Adolescents Adhere to Dietary Intervention Messages? Twelve-Month Detailed Dietary Outcomes from Curtin University's Activity, Food and Attitudes Program. Nutrients 2015; 7:4363-82. [PMID: 26043035 PMCID: PMC4488789 DOI: 10.3390/nu7064363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/31/2023] Open
Abstract
Dietary components of adolescent obesity interventions are rarely evaluated with comprehensive reporting of dietary change. The objective was to assess dietary change in overweight adolescents, including adherence to dietary intervention. The dietary intervention was part of a multi-component intervention (CAFAP) targeting the physical activity, sedentary and healthy eating behaviors of overweight adolescents (n = 69). CAFAP was a staggered entry, within-subject, waitlist controlled clinical trial with 12 months of follow up. Diet was assessed using three-day food records and a brief eating behavior questionnaire. Changes in dietary outcomes were assessed using linear mixed models, adjusted for underreporting. Food record data suggested reduced adherence to dietary intervention messages over time following the intervention, despite conflicting information from the brief eating behavior questionnaire. During the intervention, energy intake was stable but favorable nutrient changes occurred. During the 12 month maintenance period; self-reported eating behaviors improved, energy intake remained stable but dietary fat and saturated fat intake gradually returned to baseline levels. Discrepancies between outcomes from brief dietary assessment methods and three-day food records show differences between perceived and actual intake, highlighting the need for detailed dietary reporting. Further, adherence to dietary intervention principles reduces over time, indicating a need for better maintenance support.
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21
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Davis AM, Sampilo M, Gallagher KS, Dean K, Saroja MB, Yu Q, He J, Sporn N. Treating rural paediatric obesity through telemedicine vs. telephone: Outcomes from a cluster randomized controlled trial. J Telemed Telecare 2015; 22:86-95. [PMID: 26026186 DOI: 10.1177/1357633x15586642] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the current study was to examine the feasibility of telemedicine vs. telephone for the delivery of a multidisciplinary weekly family-based behavioural group intervention to treat paediatric obesity delivered to families living in rural areas using a randomized controlled trial methodology. METHODS 103 rural children and their families were recruited. Feasibility measures included participant satisfaction, session attendance and retention. Treatment outcome measures included child Body Mass Index z-score (BMIz), parent BMI, 24-hour dietary recalls, accelerometer data, the child behavior checklist and the behavioral pediatrics feeding assessment scale. RESULTS Participants were highly satisfied with the intervention both via telemedicine and via telephone. Completion rates were much higher than for other paediatric obesity intervention programmes, and both methodologies were highly feasible. There were no differences in telemedicine and telephone groups on primary outcomes. CONCLUSION Both telemedicine and telephone intervention appear to be feasible and acceptable methods of delivering paediatric obesity treatment to rural children.
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Affiliation(s)
- Ann M Davis
- University of Kansas Medical Center, Department of Pediatrics, USA Center for Children's Healthy Lifestyles & Nutrition, USA
| | - Marilyn Sampilo
- Center for Children's Healthy Lifestyles & Nutrition, USA University of Kansas, Department of Clinical Child Psychology, USA
| | | | - Kelsey Dean
- University of Kansas Medical Center, Department of Pediatrics, USA
| | | | - Qing Yu
- University of Kansas Medical Center, Department of Biostatistics, USA
| | - Jianghua He
- University of Kansas Medical Center, Department of Biostatistics, USA
| | - Nora Sporn
- University of Kansas, Department of Psychology, USA
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da Silva DF, Bianchini JAA, Lopera CA, Capelato DA, Hintze LJ, Nardo CCS, Ferraro ZM, Nardo Junior N. Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents. Appetite 2015; 87:229-35. [DOI: 10.1016/j.appet.2014.12.221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022]
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Abstract
Type 2 diabetes (T2D) in youth is a relatively novel condition facing paediatric health care providers. Few experimental trials exist to guide clinical management in this population. Supporting and prescribing modifiable lifestyle behaviours is cornerstone in the management of T2D in adults. Clinical trials in obese adolescents suggest that intensive lifestyle interventions that include both dietary changes and increased physical activity elicit clinically meaningful reductions in weight and improve cardiovascular risk profiles. Observational studies in youth with T2D suggest that better diet quality and increased physical activity are associated with better metabolic control; however, the limited experimental data available does not support these observations. Trials evaluating lifestyle monotherapy for the treatment of hyperglycaemia in youth with T2D do not exist, and the only study evaluating combined lifestyle and pharmacologic therapy did not show additional benefit over pharmacologic treatment with metformin alone. Physiological and psychosocial differences between youth and adults with T2D likely contribute to the differences in the effectiveness of lifestyle therapy for improving glycaemic control. The current review describes these topics in detail and provides recommendations for paediatric health care providers for the promotion of lifestyle therapy for the management of hyperglycaemia and cardiovascular risk factors for youth with T2DM.
