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Mahmood L, Gonzalez-Gil EM, Makrilakis K, Liatis S, Schwarz P, Herrmann S, Willems R, Cardon G, Latomme J, Rurik I, Radó S, Iotova V, Usheva N, Tankova T, Karaglani E, Manios Y, Moreno LA. Cross-sectional and longitudinal associations between family meals frequency and children's overweight/obesity in families at high risk of type 2 diabetes: The Feel4Diabetes-study. Pediatr Obes 2023; 18:e13000. [PMID: 36632012 DOI: 10.1111/ijpo.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The frequency of family meals has been suggested as a protective factor against obesity among children. OBJECTIVE This study aimed to investigate the cross-sectional and longitudinal associations between family meals frequency and children's overweight/obesity in families at high risk of type 2 diabetes (T2D) across six European countries. METHODS 989 parent-child dyads (52% girls and 72% mothers) were included. Participants completed validated measures to assess the frequency of family meals and anthropometrics. Multivariable regression models were applied to examine the longitudinal associations between family meals frequency and overweight/obesity in children. Logistic regression was performed to predict the odds of having overweight/obesity depending on changes in family meals frequency over a two-year follow-up period. Analyses were stratified for children's sex. RESULTS High frequency of family breakfasts and/or dinners was inversely associated with children's BMI in boys and girls at T2. Results showed decreased odds of overweight/obesity at follow-up among both boys (OR = 0.65; 95% CI 0.41, 0.96) and girls (OR = 0.53; 95% CI 0.31, 0.87) who consumed minimum of three times family breakfasts and/or family dinners a week at baseline. An increase in family breakfasts and/or dinners frequency was associated with lower odds of overweight/obesity in both boys and girls at follow-up. CONCLUSION A high frequency of family breakfasts and/or dinners but not lunch during childhood is associated with lower odds of overweight/obesity development in children from families at high risk of T2D. The promotion of family meals could help in preventing the development of overweight/obesity among children.
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Affiliation(s)
- Lubna Mahmood
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Esther M Gonzalez-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Stavros Liatis
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Peter Schwarz
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany.,Department for Prevention and Care of Diabetes, Medical Faculty Carl Gustav Carus at the Technical University of Dresden, Dresden, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Sandra Herrmann
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany.,Department for Prevention and Care of Diabetes, Medical Faculty Carl Gustav Carus at the Technical University of Dresden, Dresden, Germany.,German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Julie Latomme
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Imre Rurik
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Sándorné Radó
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Violeta Iotova
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Natalya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Tsvetalina Tankova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.,Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
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Rojo M, Lacruz T, Solano S, Vivar M, Del Río A, Martínez J, Foguet S, Marín M, Moreno-Encinas A, Veiga ÓL, Cabanas V, Rey C, Graell M, Sepúlveda AR. ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care. Obes Res Clin Pract 2022; 16:319-329. [PMID: 35871907 DOI: 10.1016/j.orcp.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/14/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring). METHODS/DESIGN The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling. DISCUSSION To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.
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Affiliation(s)
- Marta Rojo
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain.
| | - Tatiana Lacruz
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Santos Solano
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Mario Vivar
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Andrea Del Río
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Jone Martínez
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Sara Foguet
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Marta Marín
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Alba Moreno-Encinas
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain
| | - Óscar Luis Veiga
- Department of Physical Education, Sport & Human Motricity, Faculty of Teacher Training and Education, Autonomous University of Madrid, Spain
| | - Verónica Cabanas
- Department of Physical Education, Sport & Human Motricity, Faculty of Teacher Training and Education, Autonomous University of Madrid, Spain
| | - Consuelo Rey
- Valdelasfuentes Primary Health Care Center (Alcobendas), Public Health System from Madrid, Spain
| | - Montserrat Graell
- Child and Adolescent Psychiatry and Psychology Department, University Hospital Niño Jesús, Centro de Investigación Biomédica en Red de SaludMental (CIBERSAM), Madrid, Spain
| | - Ana Rosa Sepúlveda
- Department of Biological and Health Psychology, Faculty of Psychology (Department of Biological and Clinical Psychology), Autonomous University of Madrid, Spain.
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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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Influencing factors of children's physical activity in family. BMC Public Health 2022; 22:787. [PMID: 35440083 PMCID: PMC9020037 DOI: 10.1186/s12889-022-13235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's physical activity (PA) is an important guarantee for children's physical and mental health. Influencing factors of children's PA in family is related to the healthy growth of children and the happy life of families. METHODS This is a cross-sectional study of influencing factors of children's PA in family. Parents whose children in 15 kindergartens(i.e., children are aged from 3 to 6 years) were sampled. RESULTS Government had a significant negative impact on parents' perceived risks. Community has a significant positive effect on parents' perceived benefits and a significant negative effect on parents' perceived risks. Kindergarten has a significant positive effect on parents' perceived benefits, but has no significant effect on the parents' perceived risks. Children sports club has a significant positive effect on parents' perceived benefits. Parents' perceived benefits has a significant positive impact on children's PA in family, while perceived risks has a significant negative impact. CONCLUSION Government should play a leading role in the development of children's PA in family. Community provides supplementary support. Kindergarten is the key point of developing children's PA in family. Children sports club is the auxiliary force of children's PA in 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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PCIT-Health: Preventing Childhood Obesity by Strengthening the Parent–Child Relationship. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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The risk of developing disordered eating following a family-based program among children with overweight and obesity and their siblings: Retrospective and prospective analyses. Obes Res Clin Pract 2020; 14:279-285. [PMID: 32475705 DOI: 10.1016/j.orcp.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/08/2020] [Accepted: 04/18/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies have raised the concern that dieting and weight-loss programs may be a potential risk factor for developing eating disorders, and may have a potential to affect siblings as well. This study assessed the long-term risk of developing disordered eating among children with overweight and obesity and their siblings as well as the change in the obesogenic environment following a family-based intervention program. METHODS In a 30-month retrospective follow-up study (n=18 families in intervention group, n=26 families in control group, total of 81 children and siblings) and a 14-month prospective follow-up study (n=42 families, 78 children and siblings), families with one or more children with overweight or obesity ages 8-14 years participated in a multidisciplinary parent-child program called "Maccabi Active". Children's version of the eating-attitude-test (ChEAT) questionnaire, family eating-and-activity-habits questionnaire (FEAHQ) and BMI z-score were measured. RESULTS in the retrospective study, no difference between groups with respect to ChEAT scores in children and siblings was found. In the prospective study, the FEAHQ score significantly decreased after completion of the program (ΔFEAHQ=-16.2±4.9, p=0.001) and continued to decrease in the 8-month follow-up (ΔFEAHQ=-23.2±5.7, p=0.001). BMI z-scores decreased after 6 months (ΔBMI z-score=-0.3±0.1, p=0.014), and did not increase in the 8-month follow-up. CONCLUSIONS Our findings suggest no exacerbation in disordered eating behaviors among children with overweight or obesity or their siblings, thus alleviating concerns surrounding the development of disordered eating after participating in a family-based intervention. Moreover, improvement in obesogenic environment suggests potential benefits to the entire family.
