Body fat and fitness improvements in Hispanic and African American girls

Impact of child summertime obesity interventions on body mass index and weight-related behaviors: A systematic review and meta-analysis

INTRODUCTION

Obesity during childhood is a critical public health issue. The summer break from school is a time when children are prone to accelerated weight gain. We aimed to investigate how obesity prevention or treatment programs implemented over the summer affect anthropometric measures or weight-related behaviors.

METHODS

Published studies examining the impact of obesity prevention/treatment interventions targeting the summer with anthropometric or weight-related behaviors in children (5-18 years old) were identified using systematic searches of Medline, Cochrane, Scopus, CINAHL, PsycINFO, and EMBASE until April 2024. The summarized effect estimate was computed by applying the random-effects approach. The evidence certainty was assessed using GRADE.

RESULTS

Forty-seven studies were identified for inclusion. The majority of studies identified focused on physical activity and dietary habits. Only six studies that examined the effects of prevention interventions on weight, body mass index (BMI), and waist circumference (WC) were meta-analyzed. There was no evidence that prevention interventions impacted children's weight, BMI, and WC. However, most of the studies included in the systematic review indicated beneficial effects of interventions for anthropometric measures.

CONCLUSION

There was no evidence that summertime obesity interventions targeting physical activity and dietary intake were effective in the prevention of obesity in children.

A systematic review of the intervention characteristics, and behavior change theory and techniques used in mother-daughter interventions targeting physical activity

Growing gender disparities in levels of physical inactivity put women and female youths at a greater risk of associated health problems. Mother-daughter interventions have been proposed as means to promote physical activity in this at-risk cohort. However, there is a lack of clarity as to if and why these types of interventions might be effective. This systematic review examined the intervention characteristics, and behavior change theory and techniques used in these interventions to promote physical activity for mothers and daughters. PubMed, EMBASE, PsycINfO, CINAHL and Cochrane Library (Wiley) databases were searched for English language studies from inception to 13th May 2020. Interventions of any design that targeted daughters and mothers' physical activity were included. Data was extracted using the Template for Intervention Description and Replication (TIDieR) checklist, and the Behavior Change Technique (BCT) Taxonomy v1. 4962 articles were screened and 11 unique studies met the inclusion criteria. The risk of bias in studies was generally high. Narrative summary highlighted that many studies used social cognitive theory as a theoretical foundation, were based in the community and less than three months in duration with multiple sessions per week. Thirty-seven behavior change techniques were identified across studies. Some techniques were deemed potentially effective including credible source, information on the health consequences of the behavior and the self-regulatory techniques of goal-setting, self-monitoring and problem-solving. Future research should consider the use of the TIDieR guidelines and BCT Taxonomy v1 to improve the quality of information for intervention development, implementation, and reporting phases.

Web-Based Program Exposure and Retention in the Families Improving Together for Weight Loss Trial

BACKGROUND

Interventions that incorporate behavioral skills training and parental involvement have been effective for promoting weight loss among middle and upper class youth; however, few studies have produced similar weight loss effects in underserved ethnic minority youth.

PURPOSE

This study examined whether online program exposure (in both an online tailored intervention and an online health education comparison program) predicted greater retention among African American youth and their parents in the Families Improving Together (FIT) for Weight Loss trial.

METHODS

Parent-adolescent dyads (N = 125) were randomized to either an online tailored intervention program (n = 63) or an online health education comparison program (n = 62). Paradata including login data were used to determine the number of sessions viewed (0-8) and the number of minutes spent online per session. Study retention, defined as collection of adolescent anthropometric measures at 6 months postintervention, was the outcome.

RESULTS

Logistic regression analyses showed a significant effect for login rate on retention (OR = 1.21, 95% CI [1.04, 1.39]). Total number of sessions viewed, child age, child sex, parent age, and parent sex accounted for 11% of the variance in retention at 6 months post- intervention. Participants who were retained spent a significantly greater number of minutes during each session (M = 12.99, SD = 11.63) than participants who were not retained (M = 7.77, SD = 11.19), t(123) = 2.24, p = .027, d = 0.45.

CONCLUSIONS

The use of paradata from online interventions is a novel and feasible approach for examining exposure in web-based interventions and program retention in underserved ethnic minority families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01796067. Registered January 23, 2013.

Physical activity in the Families in Transformation (FIT) weight management program for children

Background: The purpose was to determine if an 8-week nutrition education and exercise program for families could influence health and fitness parameters, and retention of nutrition knowledge.

Methods: Eighteen children (mean age: 10.52 ± 1.26 year; 50% boys, 50% girls; 56% white, 25% black, 19% multiracial) participated in the Families in Transformation (FIT) program. Preand post-study anthropocentric, blood pressure, fitness, and nutrition knowledge data was collected.

