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Raducha D, Ratajczak J, Jackowski T, Horodnicka-Józwa A, Szmit-Domagalska J, Walczak M, Petriczko E. Effects of 12-Month Interdisciplinary Interventions in 8- and 9-Year-Old Children with Excess Body Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15899. [PMID: 36497979 PMCID: PMC9736514 DOI: 10.3390/ijerph192315899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Childhood obesity remains one of the most serious medical challenges of the 21st century. The aim of the study was to obtain epidemiological data on the prevalence of overweight and obesity among 8- and 9-year-old children in Szczecin, and to evaluate the effectiveness of medical intervention in the form of a year of interdisciplinary work with children with excess body weight. The study consisted of two main stages: I-screening, II-intervention. The program was implemented for three consecutive years, starting in 2016-2018. The entire population of 8-9-year-olds in Szczecin is 11,494 children. In the screening part of the study, 4890 children took part, whose parent agreed to participate (42.54%). In the intervention part of the study, we analyzed a group of 515 children. Children were further divided into subgroups according to the number of visits completed. Anthropometric parameters were measured on each visit. The prevalence of overweight and obesity in the screened population was 16.9% and 6.4%, respectively. Statistically significant changes were observed in BMI (Body Mass Index) percentiles and BMI z-scores, as well as WHR (Waist-Hip Ratio) during the one year observation time. The best effects were achieved by the 3rd visit (for the first 6 months of the program). Thereafter, the effects diminished due to the longer interval between the 3rd and 4th visits (6 months). There is the need for long-term programs for the prevention of excessive body weight in children and adolescents with frequent checkpoints.
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Affiliation(s)
- Dominika Raducha
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Joanna Ratajczak
- Institute of Physical Culture and Health Sciences, University of Szczecin, 70-453 Szczecin, Poland
| | - Tomasz Jackowski
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Anita Horodnicka-Józwa
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Justyna Szmit-Domagalska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
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Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program. CHILDREN 2022; 9:children9050737. [PMID: 35626914 PMCID: PMC9139264 DOI: 10.3390/children9050737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children’s family.
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Varagiannis P, Magriplis E, Risvas G, Vamvouka K, Nisianaki A, Papageorgiou A, Pervanidou P, Chrousos GP, Zampelas A. Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The "4 Your Family" Randomized Controlled Trial. Nutrients 2021; 13:341. [PMID: 33498894 PMCID: PMC7911878 DOI: 10.3390/nu13020341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Childhood overweight and obesity prevalence has risen dramatically in the past decades, and family-based interventions may be an effective method to improve children's eating behaviors. This study aimed to evaluate the effectiveness of three different family-based interventions: group-based, individual-based, or by website approach. Parents and school aged overweight or obese children, 8-12 years of age, were eligible for the study. A total of 115 children were randomly allocated in one of the three interventions, and 91 completed the study (79% compliance); Group 1 (n = 36) received group-based interventions by various experts; Group 2 (n = 30) had interpersonal family meetings with a dietitian; and Group 3 (n = 25) received training through a specifically developed website. Anthropometric, dietary, physical activity, and screen time outcomes were measured at baseline and at the end of the study. Within-group comparisons indicated significant improvement in body weight, body mass index (BMI)-z-score, physical activity, and screen time from baseline in all three study groups (p < 0.05). Furthermore, total body fat percentage (%TBF) was also decreased in Groups 2 and 3. Between-group differences varied with body weight and %TBF change, being larger in Group 3 compared to Groups 1 and 2, in contrast to BMI-z-score, screen time, and health behaviors, which were significantly larger in Group 2 than the other two groups. In conclusion, personalized family-based interventions are recommended to successfully improve children's lifestyle and body weight status.
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Affiliation(s)
- Panagiotis Varagiannis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
| | - Grigoris Risvas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
| | - Katerina Vamvouka
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
| | - Adamantia Nisianaki
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
| | - Anna Papageorgiou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
| | - Panagiota Pervanidou
- 1st Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27 Athens, Greece; (P.P.); (G.P.C.)
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 115 27 Athens, Greece
| | - George P. Chrousos
- 1st Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27 Athens, Greece; (P.P.); (G.P.C.)
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 115 27 Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece; (P.V.); (E.M.); (G.R.); (K.V.); (A.N.); (A.P.)
