Promotion of physical activity in primary care for obesity treatment/prevention in children

Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes

In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.

Are interventions delivered by healthcare professionals effective for weight management? A systematic review of systematic reviews

OBJECTIVE

There are many systematic reviews of weight management interventions delivered by healthcare professionals (HCP), but it is not clear under what circumstances interventions are effective due to differences in review methodology. This review of systematic reviews synthesises the evidence about: (a) the effectiveness of HCP-delivered weight management interventions and (b) intervention and sample characteristics related to their effectiveness.

DESIGN

The review of reviews involved searching six databases (inception - October 2020). Reviews were included if they were (a) systematic, (b) weight management interventions delivered, at least partially, by HCP, (c) of randomised controlled trials and (d) written in English. Data regarding weight management outcomes (e.g. weight) and moderating factors were extracted. Secondary analyses were conducted using study-level data reported in each of the reviews.

SETTING

The review included studies that were delivered by HCP in any clinical or non-clinical setting.

PARTICIPANTS

Not applicable.

RESULTS

Six systematic reviews were included (forty-six unique studies). First-level synthesis showed that weight management interventions delivered by HCP are effective. The second-level synthesis found that interventions are only successful for up to 6 months, are most effective for women, non-Caucasians and adults and are most effective if they have at least six sessions.

CONCLUSIONS

As interventions are only successful for up to 6 months, they are not sufficient for achieving and maintaining a healthy weight.

How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings

Introduction: A vast majority of children and adolescents are physically inactive. As a result, high obesity rates and related diseases have made physical activity promotion a politically relevant topic. In order to form the basis for political decision making, evidence is required regarding the efficacy and effectiveness of interventions for physical activity promotion. In contrast to previous research, this systematic review of reviews targets three key settings (family and home, childcare, school), and is among the largest to have been conducted. Methods: A systematic review of reviews was conducted as part of a large-scale project to develop national recommendations for physical activity promotion in Germany. Six electronic databases were searched and inclusion criteria were defined. Two independent reviewers screened the titles and abstracts of potentially relevant literature. 213 reviews were identified and categorised by target group. A total of 74 reviews were identified dealing with children and adolescents. Each review underwent a quality assessment. Results: 39 reviews with the highest quality and relevance were analysed. Three reviews focused on the family and home setting, 4 on the childcare setting, 28 on the school setting and 4 on other settings. Evidence revealed the key role played by parents in promoting physical activity in children within each setting. Furthermore, evidence pointed toward the efficacy of multi-component interventions in the childcare and school setting. Several evidence-based intervention strategies were identified for childcare facilities and schools. Discussion: The review of reviews identified a number of promising strategies for PA promotion among children and adolescents. Among reviews, multi-component interventions in childcare facilities and schools stand out prominently. At the same time, the review of reviews indicated that there is still a lack of studies on the efficacy of interventions that go beyond the individual level. We recommend that future research should also target community and policy level interventions and interventions other than the school setting. In order to make more specific recommendations regarding the scale-up of promising intervention strategies, further knowledge about the effectiveness, health equity and cost effectiveness of interventions is needed.

Pedometer-determined physical activity among primary schoolchildren in Kuala Lumpur

Objective:

The aim of this study was to objectively measure physical activity and its association with sociodemographic factors among Malaysian primary school-age children.

Methods:

A total of 111 primary school children in Kuala Lumpur were selected through random sampling. Activity pattern was determined using pedometers and differences by sex, ethnicity and body mass index categories were analysed. The relationship between pedometer-determined physical activity and sociodemographic factors were also studied.

Results:

Overall, boys attained significantly higher daily step counts than girls (9573 ± 4145 vs 7313 ± 2697). Significant difference in daily step counts between boys and girls were observed during weekdays ( p<0.01), weekends ( p<0.05) and total mean step counts ( p<0.01). Malay ethnicity showed higher daily step counts during weekdays than weekends ( p<0.05). Compared with boys, girls had higher odds (OR=5.58; 95% CI 1.12, 27.77) of not meeting the recommended daily step counts. Those who had low physical activity levels had higher odds (OR=15.75; 95% CI 1.78, 139.33) of not meeting recommended daily step counts than children who had moderate physical activity level.

Conclusion:

Boys were significantly more active than girls and physical activity was greater during weekdays than on weekends. The primary schoolchildren in Kuala Lumpur were sedentary, with minimum physical activity being observed. Differences in sexes and physical activity levels influenced pedometer step counts in children.