Results: Diastolic blood pressure decreased for the total group (66.63 ± 8.81 to 63.75 ± 11.81mm Hg). Significant (P < 0.05) increases were seen for the group for push-ups (14.31 ± 7.62 to 19.63 ± 6.62) and chair squats (30.50 ± 10.21 to 34.44 ± 7.39). The reinforcing physical activity group performed significantly better on nutrition knowledge quizzes.

Conclusion: Although, body mass index (BMI) z-scores did not change, there was a decrease in diastolic blood pressure, increase in fitness parameters, and increased retention of nutrition knowledge.

Promoting health and activity in the summer trial: Implementation and outcomes of a pilot study

The objectives of this study were to implement, test adherence to and examine the preliminary effectiveness of a summertime weight-gain prevention intervention in youth from a low-income, Rhode Island community. In 2016, 51 children, ages 6-12 years, participated in a daily, summertime intervention, which offered a minimum of two hours of physical activity programming and free lunch through the USDA's Summer Food Service Program (SFSP). Thirty children from the same community with similar SFSP access served as a comparison group. Height and weight were measured before and at the end of summer to assess change in body mass index z-score (BMIz). Diet and physical activity were assessed midsummer. Multivariate mixed models were used to test group differences in change in BMIz over the summer and weight-related behaviors midsummer. Repeated measures ANOVA was used to examine the relationships of intervention participation with change in BMIz and weight-related behaviors in intervention participants. On average, intervention participants attended 65.6% of program sessions. They lost 0.04 BMIz units, while those in the comparison group gained 0.03 BMIz units (p = 0.07). Midsummer, intervention participants spent 4.6% less time sedentary on weekdays as compared to comparison participants (p = 0.03). Among intervention participants, attendance was significantly associated with change in BMIz (p = 0.01), spending 41 more minutes in moderate to vigorous physical activity (MVPA) (p = 0.004) and 8.5% less time sedentary (p < 0.001). Implementing a summertime obesity prevention intervention in a low-income community is feasible. Despite moderate adherence, preliminary findings suggest that participation in the intervention was associated with reductions in BMIz.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.govNCT03118635.

Effectiveness of mother and daughter interventions targeting physical activity, fitness, nutrition and adiposity: A systematic review

BACKGROUND

Physical inactivity and poor dietary habits in women pose a clear public health burden. Mothers are generally the main female role model for daughters, therefore, targeting intergenerational females simultaneously may be a novel approach. However, the effectiveness of this approach to improve physical activity, fitness, nutrition and adiposity has not been systematically examined.

OBJECTIVES

To assess the effectiveness of physical activity, fitness and nutrition interventions targeting mothers and their daughters.

DATA SOURCES

PubMed, Psychinfo, EMBASE, Ovid Medline, SCOPUS, CINAHL, Sportdiscus and Informit were searched for English language studies (1980-2015).

STUDY SELECTION

Randomized controlled trials (RCTS), non-randomized experimental trials and pre-post studies of physical activity, fitness, nutrition and adiposity interventions targeting mothers and daughters were eligible if they reported changes in physical activity, fitness, dietary intake or adiposity.

DATA EXTRACTION

Data were extracted using a standardized template and checked by a second author.

DATA SYNTHESIS

3577 articles were screened and 14 unique studies (7 RCTs, 1 pseudo-randomized, 1 non-randomized, 5 pre-post) met the inclusion criteria. The majority of studies were conducted in the US (n=11) and most were limited by methodological concerns. Of the RCTs that targeted each outcome exclusively, ≤20%, ≤20% ≤21% and 0% were successful for improving physical activity, fitness, nutrition and adiposity respectively.

CONCLUSIONS

Overall, evidence for the effectiveness of mother-daughter interventions to improve physical activity, fitness, nutrition and adiposity is inconclusive. The diversity of study designs, exposures and outcomes used, along with methodological weaknesses means that well-designed and reported RCTs are warranted.

Impact of child summertime obesity interventions on body mass index, and weight-related behaviours: a systematic review and meta-analysis protocol

INTRODUCTION

In previous studies, it has been found that on average, children consistently gained weight during the summer months at an increased rate compared with the 9-month school year. This contributed to an increased prevalence of overweight and obesity in children. Several obesity-related interventions have occurred during or targeting the summer months. We propose to conduct a systematic review and meta-analysis of the impact of obesity prevention and treatment interventions for school-age children conducted during the summer or targeting the summer months when children are not in school on their body mass index (BMI), or weight-related behaviours.