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Gow ML, Tee MSY, Garnett SP, Baur LA, Aldwell K, Thomas S, Lister NB, Paxton SJ, Jebeile H. Pediatric obesity treatment, self-esteem, and body image: A systematic review with meta-analysis. Pediatr Obes 2020; 15:e12600. [PMID: 32020780 DOI: 10.1111/ijpo.12600] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric obesity impacts on multiple domains of psychological health, including self-esteem and body image. OBJECTIVE To determine the effect of multicomponent pediatric obesity treatment interventions on self-esteem and body image. METHODS A systematic search of published literature up to June 2019 was undertaken using electronic databases MEDLINE, EMBASE, Cochrane Library, and PsychINFO. Eligible studies implemented an obesity treatment intervention, including a dietary and physical activity component with/without a behavioral component, in children and adolescents with overweight/obesity, and assessed self-esteem and/or body image. Data were extracted by one reviewer and cross-checked. Meta-analysis was used to combine outcome data and moderator analysis conducted to identify intervention characteristics influencing outcomes. RESULTS 64 studies were identified. Meta-analysis of 49 studies (n = 10471) indicated that pediatric obesity treatment results in increased self-esteem postintervention (standardized mean difference, [SE] 0.34 [0.03], P < .001, I2 87%), maintained at follow-up (0.35 [0.05] P < .001, I2 79%, 17 studies). Similarly, meta-analysis of 40 studies (n = 2729) indicated improvements in body image postintervention (0.40 [0.03], P < .001, I2 73%), maintained at follow-up (0.41 [0.08], P < .001, I2 89%, 16 studies). CONCLUSIONS Pediatric obesity treatment improves self-esteem and body image in the short and medium term. These findings may underpin improvements in other psychological outcomes.
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Affiliation(s)
- Megan L Gow
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Melissa S Y Tee
- The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Weight Management Services, The Children's Hospital at Westmead, Sydney, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Sarah Thomas
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
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Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong IC. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundFive linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.Objectives(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).MethodsFive substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.ResultsStudy A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.Future work and limitationsWork is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.Trial registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Sanjay Kinra
- Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J Cole
- Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK
| | - Silvia Costa
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Helen Croker
- The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK
| | - Tam Fry
- Child Growth Foundation, Edgware, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lee Hudson
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anthony S Kessel
- Director of Global Public Health, Public Health England, London, UK
| | - Steve Morris
- Centre of Applied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Science, University College London, London, UK
| | - Dasha Nicholls
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Faculty of Medicine, Imperial College London, London, UK
| | - Barry Taylor
- Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Billy White
- Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK
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Beets MW, Weaver RG, Ioannidis JPA, Geraci M, Brazendale K, Decker L, Okely AD, Lubans D, van Sluijs E, Jago R, Turner-McGrievy G, Thrasher J, Li X, Milat AJ. Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:19. [PMID: 32046735 PMCID: PMC7014944 DOI: 10.1186/s12966-020-0918-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity. METHODS We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes. RESULTS A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively. CONCLUSIONS Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Marco Geraci
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Keith Brazendale
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lindsay Decker
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - David Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - Esther van Sluijs
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Russell Jago
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - James Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Andrew J Milat
- New South Wales (NSW) Ministry of Health, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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Mohd Roslan NA, Mokhtar AH. Effects of an 8-week community exercise program on health-related physical fitness in overweight and obese working adults. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.18.03993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Van Stappen V, De Lepeleere S, Huys N, Latomme J, Verloigne M, Cardon G, Androutsos O, Manios Y, De Bourdeaudhuij I, De Craemer M. Effect of integrating a video intervention on parenting practices and related parental self-efficacy regarding health behaviours within the Feel4Diabetes-study in Belgian primary schoolchildren from vulnerable families: A cluster randomized trial. PLoS One 2019; 14:e0226131. [PMID: 31826024 PMCID: PMC6905545 DOI: 10.1371/journal.pone.0226131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effect of integrating a video intervention "Movie Models" within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children's physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents. METHODS Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The "Movie Models" videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects. RESULTS Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children's eating behaviours, however almost no effects were found on parenting-related factors regarding children's physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them. CONCLUSION The integration of "Movie Models" within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children's health behaviours, however most parenting-related factors could not be improved. The implementation of "Movie Models" as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families. TRIAL REGISTRATION ClinicalTrials.gov NCT02278809.
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Affiliation(s)
- Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- * E-mail:
| | - Sara De Lepeleere
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Nele Huys
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Julie Latomme
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Maïté Verloigne
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Kallithea, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Kallithea, Athens, Greece
| | | | - Marieke De Craemer
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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13
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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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14
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Jung ME, Bourne JE, Gainforth HL. Evaluation of a community-based, family focused healthy weights initiative using the RE-AIM framework. Int J Behav Nutr Phys Act 2018; 15:13. [PMID: 29373975 PMCID: PMC5787319 DOI: 10.1186/s12966-017-0638-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background Childhood overweight and obesity is a major public health concern. Community-based interventions have the potential to reach caregivers and children. However, the overall health impact of these programs is rarely comprehensively assessed. This study evaluated a physical activity and healthy eating family program (Healthy Together; HT) using the RE-AIM framework. Methods Ten sites implemented the 5-week program. Thirty-nine staff members and 277 program participants (126 caregivers [Mage = 35.6] and 151 children [Mage = 13]) participated in the evaluation. Each RE-AIM dimension was assessed independently using a mixed-methods approach. Sources of data included archival records, interviews and surveys. Effectiveness outcome variables were assessed at pre- and post-intervention and 6-month follow-up. Results Reach: HT participants were almost entirely recruited from existing programs within sites. Effectiveness: Caregivers’ nutrition related efficacy beliefs increased following HT (ps < .03). Participation in HT was not associated with significant changes in physical activity or nutrition behaviour or perceived social support (ps > .05). Knowledge surrounding healthy diets and physical activity increased in children and caregivers (ps < .05). Adoption: Thirty-five percent of sites approached to implement HT expressed interest. The 10 sites selected recruited existing staff members to implement HT. Implementation: Program objectives were met 72.8% of the time and 71 adaptations were made. HT was finance- and time-dependent. Maintenance: Two sites fully implemented HT in the follow-up year and 5 sites incorporated aspects of HT into other programs. Conclusions Working alongside organizations that develop community programs to conduct comprehensive, arms-length evaluations can systematically highlight areas of success and challenges. Overall HT represents a feasible community-based intervention; however further support is required in order to ensure the program is effective at positively targeting the desired outcomes. As a result of this evaluation, modifications are currently being implemented to HT. Electronic supplementary material The online version of this article (10.1186/s12966-017-0638-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada.