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Stea TH, Tveter ET, te Velde SJ, Vik FN, Klepp KI, Bere E. The effect of an extra piece of fruit or vegetables at school on weight status in two generations - 14 years follow-up of the Fruit and Vegetables Makes the Marks study. PLoS One 2018; 13:e0205498. [PMID: 30321202 PMCID: PMC6188749 DOI: 10.1371/journal.pone.0205498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants' children. METHODS In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study "Fruits and Vegetables Make the Marks" (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents' weight status, and the nested design (child/parent). RESULTS The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period. CONCLUSIONS One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted.
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Affiliation(s)
- Tonje Holte Stea
- University of Agder, Department of Public Health, Sport and Nutrition, Kristiansand, Norway
| | - Eline Tønnesson Tveter
- University of Agder, Department of Public Health, Sport and Nutrition, Kristiansand, Norway
| | - Saskia J. te Velde
- University of Agder, Department of Public Health, Sport and Nutrition, Kristiansand, Norway
| | - Frøydis Nordgård Vik
- University of Agder, Department of Public Health, Sport and Nutrition, Kristiansand, Norway
| | | | - Elling Bere
- University of Agder, Department of Public Health, Sport and Nutrition, Kristiansand, Norway
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Robertson W, Fleming J, Kamal A, Hamborg T, Khan KA, Griffiths F, Stewart-Brown S, Stallard N, Petrou S, Simkiss D, Harrison E, Kim SW, Thorogood M. Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years. Health Technol Assess 2018; 21:1-180. [PMID: 28059054 DOI: 10.3310/hta21010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effective programmes to help children manage their weight are required. 'Families for Health' focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project. OBJECTIVE The aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT). DESIGN The trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families. SETTING Three sites in the West Midlands, England, UK. PARTICIPANTS Children aged 6-11 years who were overweight (≥ 91st centile BMI) or obese (≥ 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral. INTERVENTIONS Families for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality. MAIN OUTCOME MEASURES Joint primary outcome measures were change in children's BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months' follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods. RESULTS The study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the 'usual-care' control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) -0.001 to 0.229; p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (-0.118, 95% CI -0.203 to -0.034; p = 0.007), but not in the Families for Health arm (-0.005, 95% CI -0.085 to 0.078; p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care (£998 vs. £548; p < 0.001). The mean incremental cost-effectiveness of Families for Health was estimated at £552,175 per QALY gained. The probability that the Families for Health programme is cost-effective did not exceed 40% across a range of thresholds. The process evaluation demonstrated that the programme was implemented, as planned, to the intended population and any adjustments did not deviate widely from the handbook. Many families waited more than 3 months to receive the intervention. Facilitators', parents' and children's experiences of Families for Health were largely positive and there were no adverse events. Further analysis could explore why some children show a clinically significant benefit while others have a worse outcome. CONCLUSIONS Families for Health was neither effective nor cost-effective for the management of obesity in children aged 6-11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment. TRIAL REGISTRATION Current Controlled Trials ISRCTN45032201. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.
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Burchett HED, Sutcliffe K, Melendez-Torres GJ, Rees R, Thomas J. Lifestyle weight management programmes for children: A systematic review using Qualitative Comparative Analysis to identify critical pathways to effectiveness. Prev Med 2018; 106:1-12. [PMID: 28865809 DOI: 10.1016/j.ypmed.2017.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
This study aimed to identify critical features of successful lifestyle weight management interventions for overweight children (0-11years). Eleven qualitative UK-based studies examining children's, parents' and providers' perspectives and experiences of programmes were synthesised to identify components felt to be critical. Studies for this views synthesis were identified from existing reviews and an update of one review's search, which was run in December 2015. The identified components were then explored in a synthesis of intervention evaluations (five 'most effective' and 15 'least effective') conducted in western Europe, North America, Australia or New Zealand. The intervention evaluations were identified from existing reviews and an update of one review's search, which was run in March 2016. This evaluation synthesis was carried out using Qualitative Comparative Analysis. Three important mechanisms were present in all the most effective interventions but absent in all the least effective: 1/ showing families how to change: a) providing child physical activity sessions, b) delivering practical behaviour change strategy sessions, c) providing calorie intake advice; 2/ ensuring all the family are on board: a) delivering discussion/education sessions for both children and parents, b) delivering child-friendly sessions, c) aiming to change behaviours across the whole family; 3/ enabling social support for both parents and children by delivering both child group sessions and parent group sessions. To conclude, programmes should ensure the whole family is on board the programme, that parents and children can receive social support and are not just told what to change, but shown how.