METHODS AND ANALYSES

A literature search will be conducted by the first author (JPM) using MEDLINE/PubMed, Cochrane Library, Scopus, CINAHL, PsycINFO, EMBASE and Proquest Dissertations and Theses databases from the date of inception to present. Studies must examine interventions that address the modification or promotion of weight-related behaviours (eg, dietary patterns, eating behaviours, physical activity (PA), sedentary behaviour or sleep) and target school-age children (ages 5-18). The primary outcomes will be changes from baseline to postintervention and/or the last available follow-up measurement in weight, BMI, BMI percentile, standardised BMI or per cent body fat. Secondary outcomes will include changes in dietary intake, PA, sedentary behaviour or sleep. Risk of bias will be assessed using the Cochrane risk of bias tool for randomised and non-randomised studies, as appropriate.

ETHICS AND DISSEMINATION

Because this is a protocol for a systematic review, ethics approval will not be required. The findings will be disseminated via presentations at scientific conferences and published in a peer-reviewed journal. All amendments to the protocol will be documented and dated and reported in the PROSPERO trial registry.

PROSPERO REGISTRATION NUMBER

CRD42016041750.

The effect of a physical activity consultation on body mass index z-score of overweight adolescents: results from a pediatric outpatient obesity clinic

Physical activity (PA) is recognized as having many health benefits. Despite of all the efforts, the majority of the overweight adolescents still present low levels of PA. PA consultation can be a cost-effective way of enhancing PA and improve weight status among overweight adolescents. The main aim of this study was to analyze whether adolescents attending a PA consultation in a clinical setting show more therapeutic success at 6 months, based on body mass index (BMI) z-score and waist circumference (WC), compared to those only followed by the pediatrician and nutritionist. Clinical records from 396 patients were analyzed: PA consultation (PAc) group, n = 198; standard consultation (STc) group, n = 198. Baseline differences between groups were analyzed using chi-square and independent sample t tests. Changes within groups and between groups were analyzed using paired sample t tests and independent sample t tests, respectively. Patients in both groups decreased their BMI z-score. The PAc has shown a higher decrease in the BMI z-score (PAc -0.12, p < 0.0001; STc -0.05, p < 0.0001). The WC of the PAc group has increased 2.2 cm less than the one of the STc group (p < 0.005). The difference in waist-to-height ratio between the PAc and STc groups was of 0.015 (p < 0.005), showing a trend to decrease in the PAc group (-0.005, p = 172).

CONCLUSION

Although the success of adolescent obesity management cannot be based only on BMI, a PA consultation on the top of the traditional pediatric and nutrition interventions may further improve the BMI z-score outcome at 6 months. What is Known: • Physical activity (PA) plays an important role in weight management. However, most adolescents, in particular those who are overweight, present low levels of PA. • There is no consensus whether PA counseling influences PA behavior. What is New: • A PA consultation (a structured form of PA counseling) as part of a multidisciplinary team may further be useful for weight management of overweight adolescents followed at the clinical setting, compared to the traditional approach including only the pediatric and nutrition consultations. • Waist-to-height ratio may be more suitable than waist circumference per se to track changes in abdominal adiposity among adolescents who are still growing.

An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families

BACKGROUND

The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents.

DESIGN AND SETTING

The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11-16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M + FWL (Motivational Plus Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M + FWL vs. CHE group) × 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up.

INTERVENTION

The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback.

Commentary: Pediatric obesity: systems science strategies for prevention

OBJECTIVES

Pediatric obesity is a major public health problem that undermines the physical and mental health of children and increases their risk for adult obesity and other chronic illnesses. Although health care providers, including pediatric psychologists, have implemented prevention programs, effects have been minimal, with no solid evidence of sustainable programs.

METHODS

A systems science framework that incorporates the multiple interacting factors that influence pediatric obesity may be useful in guiding prevention.

RESULTS

The National Prevention Strategy provides recommendations that can be incorporated into systems science designs, including (1) Healthy and Safe Environments, (2) Clinical and Community Preventive Services, (3) Empowering People, and (4) Elimination of Health Disparities. In addition, our recommendation is that future obesity prevention programs target early in life (pre-pregnancy through toddlerhood) and use multilevel multidisciplinary designs.

CONCLUSIONS

The benefits of preventing pediatric obesity extend from the health and well-being of individual children to the economic security of the nation.

Context matters in pediatric obesity: commentary on innovative treatment and prevention programs for pediatric overweight and obesity

This commentary reviews the 9 articles in the Special Issue on Innovative Treatment and Prevention Programs for Pediatric Overweight and Obesity. Taking a socio-ecological perspective, contextual factors such as characteristics of the child, family, community, and culture are offered as ways to improve treatment and prevention programs. Using a more tailored approach that takes into account individual differences in family communication patterns and problem solving is warranted. Pediatric psychologists are urged to consider the role of prevention and targeted efforts during early childhood to reduce the prevalence of childhood obesity.