| | - Jessica E Bourne
- Centre for Exercise, Nutrition and health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Heather L Gainforth
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
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15
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Christie D, Hudson LD, Kinra S, Wong ICK, Nazareth I, Cole TJ, Sovio U, Gregson J, Kessel AS, Mathiot A, Morris S, Panca M, Costa S, Holt R, Viner RM. A community-based motivational personalised lifestyle intervention to reduce BMI in obese adolescents: results from the Healthy Eating and Lifestyle Programme (HELP) randomised controlled trial. Arch Dis Child 2017; 102:695-701. [PMID: 28687677 PMCID: PMC5537518 DOI: 10.1136/archdischild-2016-311586] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Approximately 7% of children and young people aged 5-15 years in the UK have obesity at a level likely to be associated with comorbidities. The majority of multicomponent lifestyle programmes have limited applicability and generalisability for British adolescents.The Healthy Eating and Lifestyle Programme (HELP) was a specific adolescent-focused intervention, designed for obese 12 to 18-year-olds seeking help to manage their weight. Participants were randomised to the 12-session HELP intervention or standard care. The primary outcome was difference in mean body mass index (BMI) (kg/m2) between groups at week 26 adjusted for baseline BMI, age and sex. SUBJECTS 174 subjects were randomised (87 in each arm), of whom 145 (83%) provided primary outcome data at week 26. RESULTS At week 26 there were no significant effects of the intervention on BMI (mean change in BMI 0.18 kg/m2 for the intervention arm, 0.25 kg/m2 for the control arm; adjusted difference between groups: -0.11 kg/m2 (95% CI -0.62 to 0.40), p=0.7). At weeks 26 and 52 there were no significant differences between groups in any secondary outcomes. CONCLUSION At minimum this study reinforces the need for higher level, structured interventions to tackle the growing public health burden of obesity in the UK and internationally.The HELP intervention was no more effective than a single educational session for reducing BMI in a community sample of obese adolescents.Further work is needed to understand how weight management programmes can be delivered effectively to young people from diverse and deprived backgrounds in which childhood obesity is common. The study has significant implications in terms of informing public health interventions to tackle childhood obesity. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN99840111.
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Affiliation(s)
- Deborah Christie
- University College London Hospitals and UCL Institute of Epidemiology and Health Care, London, UK
| | | | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Irwin Nazareth
- Primary Care and Population Health, UCL Institute of Epidemiology & Health, London, UK
| | - Tim J Cole
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Anne Mathiot
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK,UCL Institute of Epidemiology & Health, London, UK
| | | | - Monica Panca
- UCL Institute of Epidemiology & Health, London, UK
| | - Silvia Costa
- UCL Institute of Epidemiology & Health, London, UK
| | - Rebecca Holt
- UCL Institute of Epidemiology & Health, London, UK
| | - Russell M Viner
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
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16
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Williams SL, Van Lippevelde W, Magarey A, Moores CJ, Croyden D, Esdaile E, Daniels L. Parent engagement and attendance in PEACH™ QLD - an up-scaled parent-led childhood obesity program. BMC Public Health 2017; 17:559. [PMID: 28599644 PMCID: PMC5466714 DOI: 10.1186/s12889-017-4466-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/25/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parenting, Eating and Activity for Child Health (PEACH™) is a multicomponent treatment program delivered over ten group sessions to parents of overweight/obese primary school-aged children. It has been shown to be efficacious in an RCT and was recently translated to a large-scale community intervention funded by the Queensland (Australia) Government. Engagement (enrolment and attendance) was critical to achieving program outcomes and was challenging. The purpose of the present study was to examine sample characteristics and mediating factors that potentially influenced program attendance. METHODS Data collected from parents who attended at least one PEACH™ Queensland session delivered between October 2013 and October 2015 (47 programs implemented in 29 discrete sites), was used in preliminary descriptive analyses of sample characteristics and multilevel single linear regression analyses. Mediation analysis examined associations between socio-demographic and parent characteristics and attendance at group sessions and potential mediation by child and parent factors. RESULTS 365/467 (78%) enrolled families (92% mothers) including 411/519 (79%) children (55% girls, mean age 9 ± 2 years) attended at least one session (mean 5.6 ± 3.2). A majority of families (69%) self-referred to the program. Program attendance was greater in: advantaged (5.9 ± 3.1 sessions) vs disadvantaged families (5.4 ± 3.4 sessions) (p < 0.05); partnered (6.1 ± 3.1 sessions) vs un-partnered parents (5.0 ± 3.1 sessions) (p < 0.01); higher educated (6.1 ± 3.0 sessions) vs lower educated parents (5.1 ± 3.3 sessions) (p = 0.02); and self-referral (6.1 ± 3.1) vs professional referral (4.7 ± 3.3) (p < 0.001). Child (age, gender, pre-program healthy eating) and parent (perceptions of child weight, self-efficacy) factors did not mediate these relationships. CONCLUSIONS To promote reach and effectiveness of up-scaled programs, it is important to identify ways to engage less advantaged families who carry higher child obesity risk. Understanding differences in referral source and parent readiness for change may assist in tailoring program content. The influence of program-level factors (e.g. facilitator and setting characteristics) should be investigated as possible alternative mediators to program engagement.
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Affiliation(s)
- Susan L. Williams
- Central Queensland University, School of Health, Medical and Applied Sciences, Building 6, Bruce Highway, Rockhampton, QLD 4702 Australia
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, De Pintelaan 185 – 4K3 room 036, 9000 Ghent, Belgium
| | - Anthea Magarey
- Flinders University, Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Carly J. Moores
- Flinders University, Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Debbie Croyden
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
| | - Emma Esdaile
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
| | - Lynne Daniels
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research (CCHR), Level 6, 62 Graham St, South Brisbane, Qld 4101 Australia
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17
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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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Nobles J, Radley D, Dimitri P, Sharman K. Psychosocial Interventions in the Treatment of Severe Adolescent Obesity: The SHINE Program. J Adolesc Health 2016; 59:523-529. [PMID: 27544459 DOI: 10.1016/j.jadohealth.2016.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Psychosocial interventions (PSIs) are characterized by three phases: (1) an initial in-depth assessment, (2) an intensive multifaceted intervention to stem a condition, and (3) an extensive maintenance program. PSIs are often used for treatment of mental health conditions; however, applicability in the treatment of adolescent obesity is unknown. This article sought to evaluate the service-level outcomes of a PSI for young people (aged 10-17) with severe obesity. METHODS A retrospective evaluation of participants attending the Self Help, Independence, Nutrition and Exercise program between 2011 and 2016 (n = 435; age: 13.1 ± 2.1 years, male: 51%, white: 87.4%, body mass index [BMI]: 33.5 ± 7.5 kg/m2, standardized BMI [BMI SDS]: 3.1 ± .5 units). Anthropometric measurements (BMI and waist circumference) were collected at baseline, 3, 6, 9, and 12 months. Psychosocial measures (anxiety, depression, and self-esteem) were collected at baseline and 3 months. Participant retention was also assessed. RESULTS After 3 months, 95% of participants remained with a mean BMI SDS reduction of .19 units (95% confidence interval: .17, .21). Anxiety, depression, and self-esteem improved by 50%, 54%, and 38%, respectively. BMI SDS reductions of .29, .35, and .41 units were found at 6, 9, and 12 months. Fifty-four percent of participants chose to attend the final intervention phase. A higher baseline BMI SDS and a greater reduction in BMI SDS predicted final intervention phase attendance. CONCLUSIONS The Self Help, Independence, Nutrition and Exercise PSI demonstrated positive mean reductions in all measurements across all time points. In contrast to other community-based weight management services, these results suggest the utility of, and further exploration of, PSIs in the treatment of severe adolescent obesity.