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Affiliation(s)
- Helen E D Burchett
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Katy Sutcliffe
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | | | - Rebecca Rees
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - James Thomas
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
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Dinkel D, Tibbits M, Hanigan E, Nielsen K, Jorgensen L, Grant K. Healthy Families: A Family-Based Community Intervention To Address Childhood Obesity. J Community Health Nurs 2017; 34:190-202. [PMID: 29023158 DOI: 10.1080/07370016.2017.1369808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to determine the effectiveness of Healthy Families, a family-based community intervention, in improving the knowledge, self-efficacy, and health behaviors of overweight/obese children and their families as well as to explore the lessons learned. Results showed families who completed the program had significant improvements for children and parents in areas such as nutrition knowledge and self-efficacy in making healthy eating choices as well as participating in physical activity. Additionally, families reported decreasing their intake of sugar-sweetened beverages. Participating families and community partners provided valuable lessons for other communities seeking to implement a similar program.
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Affiliation(s)
- Danae Dinkel
- a School of Health and Kinesiology , University of Nebraska at Omaha , Omaha , Nebraska
| | - Melissa Tibbits
- b Department of Health Promotion, Social & Behavioral Health , University of Nebraska Medical Center College of Public Health , Omaha , Nebraska
| | - Emily Hanigan
- c UNMC School of Allied Health, Physician Assistant Studies , University of Nebraska Medical Center , Omaha , Nebraska
| | - Kelly Nielsen
- d Healthier Communities and Community Benefit , CHI Health (Catholic Health Initiatives) , Omaha , Nebraska
| | - Leah Jorgensen
- e OneWorld Community Health Center , Omaha , Nebraska.,f Office of Health Professions Education , Nebraska Medicine , Omaha , Nebraska
| | - Kay Grant
- e OneWorld Community Health Center , Omaha , Nebraska.,f Office of Health Professions Education , Nebraska Medicine , Omaha , Nebraska
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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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Robertson W, Fleming J, Kamal A, Hamborg T, Khan KA, Griffiths F, Stewart-Brown S, Stallard N, Petrou S, Simkiss D, Harrison E, Kim SW, Thorogood M. Randomised controlled trial and economic evaluation of the 'Families for Health' programme to reduce obesity in children. Arch Dis Child 2017; 102:416-426. [PMID: 28003178 PMCID: PMC6234231 DOI: 10.1136/archdischild-2016-311514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Evaluating effectiveness and cost-effectiveness of 'Families for Health V2' (FFH) compared with usual care (UC). DESIGN Multicentre randomised controlled trial (RCT) (investigators blinded, families unblinded) and economic evaluation. Stratified randomisation by family; target of 120 families. SETTING Three National Health Service Primary Care Trusts in West Midlands, England. PARTICIPANTS Overweight or obese (≥91st or ≥98th centile body mass index (BMI)) children aged 6-11 years and their parents/carers, recruited March 2012-February 2014. INTERVENTIONS FFH; a 10-week community-based family programme addressing parenting, lifestyle change and social and emotional development. UC; usual support for childhood obesity at each site. MAIN OUTCOME MEASURES Primary outcomes were 12-months change in children's BMI z-score and incremental cost per quality-adjusted life-year gained (QALY). Secondary outcomes included changes in children's physical activity, fruit and vegetable consumption and quality of life, parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style. RESULTS 115 families (128 children) were randomised to FFH (n=56) or UC (n=59). There was no significant difference in BMI z-score 12-months change (0.114, 95% CI -0.001 to 0.229, p=0.053; p=0.026 in favour of UC with missing value multiple imputation). One secondary outcome, change in children's waist z-score, was significantly different between groups in favour of UC (0.15, 95% CI 0.00 to 0.29). Economic evaluation showed that mean costs were significantly higher for FFH than UC (£998 vs £548, p<0.001). Mean incremental cost-effectiveness of FFH was estimated at £552 175 per QALY. CONCLUSIONS FFH was neither effective nor cost-effective for the management of obesity compared with UC. TRIAL REGISTRATION NUMBER ISRCTN45032201.