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Affiliation(s)
- Jonathan McGavock
- Department of Pediatrics and Child Health, Faculty of Medicine, Manitoba Institute of Child Health, University of Manitoba, 511 JBRC 715 McDermot ave., Winnipeg, MB, R3E 3P4, Canada,
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Altman M, Wilfley DE. Evidence update on the treatment of overweight and obesity in children and adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:521-37. [PMID: 25496471 DOI: 10.1080/15374416.2014.963854] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Childhood obesity is associated with increased medical and psychosocial consequences and mortality and effective interventions are urgently needed. Effective interventions are urgently needed. This article reviews the evidence for psychological treatments of overweight and obesity in child and adolescent populations. Studies were identified through searches of online databases and reference sections of relevant review articles and meta-analyses. Treatment efficacy was assessed using established criteria, and treatments were categorized as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy. Well-established treatments included family-based behavioral treatment (FBT) and Parent-Only Behavioral Treatment for children. Possibly efficacious treatments include Parent-Only Behavioral Treatment for adolescents, FBT-Guided Self-Help for children, and Behavioral Weight Loss treatment with family involvement for toddlers, children, and adolescents. Appetite awareness training and regulation of cues treatments are considered experimental. No treatments are considered probably efficacious, or of questionable efficacy. All treatments considered efficacious are multicomponent interventions that include dietary and physical activity modifications and utilize behavioral strategies. Treatment is optimized if family members are specifically targeted in treatment. Research supports the use of multicomponent lifestyle interventions, with FBT and Parent-Only Behavioral Treatment being the most widely supported treatment types. Additional research is needed to test a stepped care model for treatment and to establish the ideal dosage (i.e., number and length of sessions), duration, and intensity of treatments for long-term sustainability of healthy weight management. To improve access to care, the optimal methods to enhance the scalability and implementability of treatments into community and clinical settings need to be established.
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Affiliation(s)
- Myra Altman
- a Department of Psychology , Washington University in St. Louis
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Ligthart KAM, Paulis WD, Djasmo D, Koes BW, van Middelkoop M. Effect of multidisciplinary interventions on quality of life in obese children: a systematic review and meta-analysis. Qual Life Res 2014; 24:1635-43. [DOI: 10.1007/s11136-014-0881-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 02/03/2023]
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Van Allen J, Borner KB, Gayes LA, Steele RG. Weighing physical activity: the impact of a family-based group lifestyle intervention for pediatric obesity on participants' physical activity. J Pediatr Psychol 2014; 40:193-202. [PMID: 25241402 DOI: 10.1093/jpepsy/jsu077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. METHODS Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. RESULTS Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. CONCLUSIONS Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.
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Affiliation(s)
- Jason Van Allen
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
| | - Kelsey B Borner
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
| | - Laurie A Gayes
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
| | - Ric G Steele
- Clinical Psychology Program, Texas Tech University and Clinical Child Psychology Program, University of Kansas
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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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Cushing CC, Suorsa KI. Intensive Treatments for Pediatric Obesity: An Acceptability Analogue Study. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2013.837823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.