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Affiliation(s)
- James Nobles
- Institute of Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, United Kingdom.
| | - Duncan Radley
- Institute of Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, United Kingdom
| | - Paul Dimitri
- Department of Paediatric Endocrinology, The Academic Unit of Child Health, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Kath Sharman
- SHINE Health Academy Ltd., Sheffield, United Kingdom
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Ho J, Pedersen SD, Virtanen H, Nettel-Aguirre A, Huang C. Family Intervention for Obese/Overweight Children Using Portion Control Strategy (FOCUS) for Weight Control: A Randomized Controlled Trial. Glob Pediatr Health 2016; 3:2333794X16669014. [PMID: 27699184 PMCID: PMC5030784 DOI: 10.1177/2333794x16669014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 01/23/2023] Open
Abstract
Nutritional counseling for children with obesity is an important component of management. This randomized controlled trial was conducted to compare change in body mass index (BMI) z score after 6 months. Children 8 to 16 years with a BMI greater than the 85th percentile were randomized to standard of care nutrition counseling versus intervention with standard nutrition counseling including portion control tool training for the family. Measures were completed at baseline, 3 months, and 6 months. Fifty-one children were randomized to control and 48 to intervention. Mean age was 11 years (SD = 2.2). Mean BMI z score was 2.7 (SD = 0.4). Forty-five percent were male (n = 45). Follow-up at 6 months was 73.7% (73/99). Although no differences were seen between the groups, there was a significant decrease in BMI z score between baseline and 6 months within each group.
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Affiliation(s)
- Josephine Ho
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Sue D. Pedersen
- C-ENDO Diabetes & Endocrinology Clinic, Calgary, Alberta, Canada
| | | | - Alberto Nettel-Aguirre
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Carol Huang
- Alberta Children’s Hospital, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
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20
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Bejarano CM, Milkes A, Hossain MJ, Argueta-Ortiz F, Wysocki T. Longitudinal associations of visit satisfaction and treatment alliance with outcomes in pediatric obesity clinic visits. CHILDRENS HEALTH CARE 2016. [DOI: 10.1080/02739615.2016.1163490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Carolina M. Bejarano
- Center for Health Care Delivery Science, Nemours Children’s Specialty Care, Jacksonville, FL
| | - Amy Milkes
- Center for Health Care Delivery Science, Nemours Children’s Specialty Care, Jacksonville, FL
| | - Md Jobayer Hossain
- Biostatistics Core, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Francisco Argueta-Ortiz
- Center for Health Care Delivery Science, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Tim Wysocki
- Center for Health Care Delivery Science, Nemours Children’s Specialty Care, Jacksonville, FL
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Jago R, Zahra J, Edwards MJ, Kesten JM, Solomon-Moore E, Thompson JL, Sebire SJ. Managing the screen-viewing behaviours of children aged 5-6 years: a qualitative analysis of parental strategies. BMJ Open 2016; 6:e010355. [PMID: 26932143 PMCID: PMC4785319 DOI: 10.1136/bmjopen-2015-010355] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The present study used qualitative methods to: (1) examine the strategies that were used by parents of children aged 5-6 years to manage screen viewing; (2) identify key factors that affect the implementation of the strategies and (3) develop suggestions for future intervention content. DESIGN Telephone interviews were conducted with parents of children aged 5-6 years participating in a larger study. Interviews were transcribed verbatim and analysed using an inductive and deductive content analysis. Coding and theme generation was iterative and refined throughout. SETTING Parents were recruited through 57 primary schools located in the greater Bristol area (UK). PARTICIPANTS 53 parents of children aged 5-6 years. RESULTS Parents reported that for many children, screen viewing was a highly desirable behaviour that was difficult to manage, and that parents used the provision of screen viewing as a tool for reward and/or punishment. Parents managed screen viewing by setting limits in relation to daily events such as meals, before and after school, and bedtime. Screen-viewing rules were often altered depending on parental preferences and tasks. Inconsistent messaging within and between parents represented a source of conflict at times. Potential strategies to facilitate reducing screen viewing were identified, including setting screen-viewing limits in relation to specific events, collaborative rule setting, monitoring that involves mothers, fathers and the child, developing a family-specific set of alternative activities to screen viewing and developing a child's ability to self-monitor their own screen viewing. CONCLUSIONS Managing screen viewing is a challenge for many parents and can often cause tension in the home. The data presented in this paper provide key suggestions of new approaches that could be incorporated into behaviour change programmes to reduce child screen viewing.
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Affiliation(s)
- R Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J Zahra
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - M J Edwards
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J M Kesten
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Solomon-Moore
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - J L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - S J Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Fleming J, Kamal A, Harrison E, Hamborg T, Stewart-Brown S, Thorogood M, Griffiths F, Robertson W. Evaluation of recruitment methods for a trial targeting childhood obesity: Families for Health randomised controlled trial. Trials 2015; 16:535. [PMID: 26607762 PMCID: PMC4660776 DOI: 10.1186/s13063-015-1062-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment to trials evaluating the effectiveness of childhood obesity management interventions is challenging. We report our experience of recruitment to the Families for Health study, a randomised controlled trial evaluating the effectiveness of a family-based community programme for children aged 6-11 years, versus usual care. We evaluated the effectiveness of active recruitment (contacting eligible families directly) versus passive recruitment (informing the community through flyers, public events, media). METHODS Initial approaches included passive recruitment via the media (newspapers and radio) and two active recruitment methods: National Child Measurement Programme (letters to families with overweight children) and referrals from health-care professionals. With slow initial recruitment, further strategies were employed, including active (e.g. targeted letters from general practices) and passive (e.g. flyers, posters and public events) methods. At first enquiry from a potential participant, families were asked where they heard about the study. Further quantitative (questionnaire) and qualitative data (one-to-one interviews with parents/carers), were collected from recruited families at baseline and 3-month follow-up and included questions about recruitment. RESULTS In total, 194 families enquired about Families for Health, and 115 (59.3 %) were recruited and randomised. Active recruitment yielded 85 enquiries, with 43 families recruited (50.6 %); passive recruitment yielded 99 enquiries with 72 families recruited (72.7 %). Information seen at schools or GP surgeries accounted for over a quarter of enquiries (28.4 %) and over a third (37.4 %) of final recruitment. Eight out of ten families who enquired this way were recruited. Media-led enquiries were low (5 %), but all were recruited. Children of families recruited actively were more likely to be Asian or mixed race. Despite extensive recruitment methods, the trial did not recruit as planned, and was awarded a no-cost extension to complete the 12-month follow-up. CONCLUSIONS The higher number of participants recruited through passive methods may be due to the large number of potential participants these methods reached and because participants may see the information more than once. Recruiting to a child obesity treatment study is complex and it is advisable to use multiple recruitment strategies, some aiming at blanket coverage and some targeted at families with children who are overweight. TRIAL REGISTRATION Current Controlled Trials ISRCTN45032201 (Date: 18 August 2011).