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Affiliation(s)
- Wendy Robertson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Fleming
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Atiya Kamal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas Hamborg
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamran A Khan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Stallard
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Douglas Simkiss
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Elizabeth Harrison
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sung Wook Kim
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Margaret Thorogood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Kolotourou M, Radley D, Gammon C, Smith L, Chadwick P, Sacher PM. Long-Term Outcomes following the MEND 7-13 Child Weight Management Program. Child Obes 2015; 11:325-30. [PMID: 25764056 DOI: 10.1089/chi.2014.0092] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the current study, we report outcomes 2.4 years from baseline in a random subsample of overweight and obese children who attended MEND 7-13 programs delivered in UK community settings under service level conditions. METHODS The study employed an uncontrolled pre-follow-up design. A total of 165 children were measured. Outcomes included anthropometry, parental perception of emotional distress, body esteem, and self-esteem. RESULTS Overall, there were significant improvements in all outcomes apart from BMI z-score. In boys, BMI z-score, waist circumference z-score, and psychometrics all improved. In girls, there were no statistically significant differences at 2.4 years, except for body esteem. CONCLUSIONS In real-world settings, the MEND intervention, when delivered by nonspecialists, may result in modest, yet positive, long-term outcomes. Subsequent research should focus on improving the outcome effect size, providing effective behavior change maintenance strategies, and further investigating the reasons behind the observed gender differences.
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Affiliation(s)
| | - Duncan Radley
- 2Leeds Metropolitan University, School of Sport, Carnegie Faculty, Leeds, United Kingdom
| | - Catherine Gammon
- 3Department of Kinesiology, Michigan State University, East Lansing, MI
| | - Lindsey Smith
- 4University of Derby, Department of Sport and Exercise Science, Derby, United Kingdom
| | - Paul Chadwick
- 5Department of Diabetes, Royal Free Hampstead NHS Trust, London, United Kingdom
| | - Paul M Sacher
- 1Mytime Active, Bromley, United Kingdom
- 6Childhood Nutrition Research Center, University College London, Institute of Child Health, London, United Kingdom
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Time, monetary and other costs of participation in family-based child weight management interventions: qualitative and systematic review evidence. PLoS One 2015; 10:e0123782. [PMID: 25853729 PMCID: PMC4390145 DOI: 10.1371/journal.pone.0123782] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood overweight and obesity have health and economic impacts on individuals and the wider society. Families participating in weight management programmes may foresee or experience monetary and other costs which deter them from signing up to or completing programmes. This is recognised in the health economics literature, though within this sparse body of work, costs to families are often narrowly defined and not fully accounted for. A societal perspective incorporating a broader array of costs may provide a more accurate picture. This paper brings together a review of the health economics literature on the costs to families attending child weight management programmes with qualitative data from families participating in a programme to manage child overweight and obesity. METHODS A search identified economic evaluation studies of lifestyle interventions in childhood obesity. The qualitative work drew on interviews with families who attended a weight management intervention in three UK regions. RESULTS We identified four cost-effectiveness analyses that include information on costs to families. These were categorised as direct (e.g. monetary) and indirect (e.g. time) costs. Our analysis of qualitative data demonstrated that, for families who attended the programme, costs were associated both with participation on the scheme and with maintaining a healthy lifestyle afterwards. Respondents reported three kinds of cost: time-related, social/emotional and monetary. CONCLUSION Societal approaches to measuring cost-effectiveness provide a framework for assessing the monetary and non-monetary costs borne by participants attending treatment programmes. From this perspective, all costs should be considered in any analysis of cost-effectiveness. Our data suggest that family costs are important, and may act as a barrier to the uptake, completion and maintenance of behaviours to reduce child obesity. These findings have implications for the development and implementation of child weight initiatives in particular, in relation to reducing inequalities in health.
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Martins LCCDO, Ferreira EAP, Silva LCCD, Almeida FP. Seguimento de Regras Nutricionais em Crianças com Excesso de Peso. PSICOLOGIA: TEORIA E PESQUISA 2015. [DOI: 10.1590/0102-37722015011465033041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Foram avaliados efeitos de instruções, treino de relato verbal (TRV) e treino de automonitoração (TA), com e sem a presença do cuidador principal, sobre o seguimento de regras nutricionais em crianças com excesso de peso. Participaram duas crianças (P1: menino de 9 anos; P2: menina de 11 anos) e suas cuidadoras, por meio de entrevistas em ambulatório. Após instruções, P1 manteve e P2 melhorou o conhecimento das orientações nutricionais. Os Índices de adesão à dieta obtidos por P2 foram mais elevados do que os obtidos por P1 em todas as fases. Houve mudança com significância clínica após introdução de TRV em ambos os participantes. Discute-se a eficácia dos procedimentos de intervenção utilizados e a importância da presença do cuidador.