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Affiliation(s)
- Elizabeth R Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA, 33136
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Steele RG, Jensen CD, Gayes LA, Leibold HC. Medium Is the Message: Moderate Parental Control of Feeding Correlates With Improved Weight Outcome in a Pediatric Obesity Intervention. J Pediatr Psychol 2014; 39:708-17. [DOI: 10.1093/jpepsy/jsu035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hausman NL, Borrero JC, Fisher A, Kahng S. Improving accuracy of portion-size estimations through a stimulus equivalence paradigm. J Appl Behav Anal 2014; 47:485-99. [PMID: 24842700 DOI: 10.1002/jaba.139] [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] [Received: 06/10/2013] [Accepted: 03/18/2014] [Indexed: 11/11/2022]
Abstract
The prevalence of obesity continues to increase in the United States (Gordon-Larsen, The, & Adair, 2010). Obesity can be attributed, in part, to overconsumption of energy-dense foods. Given that overeating plays a role in the development of obesity, interventions that teach individuals to identify and consume appropriate portion sizes are warranted. Specifically, interventions that teach individuals to estimate portion sizes correctly without the use of aids may be critical to the success of nutrition education programs. The current study evaluated the use of a stimulus equivalence paradigm to teach 9 undergraduate students to estimate portion size accurately. Results suggested that the stimulus equivalence paradigm was effective in teaching participants to make accurate portion size estimations without aids, and improved accuracy was observed in maintenance sessions that were conducted 1 week after training. Furthermore, 5 of 7 participants estimated the target portion size of novel foods during extension sessions. These data extend existing research on teaching accurate portion-size estimations and may be applicable to populations who seek treatment (e.g., overweight or obese children and adults) to teach healthier eating habits.
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Affiliation(s)
- Nicole L Hausman
- University of Maryland, Baltimore County and Kennedy Krieger Institute
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Abstract
OBJECTIVE Rates of obesity are elevated among children with special needs (e.g., autism spectrum disorder, Down syndrome, or developmental disabilities). The objective of this study was to evaluate the effectiveness of a multidisciplinary tailored intervention to treat obesity among youth with special needs. METHOD Seventy-six children aged 2 to 19 years participated in a multidisciplinary weight management clinic adapted for children with special needs. A description of the patients presenting for specialized clinical services is provided, and the impact of the intervention on child body mass index (BMI) and food variety was examined for a subset (n = 30) of children. Descriptive statistics of the patient population at baseline were calculated and a series of t tests, correlations, and analysis of variance models examined change in BMI z-scores (BMIz) and diet variety. Factors related to treatment outcomes were also explored. RESULTS BMIz decreased significantly by the 6-month follow-up (M = 2.43 to M = 2.36, p < .01). There were significant increases in the variety of fruits, vegetables, and grains that children ate (t(16) = 3.18, p < .01; t(16) = 2.63, p = .02; t(16) = 2.37, p = .03, respectively). CONCLUSION A multidisciplinary clinic-based intervention was effective in reducing BMIz over a 6-month period and increasing the variety of foods that children were eating. These results have implications for providing tailored weight management interventions for youth with obesity and special needs.
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Smith KL, Straker LM, McManus A, Fenner AA. Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders. BMC Pediatr 2014; 14:53. [PMID: 24552207 PMCID: PMC3942615 DOI: 10.1186/1471-2431-14-53] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/13/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs. METHODS This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses. RESULTS Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services. CONCLUSIONS This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.
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Affiliation(s)
- Kyla L Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Alexandra McManus
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Ashley A Fenner
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Dalton WT, Schetzina KE, McBee MT, Maphis L, Fulton-Robinson H, Ho AL, Tudiver F, Wu T. Parent report of child's health-related quality of life after a primary-care-based weight management program. Child Obes 2013; 9:501-8. [PMID: 24152081 PMCID: PMC3868295 DOI: 10.1089/chi.2013.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) has been recognized as an important target and health outcome in obesity research. The current study aimed to examine HRQoL in overweight or obese children after a 10-week primary-care-based weight management program, Parent-Led Activity and Nutrition for Healthy Living, in southern Appalachia. METHODS Sixty-seven children (ages 5-12 years) and their caregivers were recruited from four primary care clinics, two of which were randomized to receive the intervention. Caregivers in the intervention groups received two brief motivational interviewing visits and four group sessions led by providers as well as four phone follow-ups with research staff. Caregivers completed the PedsQL and demographic questionnaires at baseline and at 3, 6, and 12 months postintervention. Child height and weight were collected to determine standardized BMI. RESULTS Caregivers of children receiving the weight control intervention reported no statistically significant improvements in child total HRQoL, as compared to the control group, across the course of treatment (β=0.178; 95% confidence interval, -0.681, 1.037; p=0.687). Additionally, no statistically significant improvements were found across other HRQoL domains. CONCLUSIONS Future studies examining HRQoL outcomes in primary care may consider treatment dose as well as methodological factors, such as utilization of multiple informants and different measures, when designing studies and interpreting outcomes.