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Affiliation(s)
- J Fleming
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - A Kamal
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - E Harrison
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - T Hamborg
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - S Stewart-Brown
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - M Thorogood
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - F Griffiths
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - W Robertson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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Guo H, Zeng X, Zhuang Q, Zheng Y, Chen S. Intervention of childhood and adolescents obesity in Shantou city. Obes Res Clin Pract 2015; 9:357-64. [PMID: 25596004 DOI: 10.1016/j.orcp.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/12/2014] [Accepted: 11/28/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification, regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents. And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city. METHODS Two schools were randomised to intervention group and control group respectively. A total of 41 students enrolled were diagnosed as overweight or obese. Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification, regular exercise and psychological consultation except two of them were transferred to another school. The differences of BMI, anthropometric measures, metabolic profile and the scores of questionnaire and the scale were compared to evaluate the effects of the intervention programme. RESULTS After one-year intervention, it observed in the intervention group that BMI-Z score, WHR and WHtR had significant improvements, and there was a nonsignificant trend (P=0.053) for a decrease in BMI-P. Fasting plasma glucose, cholesterol (CH) and low-density-lipoprotein cholesterol (LDL-C) levels in the intervention group showed nonsignificant trend for a decrease (PFPG=0.084, PCH=0.057, PLDLC=0.098), compared with a significant increase of triglycerides (TG) and LDL-C levels in the control group (PTG=0.041, PLDL-C=0.038). There were some positive dietary, physical activity, or sedentary behaviour changes found in the students of the intervention group as the scores of the questionnaire got significant improvement (P=0.04). CONCLUSIONS Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents, which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city.
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Affiliation(s)
- Haiting Guo
- Department of Endocrinology, The 2nd Affiliated Hospital of SUMC, Shantou, Guangdong Province 515043, China; Shantou University Medical College, Shantou, Guangdong Province 515043, China
| | - Xiaoshan Zeng
- Shantou University Medical College, Shantou, Guangdong Province 515043, China; Shantou Central Hospital, Shantou, Guangdong Province 515043, China
| | - Qiaoyu Zhuang
- Department of Endocrinology, The 2nd Affiliated Hospital of SUMC, Shantou, Guangdong Province 515043, China
| | - Yubin Zheng
- Shantou University Medical College, Shantou, Guangdong Province 515043, China; Yue Bei People's Hospital, Shaoguan, Guangdong Province 512026, China
| | - Shenren Chen
- Department of Endocrinology, The 2nd Affiliated Hospital of SUMC, Shantou, Guangdong Province 515043, China.
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24
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Burke SM, Shapiro S, Petrella RJ, Irwin JD, Jackman M, Pearson ES, Prapavessis H, Shoemaker JK. Using the RE-AIM framework to evaluate a community-based summer camp for children with obesity: a prospective feasibility study. BMC OBESITY 2015. [PMID: 26217536 PMCID: PMC4511021 DOI: 10.1186/s40608-015-0050-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Increasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children’s Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions. Methods A single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; Mage = 10.6; 53% female) and/or Year 2 (n = 25; Mage = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program. Results Overall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation). Conclusions Based on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity. Trial registration ISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.
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Affiliation(s)
- Shauna M Burke
- School of Health Studies, Western University, London, Canada
| | - Sheree Shapiro
- Health and Rehabilitation Sciences Program, Western University, London, Canada
| | - Robert J Petrella
- Department of Family Medicine, Western University, London, Canada ; School of Kinesiology, Western University, London, Canada
| | | | - Michelle Jackman
- Section of Hospital Pediatrics & Pediatric Centre for Weight & Health, Alberta Children's Hospital, Calgary, Canada
| | - Erin S Pearson
- School of Kinesiology, Lakehead University, Thunder Bay, Canada
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25
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Gerards SMPL, Dagnelie PC, Gubbels JS, van Buuren S, Hamers FJM, Jansen MWJ, van der Goot OHM, de Vries NK, Sanders MR, Kremers SPJ. The effectiveness of lifestyle triple P in the Netherlands: a randomized controlled trial. PLoS One 2015; 10:e0122240. [PMID: 25849523 PMCID: PMC4388496 DOI: 10.1371/journal.pone.0122240] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/19/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Lifestyle Triple P is a general parenting intervention which focuses on preventing further excessive weight gain in overweight and obese children. The objective of the current study was to assess the effectiveness of the Lifestyle Triple P intervention in the Netherlands. Method We used a parallel randomized controlled design to test the effectiveness of the intervention. In total, 86 child-parent triads (children 4–8 years old, overweight or obese) were recruited and randomly assigned (allocation ratio 1:1) to the Lifestyle Triple P intervention or the control condition. Parents in the intervention condition received a 14-week intervention consisting of ten 90-minute group sessions and four individual telephone sessions. Primary outcome measure was the children’s body composition (BMI z-scores, waist circumference and skinfolds). The research assistant who performed the measurements was blinded for group assignment. Secondary outcome measures were the children’s dietary behavior and physical activity level, parenting practices, parental feeding style, parenting style, and parental self-efficacy. Outcome measures were assessed at baseline and 4 months (short-term) and 12 months (long-term) after baseline. Multilevel multiple regression analyses were conducted to determine the effect of the intervention on primary and secondary outcome measures. Results No intervention effects were found on children’s body composition. Analyses of secondary outcomes showed positive short-term intervention effects on children’s soft-drink consumption and parental responsibility regarding physical activity, encouragement to eat, psychological control, and efficacy and satisfaction with parenting. Longer-term intervention effects were found on parent’s report of children’s time spent on sedentary behavior and playing outside, parental monitoring food intake, and responsibility regarding nutrition. Conclusion Although the Lifestyle Triple P intervention showed positive effects on some parent reported child behaviors and parenting measures, no effects were visible on children’s body composition or objectively measured physical activity. Several adjustments of the intervention content are recommended, for example including a booster session. Trial Registration Nederlands Trial Register NTR 2555
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Affiliation(s)
- Sanne M. P. L. Gerards
- Department of Health Promotion, and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Pieter C. Dagnelie
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Jessica S. Gubbels
- Department of Health Promotion, and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research (TNO), Leiden, the Netherlands
- Department of Methodology and Statistics, University of Utrecht, Utrecht, the Netherlands
| | - Femke J. M. Hamers
- Department of Health Promotion, and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Maria W. J. Jansen
- CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Academic Collaborative Center for Public Health Limburg, Public Health Services, Geleen, the Netherlands
| | | | - Nanne K. de Vries
- Department of Health Promotion, and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Matthew R. Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Stef P. J. Kremers
- Department of Health Promotion, and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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Abstract
This paper presents an overview to provide readers with an update on the literature about the relation between parental influences (general parenting and food parenting practices) and children's weight-related outcomes. It first summarizes the evidence regarding the role of food parenting practices in shaping and maintaining children's nutritional and weight status. It then describes empirical evidence on the relation between general parenting and children's weight status. This evidence is less convincing, possibly because general parenting has a different, more distal role in influencing child behavior than parenting practices. General parenting may moderate the impact of food parenting practices on children's nutrition behaviors. Finally, we discuss studies on interventions targeting childhood overweight and obesity. There is no consensus on the optimal intervention targets (i.e., general parenting and/or food parenting practices). Based on the overview, we offer suggestions for future research.