Implication of galanin gene rs948854 polymorphism in depressive symptoms in adolescents

Genetic, social, and environmental conditions contribute to the development of depression, but the pathophysiological mechanisms are still unclear. Data accumulated in recent years provide significant evidence for a direct role of galanin (GAL). This study aimed to investigate the relation between SNPs in the galaninergic system and depressive symptoms in adolescents. A total of112 adolescents aged 10-18years participated in this study. The Children Depression Inventory (CDI) was used to evaluate depressive symptoms. The effects of rs948854 and rs4432027 SNPs, both located within the promoter region of the GAL gene, rs11665337 in the GALR1 receptor, and rs8836 in the GALR2 receptor on depressive symptoms were examined. The results indicated that 30.4% of the participants had depression. We found that girls were significantly more likely to be depressive than boys. Furthermore, rs948854 minor (G) allele was associated with depressive symptoms. Adolescents carrying the GG and AG genotype for the A/G (rs948854) SNP showed higher CDI scores than those carrying homozygous AA. The binomial logistic regression analysis revealed that adolescents carrying the GG genotype at SNP rs948854 had a higher likelihood of being depressive than adolescents carrying the AA or AG genotypes (P=0.033). Moreover, individuals whose mothers had a positive history for depression and who were sedentary were more likely to display depressive symptoms (P=0.013 and P=0.032, respectively). In conclusion, the SNP rs948854 in the GAL gene seems to be involved in the modulation of depressive state, especially in individuals with GG genotype.

Three types of scientific evidence to inform physical activity policy: results from a comparative scoping review

OBJECTIVES

This paper presents a typology of available evidence to inform physical activity policy. It aims to refine the distinction between three types of evidence relating to physical activity and to compare these types for the purpose of clarifying potential research gaps.

METHODS

A scoping review explored the extent, range and nature of three types of physical activity-related evidence available in reviews: (I) health outcomes/risk factors, (II) interventions and (III) policy-making. A six-step qualitative, iterative process with expert consultation guided data coding and analysis in EPPI Reviewer 4.

RESULTS

856 Type I reviews, 350 Type II reviews and 40 Type III reviews were identified. Type I reviews heavily focused on obesity issues (18 %). Reviews of a systematic nature were more prominent in the Type II (>50 %). Type III reviews tended to conflate research about policy intervention effectiveness and research about policymaking processes. The majority of reviews came from the United States, United Kingdom, Australia and Canada.

CONCLUSIONS

Although evidence gaps exist regarding evidence Types I and II, the most prominent gap regards Type III, i.e. research pertaining to physical activity policymaking. The findings presented herein will be used to inform physical activity policy development and future research.

Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors?

OBJECTIVES

This study was conducted to assess the effectiveness of a simple office-based program for encouraging healthy lifestyle on controlling childhood obesity and associated cardiometabolic risk factors.

METHODS

This non-randomized 24-week lifestyle modification trial was conducted among 457 obese children and adolescents, aged 2-18 years, who had at least one cardiometabolic risk factor in addition to obesity. This trial included three components of exercise, diet education and behavior modification, with all recommendations provided by a pediatrician, two general physicians and a nurse. Instead of strict inhibitory recommendations, healthier lifestyle was encouraged.

RESULTS

Overall 448 (98.04%) of enrolled children completed the trial with a mean age of 9.6 ± 2.9 years. After the trial, the mean of anthropometric measures and cardiometabolic risk factors decreased significantly, the mean high-density lipoprotein cholesterol (HDL-C) increased significantly, and the prevalence of the metabolic syndrome decreased from 20.8% to 1.8%. Triglycerides, LDL-C, diastolic blood pressure and WC had the highest decrease in all age groups, with the most prominent changes in the 14-18-year age group. By each -1SD decline in BMI and WC, risk factors had significant improvement.

CONCLUSION

Motivational office-based counseling can be effective in treatment of childhood obesity and its associated cardio-metabolic risk factors. Such approach can be implemented in the primary health care system; and can be of special concern in low- and middle-income countries with limited human and financial resources. We suggest that expanding the roles of non-physician clinicians such as nurse practitioners can help to increase the amount of time available for such services.

Obesity and motor skills among 4 to 6-year-old children in the United States: nationally-representative surveys

BACKGROUND

Few population-based studies have assessed relationships between body weight and motor skills in young children. Our objective was to estimate the association between obesity and motor skills at 4 years and 5-6 years of age in the United States. We used repeated cross-sectional assessments of the national sample from the Early Childhood Longitudinal Survey-Birth Cohort (ECLS-B) of preschool 4-year-old children (2005-2006; n = 5 100) and 5-6-year-old kindergarteners (2006-2007; n = 4 700). Height, weight, and fine and gross motor skills were assessed objectively via direct standardized procedures. We used categorical and continuous measures of body weight status, including obesity (Body Mass Index (BMI) ≥ 95th percentile) and BMI z-scores. Multivariate logistic and linear models estimated the association between obesity and gross and fine motor skills in very young children adjusting for individual, social, and economic characteristics and parental involvement.

RESULTS

The prevalence of obesity was about 15%. The relationship between motor skills and obesity varied across types of skills. For hopping, obese boys and girls had significantly lower scores, 20% lower in obese preschoolers and 10% lower in obese kindergarteners than normal weight counterparts, p < 0.01. Obese girls could jump 1.6-1.7 inches shorter than normal weight peers (p < 0.01). Other gross motor skills and fine motor skills of young children were not consistently related to BMI z-scores and obesity.