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Affiliation(s)
- William T. Dalton
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Karen E. Schetzina
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Matthew T. McBee
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Laura Maphis
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Hazel Fulton-Robinson
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Ai-Leng Ho
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Fred Tudiver
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Tiejian Wu
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN.,Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
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Cushing CC, Walters RW, Hoffman L. Aggregated N-of-1 randomized controlled trials: modern data analytics applied to a clinically valid method of intervention effectiveness. J Pediatr Psychol 2013; 39:138-50. [PMID: 24284134 DOI: 10.1093/jpepsy/jst083] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Aggregated N-of-1 randomized controlled trials (RCTs) combined with multilevel modeling represent a methodological advancement that may help bridge science and practice in pediatric psychology. The purpose of this article is to offer a primer for pediatric psychologists interested in conducting aggregated N-of-1 RCTs. METHODS An overview of N-of-1 RCT methodology is provided and 2 simulated data sets are analyzed to demonstrate the clinical and research potential of the methodology. RESULTS The simulated data example demonstrates the utility of aggregated N-of-1 RCTs for understanding the clinical impact of an intervention for a given individual and the modeling of covariates to explain why an intervention worked for one patient and not another. CONCLUSIONS Aggregated N-of-1 RCTs hold potential for improving the science and practice of pediatric psychology.
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Affiliation(s)
- Christopher C Cushing
- PhD, Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA.
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Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L. Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet 2013; 113:1375-94. [PMID: 24054714 DOI: 10.1016/j.jand.2013.08.004] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Indexed: 12/17/2022]
Abstract
It is the position of the Academy of Nutrition and Dietetics that prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, as well as consistent and integrated messages and environmental support across all sectors of society to achieve sustained dietary and physical-activity behavior change. This position paper provides guidance and recommendations for levels of intervention targeting overweight and obesity prevention and treatment from preschool age through adolescence. Methods included a review of the literature from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based reviews. Multicomponent interventions show the greatest impact for primary prevention; thus, early childhood and school-based interventions should integrate behavioral and environmental approaches that focus on dietary intake and physical activity using a systems-level approach targeting the multilevel structure of the socioecological model as well as interactions and relationships between levels. Secondary prevention and tertiary prevention/treatment should emphasize sustained family-based, developmentally appropriate approaches that include nutrition education, dietary counseling, parenting skills, behavioral strategies, and physical-activity promotion. For obese youth with concomitant serious comorbidities, structured dietary approaches and pharmacologic agents should be considered, and weight-loss surgery can be considered for severely obese adolescents. Policy and environmental interventions are recommended as feasible and sustainable ways to support healthful lifestyles for children and families. The Academy supports commitment of resources for interventions, policies, and research that promote healthful eating and physical-activity behaviors to ensure that all youth have the opportunity to achieve and maintain a weight that is optimal for health.
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Abstract
Lifestyle interventions are regarded as the therapy of choice in children with obesity. The efficiency of lifestyle intervention for childhood obesity has been proven by several randomized controlled trials and meta-analyses. Even a stable weight in a growing child with obesity is associated with an improvement in cardiovascular risk factors and comorbidities of obesity. In particular, children aged 5-12 years and children with overweight rather than obesity profit from lifestyle interventions. However, in clinical practice, the degree of weight loss with lifestyle intervention is only moderate, and the success rate 2 years after onset of an intervention is low (<10% with a decrease in BMI SD score of <0.25). Nevertheless, the difficulty of a child with overweight or obesity to reduce their weight might be attributable to not only a lack of motivation but also genetic background and/or adaptive changes in basal metabolic rate, hunger and satiety hormones that occur with weight loss. We must accept that lifestyle interventions are successful only in a subgroup of children with obesity. Regardless, the techniques used and the education of therapists need to be improved. If lifestyle interventions do not result in weight loss in a child with obesity, drug treatment to reduce cardiovascular risk factors should be initiated but is currently seldom performed.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Straße 5, D-45711 Datteln, Germany.