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Affiliation(s)
- S. M. P. L. Gerards
- Department of Health Promotion, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - S. P. J. Kremers
- Department of Health Promotion, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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27
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Berge JM, Wall M, Hsueh TF, Fulkerson JA, Larson N, Neumark-Sztainer D. The protective role of family meals for youth obesity: 10-year longitudinal associations. J Pediatr 2015; 166:296-301. [PMID: 25266343 PMCID: PMC4308550 DOI: 10.1016/j.jpeds.2014.08.030] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/01/2014] [Accepted: 08/14/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine whether having family meals as an adolescent protects against becoming overweight or obese 10 years later as a young adult. STUDY DESIGN Data from Project Eating and Activity in Teens -III, a longitudinal cohort study with emerging young adults, were used. At baseline (1998-1999), adolescents completed surveys in middle or high schools, and at 10-year follow-up (2008-2009) surveys were completed online or via mailed surveys. Young adult participants (n = 2117) were racially/ethnically and socioeconomically diverse (52% minority; 38% low income) between the ages of 19 and 31 years (mean age = 25.3; 55% female). Logistic regression was used to associate weight status at follow-up with family meal frequency 10 years earlier during adolescence, controlling and testing for interactions with demographic characteristics. RESULTS All levels of baseline family meal frequency (ie, 1-2, 3-4, ≥5 family meals/wk) during adolescence were significantly associated with reduced odds of overweight or obesity 10 years later in young adulthood compared with never having family meals as an adolescent. Interactions by race indicated that family meals had a stronger protective effect for obesity in black vs white young adults. CONCLUSIONS Family meals during adolescence were protective against the development of overweight and obesity in young adulthood. Professionals who work with adolescents and parents may want to strategize with them how to successfully carry out at least 1 to 2 family meals per week in order to protect adolescents from overweight or obesity in young adulthood.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
| | - Melanie Wall
- Biostatistics, Columbia University, New York City, NY
| | | | | | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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28
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van de Gaar VM, Jansen W, van Grieken A, Borsboom GJJM, Kremers S, Raat H. Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial. Int J Behav Nutr Phys Act 2014; 11:98. [PMID: 25060113 PMCID: PMC4222660 DOI: 10.1186/s12966-014-0098-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since sugar-sweetened beverages (SSB) may contribute to the development of overweight in children, effective interventions to reduce their consumption are needed. Here we evaluated the effect of a combined school- and community-based intervention aimed at reducing children's SSB consumption by promoting the intake of water. Favourable intervention effects on children's SSB consumption were hypothesized. METHODS In 2011-2012, a controlled trial was conducted among four primary schools, comprising 1288 children aged 6-12 years who lived in multi-ethnic, socially deprived neighbourhoods in Rotterdam, the Netherlands. Intervention schools adopted the 'water campaign', an intervention developed using social marketing. Control schools continued with their regular health promotion programme. Primary outcome was children's SSB consumption, measured using parent and child questionnaires and through observations at school, both at baseline and after one year of intervention. RESULTS Significant positive intervention effects were found for average SSB consumption (B -0.19 litres, 95% CI -0.28;-0.10; parent report), average SSB servings (B -0.54 servings, 95% CI -0.82;-0.26; parent report) and bringing SSB to school (OR 0.51, 95% CI 0.36;0.72; observation report). CONCLUSIONS This study supports the effectiveness of the water campaign intervention in reducing children's SSB consumption. Further studies are needed to replicate our findings. TRIAL REGISTRATION Current Controlled Trials: NTR3400.
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Jurkowski JM, Lawson HA, Green Mills LL, Wilner PG, Davison KK. The empowerment of low-income parents engaged in a childhood obesity intervention. FAMILY & COMMUNITY HEALTH 2014; 37:104-18. [PMID: 24569157 PMCID: PMC5491212 DOI: 10.1097/fch.0000000000000024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Parents influence children's obesity risk factors but are infrequently targeted for interventions. This study targeting low-income parents integrated a community-based participatory research approach with the Family Ecological Model and Empowerment Theory to develop a childhood obesity intervention. This article (1) examines pre- to postintervention changes in parents' empowerment; (2) determines the effects of intervention dose on empowerment, and (3) determines whether changes in parent empowerment mediate previous changes identified in food-, physical activity-, and screen-related parenting. The pre-post quasi-experimental design evaluation demonstrated positive changes in parent empowerment and empowerment predicted improvement in parenting practices. The integrated model applied in this study provides a means to enhance intervention relevance and guide translation to other childhood obesity and health disparities studies.
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Affiliation(s)
- Janine M Jurkowski
- Department of Health Policy, Management and Behavior, School of Public Health (Dr Jurkowski and Ms Green Mills), and Department of Educational Administration & Policy Studies (Drs Lawson and Wilner) and School of Social Welfare (Dr Lawson), University at Albany, State University of New York, Albany, New York; and Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts (Dr Davison)
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30
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Golan M. Fifteen years of the Family Eating and Activity Habits Questionnaire (FEAHQ): an update and review. Pediatr Obes 2014; 9:92-101. [PMID: 23447444 DOI: 10.1111/j.2047-6310.2013.00144.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 10/26/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Family Eating and Activity Habits Questionnaire (FEAHQ) is a 32-item self-report instrument designed to assess the eating and activity habits of family members as well as obesogenic factors in the overall home environment (stimulus and behaviour patterns) related to weight. Originally, this questionnaire, which was developed in Israel, was designed for use in family-based weight-management interventions that emphasized changes in the environment, and in parents' knowledge, behaviours and modelling. It was developed for use with children aged 6-11 years and designed for co-completion by parents or caretakers and their children. Over the years, it has been administered in research and clinical settings in Israel, England, Australia and other countries. Its 15-year anniversary calls for an update in the literature regarding adjustments made to improve its use in different settings and with different ethnic populations and the psychometric properties of the revised version. OBJECTIVE The goal of this paper is threefold: (i) to describe the history and development of the FEAHQ; (ii) to present new data supporting the psychometric properties of the subscales of the Revised FEAHQ (FEAHQ-R) for ages 6-12 years and (iii) to review the clinical and research literature reporting on FEAHQ subscales. METHODS The psychometric properties of the revised questionnaire were evaluated in a randomized control trial and in a naturalistic, community-based study to promote healthy lifestyle among families with children 6-12 years of age from different ethnic populations. RESULTS The tool demonstrated good test-retest reliability when completed by caretakers and very good internal consistency. The questionnaire scores discriminated between obese and normal-weight children and predicted the weight classification of 66% of the participants. CONCLUSIONS The FEAHQ-R is a useful clinical tool for identifying target behaviors for treatment and monitoring treatment progress that centers on overweight prevention and weight management.