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Hoare E, Fuller-Tyszkiewicz M, Skouteris H, Millar L, Nichols M, Allender S. Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents. BMJ Open 2015; 5:e006586. [PMID: 25564145 PMCID: PMC4289720 DOI: 10.1136/bmjopen-2014-006586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. SETTING Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. PARTICIPANTS Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10-19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. RESULTS Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. CONCLUSIONS Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health.
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Affiliation(s)
- Erin Hoare
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | | | - Helen Skouteris
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Lynne Millar
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | - Melanie Nichols
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | - Steven Allender
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
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Three-year follow-up of 3-year-old to 5-year-old children after participation in a multidisciplinary or a usual-care obesity treatment program. Clin Nutr 2014; 33:1095-100. [DOI: 10.1016/j.clnu.2013.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE This study explored adolescents' views on the sources and types of social support they would prefer when trying to eat more healthfully and be more active, as well as their opinions regarding means of enhancing social support in interventions. METHODS A total of 28 adolescents (14 males, 14 females) ages 13 to 18 years participated in 4 focus groups that were stratified by gender and age to enhance participation. RESULTS As expected, participants most readily named parents and friends as important sources of support and described wanting instrumental and emotional support from parents, companionship and emotional support from friends, and informational support from professionals. The focus groups revealed rich information regarding parents' and peers' behaviors that are and are not received as emotionally supportive, the helpfulness of parents' concurrent changes in lifestyle, and the importance of parents not ignoring or colluding with unhealthful behavior. Most participants expressed a need for frequent contact and a trusting relationship with professionals. Opinions were mixed regarding inclusion of others in appointments, use of electronic communications and social media, and group treatment formats. CONCLUSION Results have implications for enhancing social support in behavioral weight management interventions that are developmentally relevant for adolescents.
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16
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Anderson JD, Newby R, Kehm R, Barland P, Hearst MO. Taking Steps Together. HEALTH EDUCATION & BEHAVIOR 2014; 42:194-201. [DOI: 10.1177/1090198114547813] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. Successful childhood obesity intervention models that build sustainable behavioral change are needed, particularly in low-income, ethnic minority communities disparately affected by this problem. Method. Families were referred to Taking Steps Together (TST) by their primary care provider if at least one child had a body mass index ≥85%. The TST intervention comprised 16 weekly 2-hour classes including educational activities, group cooking/eating, and physical activities for parents and children. TST’s approach emphasized building self-efficacy, targeting both children and parents for healthy change, and fostering intrinsic motivation for healthier living. Pre–post intervention data were collected on health-related behaviors using a survey, and trained staff measured weight and height. Results. Adults ( n = 33) and children ( n = 62) were largely Hispanic/Latino and low-income. Adults and children significantly increased their fruit and vegetable consumption and weekly physical activity, and adults significantly decreased sugared beverage consumption and screen time. No change in body mass index was observed for adults or children. Conclusions. This family-focused childhood obesity intervention integrated evidence-based principles with a nonprescriptive approach and produced significant improvements in key healthy behaviors for both adults and children.
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Affiliation(s)
| | - Rachel Newby
- Hennepin County Medical Center, Minneapolis, MN, USA
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17
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Ribeiro-Silva RDC, Silva LAD, Cangussu MCT. Effect of actions promoting healthy eating on students' lipid profile: A controlled trial. REV NUTR 2014. [DOI: 10.1590/1415-52732014000200005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To assess the effect of nutrition intervention actions on the lipid profile of children and adolescents enrolled in public elementary schools. METHODS: This nine-month, controlled, intervention study included 202 students aged 7 to 14 years attending two schools (intervention/control) located in a poor neighborhood of the municipality of Salvador, Bahia, Brazil. Actions were implemented in the intervention school to promote healthy eating habits, presented as "Ten steps to healthy eating". The effect of these actions was assessed by subjecting the students at baseline and end of the follow-up to biochemical, maturation, and anthropometric measurements and a produce intake survey. The dependent variables were the changes in the study biochemical parameters: total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, and triglycerides. Analysis of covariance assessed the changes that occurred over the study period. RESULTS: The mean total cholesterol, low-density lipoprotein-cholesterol, and triglycerides of the intervention students decreased 13.18 mg/dL (p=0.001), 7.41 mg/dL (p=0.038), and 12.37 mg/dL (p=0.029), respectively, compared with the control students. CONCLUSION: Actions of this nature have a positive impact on lipid profile. This study adds to those that use effective and viable public health strategies implementable at the primary care level.