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Predicting health-related quality of life from the psychosocial profiles of youth seeking treatment for obesity. J Dev Behav Pediatr 2013; 34:575-82. [PMID: 24131880 DOI: 10.1097/dbp.0b013e3182a509a6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify, in a sample of youth seeking treatment for obesity, subgroups of youth characterized by distinct profiles of psychosocial functioning and to examine whether psychosocial subgroup membership predicted treatment outcomes. METHODS Baseline psychosocial profiles identified using cluster analysis techniques were used to predict treatment outcomes (i.e., health-related quality of life, BMI z scores). Participants were 92 youths seeking treatment for obesity (mean age = 11.6 years, mean body mass index for age and sex = 30.5) and their caregivers. RESULTS Three distinct psychosocial profile subgroups were identified. Subgroups with higher levels of psychosocial problems had poorer health-related quality of life outcomes posttreatment and at 12-month follow-up. Subgroup membership did not predict weight outcomes. CONCLUSION Youth seeking weight management treatment may present with patterns of psychosocial difficulties with implications for treatment outcomes. Weight treatment interventions should be tailored to meet the needs of youth with higher levels of psychosocial problems.
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Jull A, Chen R. Parent-only vs. parent-child (family-focused) approaches for weight loss in obese and overweight children: a systematic review and meta-analysis. Obes Rev 2013; 14:761-8. [PMID: 23639069 DOI: 10.1111/obr.12042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 03/21/2013] [Accepted: 03/28/2013] [Indexed: 11/30/2022]
Abstract
Families are recommended as the agents of change for weight loss in overweight and obese children; family approaches are more effective than those that focus on the child alone. However, interventions that focus on parents alone have not been summarized. The objective of this review was to assess the effectiveness of interventions that compared a parent-only (PO) condition with a parent-child (PC) condition. Four trials using a similar between-group background approaches to overweight and obese children's weight loss met the inclusion criteria, but only one trial reported sufficient data for meta-analysis. Further information was obtained from authors. Meta-analysis showed no significant difference in z-BMI from baseline to end of treatment between the conditions (three trials) or to end of follow up (two trials). The trials were at risk of bias and no single trial was at lower risk of bias than others. There is an absence of high quality evidence regarding the effect of parent-only interventions for weight loss in children compared to parent-child interventions, but current evidence suggests the need for further investigation.
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Affiliation(s)
- A Jull
- School of Nursing, University of Auckland, Auckland, New Zealand; National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
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Berkowitz RI, Rukstalis MR, Bishop-Gilyard CT, Moore RH, Gehrman CA, Xanthopoulos MS, Cochran WJ, Louden D, Wadden TA. Treatment of adolescent obesity comparing self-guided and group lifestyle modification programs: a potential model for primary care. J Pediatr Psychol 2013; 38:978-86. [PMID: 23750019 DOI: 10.1093/jpepsy/jst035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lifestyle modification programs (LMP) for weight loss in adolescents with obesity are effective but not available. Primary care may be a setting for reaching more adolescents. Two models of LMP for use in primary care were examined. Adolescents and caregivers enrolled in a 1-year randomized trial comparing Group LMP with Self-Guided LMP. All participants (N = 169) received the same treatment recommendations and met with a health coach six times in clinic. Group LMP participants had an additional 17 group sessions; those in Self-Guided LMP followed the remainder of the program at home with parental support. The primary outcome was percentage change in initial body mass index. The mean (SE) 1.31% (0.95%) reduction in Group LMP did not differ significantly from the 1.17% (0.99%) decrease in the Self-Guided LMP (p = 0.92). Both treatments were significantly effective in reducing body mass index. Given its brevity, the Self-Guided LMP offers an innovative approach for primary care.
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Affiliation(s)
- Robert I Berkowitz
- MD, The Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA.