CONCLUSIONS

Based on objective assessment of children's motor skills and body weight and a full adjustment for confounding covariates, we find no reduction in overall coordination and fine motor skills in obese young children. Motor skills are adversely associated with childhood obesity only for skills most directly related to body weight.

Effects of a culturally tailored intervention on changes in body mass index and health-related quality of life of Latino children and their parents

PURPOSE

To evaluate the effects of a multicomponent, family-based, culturally tailored intervention for overweight Latino children and their parents.

DESIGN

One group pretest/posttest with clinic comparison group.

SETTING

Community health center in Milwaukee, Wisconsin.

SUBJECTS

54 Spanish-speaking, Latino families with children 8 to 11 years of age at enrollment and a body mass index (BMI) > 85th percentile. Thirty-one completed the 12-month follow-up.

MAIN OUTCOME

Measures. BMI, fitness measures, self-reported eating patterns, sedentary behaviors, and quality of life scales.

INTERVENTION

Index child and one (index) parent participated in interactive sessions and physical activity reinforced by family goal-setting, staff support, and supplemental activities.

RESULTS

Small but statistically significant changes in child BMI z score (Δ = .13 SD, p < .001) and parent fitness (Δ = .74, p < .04) were documented by paired t-test. Quality of life increased significantly for children (combined Pediatric Quality of Life Inventory score Δ = 10.7, p < .001) and parents (Short Form Health Survey12 mental composite score Δ = 8, p < .022; Wilcoxon rank sum test). BMI z score for clinic comparison children (n = 31) increased significantly during the same time period (Δ = .23 SD, paired t = 4.32, p < .0002).

CONCLUSIONS

A culturally tailored program for Latino families reduced BMI for enrolled children and significantly enhanced quality of life for children and parents. Intervention approaches that integrate cultural and social circumstances and emphasize goal setting and life style changes may be fruitful for this population of at-risk children.

Reducing Risk Factors for Childhood Obesity

This study has sought to determine if the Tommie Smith Youth Athletic Initiative (TSYAI) intervention could decrease the risk factors for childhood obesity among children 5 to 10 years of age. The TSYAI intervention is a 14-week after-school intervention for students in Grades K-5 that was started during the spring of 2008. It serves 63 children in a predominantly African American elementary school. The intervention consists of supervised after-school sessions 3 days per week. These sessions include 2 days of physical activity (flexibility, resistance, and track-and-field training) and 1 day of 45 min of nutrition education modules based on the Transtheoretical Model of behavior change followed by 45 min of group physical activity. Ninety-two percent of the participants are African American and 60% are overweight or obese (>85th percentile BMI for age and gender). The findings indicate that the TSYAI intervention significantly improves the participant’s cardiovascular fitness, body composition, and dietary habits.

Promotion of physical activity in children

PURPOSE OF REVIEW

Promotion of physical activity continues to be recommended as an essential component of obesity treatment and prevention interventions. This review explores recent updates in the area of physical activity promotion and its impact on the physical and mental health consequences of childhood obesity.

RECENT FINDINGS

Despite the availability of opportunities for physical activity in the school environment, namely recess and physical education classes, students do not appear to be meeting activity recommendations at school alone. Access to neighborhood parks may increase levels of physical activity and reduce time spent in sedentary behaviors at home. Less time spent watching television and in other sedentary behaviors such as playing videogames may contribute to higher rates of physical activity. Frequency of physical activity also appears to be related to improved mental health status, although the direction of this relationship warrants further exploration.

SUMMARY

Physical activity is an evidence-based intervention that offers benefits to both physical and mental health. Pediatric health care providers are encouraged to engage in discussions with patients and families on the topic of physical activity and to assist them in finding ways to incorporate activity into daily life.

Obesity prevention and the primary care pediatrician's office

PURPOSE OF REVIEW

The obesity epidemic confronts the pediatrician every day in the office. Pediatricians should help curb the epidemic through prevention and the usual pediatric primary care tasks of screening, communication and anticipatory counseling. This review highlights findings from recent literature to guide office-based prevention of obesity in children.

RECENT FINDINGS

More and more, children and society feel the effects of the obesity epidemic; prevention efforts need to begin earlier. Pediatricians' efforts to screen help identify at-risk children who may benefit from early lifestyle changes. The identification of overweight children also helps foster the appropriate work up of comorbidities. Pediatricians' communication of weight trajectories, which includes techniques like motivational interviewing, may help parents to adopt behavioral prescriptions. Pediatricians should focus on promoting breastfeeding, limiting television, increasing physical activity and reducing sugar-sweetened beverages. New tools used in the training setting show promising results.

SUMMARY

Pediatricians must focus efforts on preventing childhood overweight, while awaiting effective treatment options for this chronic illness with its many associated morbidities. Such prevention involves sensitively communicating early body mass index screening results to parents and helping them to adopt key behavioral changes in diet and physical activity.