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van der Kruk JJ, Kortekaas F, Lucas C, Jager-Wittenaar H. Obesity: a systematic review on parental involvement in long-term European childhood weight control interventions with a nutritional focus. Obes Rev 2013; 14:745-60. [PMID: 23734625 PMCID: PMC3884775 DOI: 10.1111/obr.12046] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/22/2013] [Accepted: 04/22/2013] [Indexed: 12/12/2022]
Abstract
In Europe, about 20% of children are overweight. Focus on parental responsibility is an effective method in weight control interventions in children. In this systematic review we describe the intensity of parental involvement and behaviour change aimed at parents in long-term European childhood weight control interventions. We include European Union studies targeting parents in order to improve children's weight status in multi-component (parental, behaviour change and nutrition) health promotion or lifestyle interventions. The included studies have at least one objectively measured anthropometric outcome in the weight status of the child. Parental involvement was described and categorized based on the intensity of parental involvement and coded using a validated behaviour change taxonomy specific to childhood obesity. Twenty-four studies were analysed. In effective long-term treatment studies, medium and high intensity parental involvement were identified most frequently; whereas in prevention studies low intensity parental involvement was identified most frequently. Parenting skills, generic and specific to lifestyle behaviour, scored frequently in effective weight control interventions. To list parental skills in generic and specific to lifestyle, descriptions of the included studies were summarized. We conclude that intensity of parental involvement and behaviour change techniques are important issues in the effectiveness of long-term childhood weight control interventions.
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Affiliation(s)
- J J van der Kruk
- Hanze University of Applied Sciences, Professorship in Health Care and Nursing, Groningen, The Netherlands
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19
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Robertson W, Stewart-Brown S, Stallard N, Petrou S, Griffiths F, Thorogood M, Simkiss D, Lang R, Reddington K, Poole F, Rye G, Khan KA, Hamborg T, Kirby J. Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial. Trials 2013; 14:81. [PMID: 23514100 PMCID: PMC3610242 DOI: 10.1186/1745-6215-14-81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/08/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base. METHODS/DESIGN This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (≥91st centile BMI) or obese (≥98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton).Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality.A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children's BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style will also be assessed.Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. A de novo decision-analytic model will estimate the lifetime cost-effectiveness of the Families for Health program.Process evaluation will document recruitment, attendance and drop-out rates, and the fidelity of Families for Health delivery. Interviews with up to 24 parents and children from each arm will investigate perceptions and changes made. DISCUSSION This paper describes our protocol to assess the effectiveness and cost-effectiveness of a parenting approach for managing childhood obesity and presents challenges to implementation. TRIAL REGISTRATION Current Controlled Trials http://ISRCTN45032201.
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Affiliation(s)
- Wendy Robertson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Douglas Simkiss
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Rebecca Lang
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kate Reddington
- Public Health, NHS Coventry, Civic Centre 1, Little Park Street, Coventry, CV1 5RB, UK
| | - Fran Poole
- Public Health Department, NHS Warwickshire, PO Box 43, Shire Hall, Barrack Street, Warwick, CV34 4SX, UK
| | - Gloria Rye
- Wolverhampton City Council, Civic Centre, St Peter’s Square, Wolverhampton, WV1 1RT, UK
| | - Kamran A Khan
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Thomas Hamborg
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Joanna Kirby
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Bloom T, Sharpe L, Mullan B, Zucker N. A pilot evaluation of appetite-awareness training in the treatment of childhood overweight and obesity: a preliminary investigation. Int J Eat Disord 2013; 46:47-51. [PMID: 22826019 DOI: 10.1002/eat.22041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a preliminary evaluation of Children's Appetite Awareness Training (CAAT), a treatment for childhood obesity which encourages overweight children to eat in response to internal appetite cues. METHOD Overweight children (ages 6-12 years old) were randomized to either the CAAT treatment group (N = 23), to receive 1-h treatment sessions over 6 weeks, or a wait-list group (N = 24). Weight and height of children and parents in both groups were assessed at pre- and post-treatment (or equivalent time for wait-list control) and at a 6-month follow-up for those in the CAAT group. RESULTS The intervention had a significant, short-term effect on the BMI of children who participated. Although at 6-month follow-up, children's BMI has not increased significantly, the difference between pretreatment and follow-up BMI was no longer significant. DISCUSSION These results are encouraging for the use of CAAT with overweight children. Long-term effectiveness could be enhanced through increasing the duration of the program, adding booster sessions and increased involvement of parents.
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Affiliation(s)
- Taryn Bloom
- School of Psychology, The University of Sydney, New South Wales, Australia
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