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Beebe DW, Simon S, Summer S, Hemmer S, Strotman D, Dolan LM. Dietary intake following experimentally restricted sleep in adolescents. Sleep 2013; 36:827-34. [PMID: 23729925 DOI: 10.5665/sleep.2704] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
STUDY OBJECTIVE To examine the relationship between sleep and dietary intake in adolescents using an experimental sleep restriction protocol. DESIGN Randomized crossover sleep restriction-extension paradigm. SETTING Sleep obtained and monitored at home, diet measured during an office visit. PARTICIPANTS Forty-one typically developing adolescents age 14-16 years. INTERVENTIONS The 3-week protocol consisting of a baseline week designed to stabilize the circadian rhythm, followed randomly by 5 consecutive nights of sleep restriction (6.5 hours in bed Monday-Friday) versus healthy sleep duration (10 hours in bed), a 2-night washout period, and a 5-night crossover period. MEASUREMENTS Sleep was monitored via actigraphy and teens completed validated 24-hour diet recall interviews following each experimental condition. RESULTS Paired-sample t-tests examined differences between conditions for consumption of key macronutrients and choices from dietary categories. Compared with the healthy sleep condition, sleep-restricted adolescents' diets were characterized by higher glycemic index and glycemic load and a trend toward more calories and carbohydrates, with no differences in fat or protein consumption. Exploratory analyses revealed the consumption of significantly more desserts and sweets during sleep restriction than healthy sleep. CONCLUSIONS Chronic sleep restriction during adolescence appears to cause increased consumption of foods with a high glycemic index, particularly desserts/sweets. The chronic sleep restriction common in adolescence may cause changes in dietary behaviors that increase risk of obesity and associated morbidity.
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Affiliation(s)
- Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Jensen CD, Aylward BS, Steele RG. Predictors of attendance in a practical clinical trial of two pediatric weight management interventions. Obesity (Silver Spring) 2012; 20:2250-6. [PMID: 22513495 DOI: 10.1038/oby.2012.96] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study was to evaluate demographic and psychosocial predictors of attendance in a family-based behavioral weight management clinical trial. Ninety-three children and adolescents aged 7-17 (Mean age = 11.59, s.d. = 2.6) who were either overweight or obese (Mean BMI percentile = 98.2) and their parents received either a 10-session behavioral treatment or a three-session brief family intervention in the context of a randomized clinical trial (10). Psychosocial and anthropometric measures were obtained before enrollment and at the end of 10 weeks for both treatment groups. Univariate linear regression and hierarchical multiple regression analyses were used to identify predictors of attendance to treatment from an a priori set of hypothesized predictors. Three variables demonstrated significant associations with the dependent variable, percent of treatment sessions attended. Specifically, distance from participant's home to treatment site, lower gross family income, and youth self-report of depressive symptoms were each associated with lower percent attendance (all Ps < 0.05). These results corroborate (i.e., income, depressive symptoms) and expand (i.e., distance from treatment site) previous reports in the literature of potential barriers to effective treatment for pediatric obesity, and suggest the need for research on treatment delivery methods that could increase participation among low-income families (e.g., eHealth, mHealth options). Depressive symptoms could represent an additional barrier to treatment attendance, suggesting that assessment and treatment for these symptoms may be appropriate before commencing weight management treatment.
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Affiliation(s)
- Chad D Jensen
- Department of Psychology, Brigham Young University, Provo, Utah, USA.
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Van Allen J, Steele RG. Associations Between Change in Hope and Change in Physical Activity in a Pediatric Weight Management Program. CHILDRENS HEALTH CARE 2012. [DOI: 10.1080/02739615.2012.721724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jensen CD, Steele RG. Longitudinal associations between teasing and health-related quality of life among treatment-seeking overweight and obese youth. J Pediatr Psychol 2012; 37:438-47. [PMID: 22262915 PMCID: PMC3415978 DOI: 10.1093/jpepsy/jsr108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/22/2011] [Accepted: 11/22/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine concurrent and prospective associations between perceptions of teasing and health-related quality of life (HRQOL) over the course of a behavioral/educational intervention and the subsequent year in a sample of overweight and obese children and adolescents. METHOD A clinical sample of 93 overweight or obese youths (ages 7-17 years) and 1 parent/guardian completed measures of teasing and HRQOL at pre- and posttreatment and follow-up assessments. Structural equation modeling was used to examine the factor structure of the measures and to assess prospective associations over a 15-month period. RESULTS Results indicate that, concurrently, weight-related teasing is inversely associated with HRQOL and that, prospectively, HRQOL is inversely associated with subsequent teasing. CONCLUSIONS Study findings are suggestive of a directional relationship with lower quality of life predicting subsequent higher levels of teasing. Results suggest the potential for interventions designed to improve HRQOL to reduce teasing experiences for overweight and obese youth.
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Affiliation(s)
- Chad D Jensen
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA.
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