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Affiliation(s)
- M Golan
- Department of Nutrition, Tel-Hai College, Upper Galilee, Israel; Shahaf Community Services for Eating Disorders, Tel Aviv, Israel; The Hebrew University of Jerusalem, Jerusalem, Israel
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31
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Understanding family motivations and barriers to participation in community-based programs for overweight youth: one program model does not fit all. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 19:E1-E10. [PMID: 23328502 DOI: 10.1097/phh.0b013e31825ceaf9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONTEXT Successful obesity intervention efforts depend on effective recruitment and retention, an ongoing challenge for community-based programs. OBJECTIVE We sought to provide insights into the most salient factors affecting family enrollment and retention in community-based programs for overweight youth and their families. We especially sought to understand potentially modifiable program factors affecting participation. DESIGN : We conducted semistructured, in-depth, face-to-face interviews with parents of overweight children within 1 year of referral to a public health grant-funded community-based healthy lifestyle promotion program. Purposeful sampling was used to select participants across program sites, by level of program completion, and child age and sex. Transcribed interviews were coded independently by 2 staff with a structured codebook and then analyzed by themes through an iterative process using Atlas.ti. The Integrative Model of Behavior served as an orienting theoretical framework. SETTING Community-based child obesity intervention program in King County, Washington. PARTICIPANTS Twenty-three parents from diverse socioeconomic backgrounds were interviewed, of which 10 completed the program, 9 did not complete, and 4 did not enroll. MAIN OUTCOME MEASURE(S) Parent-reported factors related to enrollment and retention. RESULTS Key parent reasons for program enrollment included: (a) addressing both eating and activity, (b) concern about child's weight, (c) seeking help outside the family, and (d) structured parent-child time. Parents perceived a lack of child motivation to enroll; some youth initially opposed attending, which was overcome through positive program experience. All families described barriers to attending, and some identified specific strategies or skills they used to overcome barriers. No single program design emerged to address every family's needs. Instead, using the themes of accessibility and accountability, we present parent- recommended design options. CONCLUSIONS To meet different families' needs, public health and health care agencies offering youth health promotion programs should consider providing program options that vary intensity level and weight loss emphasis.
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van Koperen MT, van der Kleij RM, Renders CC, Crone MM, Hendriks AMA, Jansen MM, van de Gaar VV, Raat HJ, Ruiter EE, Molleman GG, Schuit JA, Seidell JJ. Design of CIAO, a research program to support the development of an integrated approach to prevent overweight and obesity in the Netherlands. BMC OBESITY 2014. [PMID: 26217497 PMCID: PMC4472617 DOI: 10.1186/2052-9538-1-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this paper is to describe the research aims, concepts and methods of the research Consortium Integrated Approach of Overweight (CIAO). CIAO is a concerted action of five Academic Collaborative Centres, local collaborations between academic institutions, regional public health services, local authorities and other relevant sectors in the Netherlands. Prior research revealed lacunas in knowledge of and skills related to five elements of the integrated approach of overweight prevention in children (based upon the French EPODE approach), namely political support, parental education, implementation, social marketing and evaluation. CIAO aims to gain theoretical and practical insight of these elements through five sub-studies and to develop, based on these data, a framework for monitoring and evaluation. METHODS/DESIGN For this research program, mixed methods are used in all the five sub-studies. First, problem specification through literature research and consultation of stakeholders, experts, health promotion specialists, parents and policy makers will be carried out. Based on this information, models, theoretical frameworks and practical instruments will be developed, tested and evaluated in the communities that implement the integrated approach to prevent overweight in children. Knowledge obtained from these studies and insights from experts and stakeholders will be combined to create an evaluation framework to evaluate the integrated approach at central, local and individual levels that will be applicable to daily practice. DISCUSSION This innovative research program stimulates sub-studies to collaborate with local stakeholders and to share and integrate their knowledge, methodology and results. Therefore, the output of this program (both knowledge and practical tools) will be matched and form building blocks of a blueprint for a local evidence- and practice-based integrated approach towards prevention of overweight in children. The output will then support various communities to further optimize the implementation and subsequently the effects of this approach.
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Affiliation(s)
- Marije Tm van Koperen
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Rianne Mjj van der Kleij
- Department of Public Health & Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Carry Cm Renders
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Matty Mr Crone
- Department of Public Health & Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | | | - Maria M Jansen
- Caphri research School for Public Health and Primary care, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Vivian Vm van de Gaar
- Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Hein Jh Raat
- Erasmus University Medical Center, child and adolescent public health, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Emilie Elm Ruiter
- Department of Primary and Community Care, Academic Collaborative Center AMPHI Integrated Health Policy, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Gerard Grm Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI Integrated Health Policy, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jantine Aj Schuit
- National Institute for Public Health and the Environment (RIVM), PO Box 1 3720, BA Bilthoven, The Netherlands
| | - Jacob Jc Seidell
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Hollinghurst S, Hunt LP, Banks J, Sharp DJ, Shield JP. Cost and effectiveness of treatment options for childhood obesity. Pediatr Obes 2014; 9:e26-34. [PMID: 23505002 DOI: 10.1111/j.2047-6310.2013.00150.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/22/2013] [Accepted: 01/30/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED What is already known about this subject Approximately one-fifth of children in the UK are obese. There are currently few, effective interventions available in the UK. There are very little data on relative cost-effectiveness of childhood obesity interventions, which hampers the commissioning of future services. What this study adds Simple multi-component obesity interventions can be provided at relatively low cost per 0.1 body mass index standard deviation score (BMI SDS) improvement. More intensive and effective interventions incur greater cost per 0.1 BMI SDS reduction but this may be justified given the improved overall BMI SDS reduction attained. OBJECTIVE To describe the costs and outcomes of three models of care for childhood obesity previously evaluated in two 2-arm pilot randomized trials in England. The treatments were (i) a hospital clinic (control in both trials), comprising a multidisciplinary team of consultant, dietitian and exercise specialist; (ii) a nurse-led primary care clinic replicating the service provided by the hospital and (iii) an intensive intervention using Mandometer®, a behaviour modification tool aimed at encouraging slower eating and better recognition of satiety. METHOD Patient-level data on resources used to deliver each intervention were collected during the trials. Apart from the cost of the Mandometer® the majority of cost was staff time, dependent on discipline and grade. Outcome for both trials was body mass index standard deviation score (BMI SDS) measured at 12 months. RESULTS Cost and outcome data were available for 143 children in total. Cost per child was £1749 (SD £243) in the Mandometer® group, £301 (£76) in the primary care group, and £263 (£88) and £209 (£81) in the hospital groups. Mean reduction in BMI SDS was 0.40 (0.35), 0.17 (0.26), 0.15 (0.25) and 0.14 (0.32), respectively. CONCLUSION Intensive management using Mandometer® was effective but costly (£432 per 0.1 reduction in BMI SDS) compared to conventional care (range £153-£173). A total of 26% children receiving conventional care achieved a clinically meaningful reduction in BMI SDS; however, use of Mandometer® training may be justified in children not responding to conventional lifestyle interventions.
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Affiliation(s)
- S Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Kothandan SK. School based interventions versus family based interventions in the treatment of childhood obesity- a systematic review. Arch Public Health 2014; 72:3. [PMID: 24472187 PMCID: PMC3974185 DOI: 10.1186/2049-3258-72-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 11/25/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity, which has seen a rapid increase over the last decade, is now considered a major public health problem. Current treatment options are based on the two important frameworks of school- and family-based interventions; however, most research has yet to compare the two frameworks in the treatment of childhood obesity.The objective of this review is to compare the effectiveness of school-based intervention with family-based intervention in the treatment of childhood obesity. METHODS Databases such as Medline, Pub med, CINAHL, and Science Direct were used to execute the search for primary research papers according to inclusion criteria. The review included a randomised controlled trial and quasi-randomised controlled trials based on family- and school-based intervention frameworks on the treatment of childhood obesity. RESULTS The review identified 1231 articles of which 13 met the criteria. Out of the thirteen studies, eight were family-based interventions (n = 8) and five were school-based interventions (n = 5) with total participants (n = 2067). The participants were aged between 6 and 17 with the study duration ranging between one month and three years. Family-based interventions demonstrated effectiveness for children under the age of twelve and school-based intervention was most effective for those aged between 12 and 17 with differences for both long-term and short-term results. CONCLUSIONS The evidence shows that family- and school-based interventions have a considerable effect on treating childhood obesity. However, the effectiveness of the interventional frameworks depends on factors such as age, short- or long-term outcome, and methodological quality of the trials. Further research studies are required to determine the effectiveness of family- and school-based interventions using primary outcomes such as weight, BMI, percentage overweight and waist circumference in addition to the aforementioned factors.
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Grow HMG, Hencz P, Verbovski MJ, Gregerson L, Liu LL, Dossett L, Larison C, Saelens BE. Partnering for success and sustainability in community-based child obesity intervention: seeking to help families ACT! FAMILY & COMMUNITY HEALTH 2014; 37:45-59. [PMID: 24297007 DOI: 10.1097/fch.0000000000000010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sustaining community-based obesity interventions for families represents an ongoing challenge. Many initially grant-funded initiatives lack a sustainable model to continue. After initial grant funding ended, we continued a partnership between Seattle Children's Hospital and YMCA of Greater Seattle to enhance and expand a community-based family obesity program, "ACT! Actively Changing Together." We used principles of continuous process improvement, community-based participatory research, and the RE-AIM framework to successfully transition from a grant-funded to a community-supported program. Our pilot evaluation demonstrated promising results in parent behaviors, youth quality of life, ongoing family participation at the Y, and youth body mass index.
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Jago R, Sebire SJ, Bentley GF, Turner KM, Goodred JK, Fox KR, Stewart-Brown S, Lucas PJ. Process evaluation of the Teamplay parenting intervention pilot: implications for recruitment, retention and course refinement. BMC Public Health 2013; 13:1102. [PMID: 24289111 PMCID: PMC4219518 DOI: 10.1186/1471-2458-13-1102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/27/2013] [Indexed: 11/13/2022] Open
Abstract
Background Parenting programs could provide effective routes to increasing children’s physical activity and reducing screen-viewing. Many studies have reported difficulties in recruiting and retaining families in group parenting interventions. This paper uses qualitative data from the Teamplay feasibility trial to examine parents’ views on recruitment, attendance and course refinement. Methods Semi-structured interviews were conducted with 16 intervention and 10 control group parents of 6–8 year old children. Topics discussed with the intervention group included parents’ views on the recruitment, structure, content and delivery of the course. Topics discussed with the control group included recruitment and randomization. Interviews were digitally recorded, transcribed and thematically analyzed. Results Many parents in both the intervention and control group reported that they joined the study because they had been thinking about ways to improve their parenting skills, getting ideas on how to change behavior, or had been actively looking for a parenting course but with little success in enrolling on one. Both intervention and control group parents reported that the initial promotional materials and indicative course topics resonated with their experiences and represented a possible solution to parenting challenges. Participants reported that the course leaders played an important role in helping them to feel comfortable during the first session, engaging anxious parents and putting parents at ease. The most commonly reported reason for parents returning to the course after an absence was because they wanted to learn new information. The majority of parents reported that they formed good relationships with the other parents in the group. An empathetic interaction style in which leaders accommodated parent’s busy lives appeared to impact positively on course attendance. Conclusions The data presented indicate that a face-to-face recruitment campaign which built trust and emphasized how the program was relevant to families positively affected recruitment in Teamplay. Parents found the parenting component of the intervention attractive and, once recruited, attendance was facilitated by enjoyable sessions, empathetic leaders and support from fellow participants. Overall, data suggest that the Teamplay recruitment and retention approaches were successful and with small refinements could be effectively used in a larger trial.
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Affiliation(s)
- Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
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Markert J, Alff F, Zschaler S, Gausche R, Kiess W, Blüher S. Prevention of childhood obesity: Recruiting strategies via local paediatricians and study protocol for a telephone-based counselling programme. Obes Res Clin Pract 2013; 7:e476-86. [DOI: 10.1016/j.orcp.2012.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/30/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
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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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Smith LR, Chadwick P, Radley D, Kolotourou M, Gammon CS, Rosborough J, Sacher PM. Assessing the short-term outcomes of a community-based intervention for overweight and obese children: The MEND 5-7 programme. BMJ Open 2013; 3:bmjopen-2013-002607. [PMID: 23645925 PMCID: PMC3646180 DOI: 10.1136/bmjopen-2013-002607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to report outcomes of the UK service level delivery of MEND (Mind,Exercise,Nutrition...Do it!) 5-7, a multicomponent, community-based, healthy lifestyle intervention designed for overweight and obese children aged 5-7 years and their families. DESIGN Repeated measures. SETTING Community venues at 37 locations across the UK. PARTICIPANTS 440 overweight or obese children (42% boys; mean age 6.1 years; body mass index (BMI) z-score 2.86) and their parents/carers participated in the intervention. INTERVENTION MEND 5-7 is a 10-week, family-based, child weight-management intervention consisting of weekly group sessions. It includes positive parenting, active play, nutrition education and behaviour change strategies. The intervention is designed to be scalable and delivered by a range of health and social care professionals. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was BMI z-score. Secondary outcome measures included BMI, waist circumference, waist circumference z-score, children's psychological symptoms, parenting self-efficacy, physical activity and sedentary behaviours and the proportion of parents and children eating five or more portions of fruit and vegetables. RESULTS 274 (62%) children were measured preintervention and post-intervention (baseline; 10-weeks). Post-intervention, mean BMI and waist circumference decreased by 0.5 kg/m(2) and 0.9 cm, while z-scores decreased by 0.20 and 0.20, respectively (p<0.0001). Improvements were found in children's psychological symptoms (-1.6 units, p<0.0001), parent self-efficacy (p<0.0001), physical activity (+2.9 h/week, p<0.01), sedentary activities (-4.1 h/week, p<0.0001) and the proportion of parents and children eating five or more portions of fruit and vegetables per day (both p<0.0001). Attendance at the 10 sessions was 73% with a 70% retention rate. CONCLUSIONS Participation in the MEND 5-7 programme was associated with beneficial changes in physical, behavioural and psychological outcomes for children with complete sets of measurement data, when implemented in UK community settings under service level conditions. Further investigation is warranted to establish if these findings are replicable under controlled conditions.
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Affiliation(s)
- L R Smith
- Childhood Nutrition Research Centre, University College London, Institute of Child Health, London, UK
- Research and Programme Development Department, MEND, Bromley, UK
| | - P Chadwick
- Research and Programme Development Department, MEND, Bromley, UK
- Cancer Research, UK Health Behaviour Unit, University College London, London, UK
| | - D Radley
- Childhood Nutrition Research Centre, University College London, Institute of Child Health, London, UK
- Research and Programme Development Department, MEND, Bromley, UK
| | - M Kolotourou
- Research and Programme Development Department, MEND, Bromley, UK
| | - C S Gammon
- Research and Programme Development Department, MEND, Bromley, UK
| | - J Rosborough
- Research and Programme Development Department, MEND, Bromley, UK
| | - P M Sacher
- Childhood Nutrition Research Centre, University College London, Institute of Child Health, London, UK
- Research and Programme Development Department, MEND, Bromley, UK
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A Randomized Clinical Trial of the Building on Family Strengths Program: An Education Program for Parents of Children with Chronic Health Conditions. Matern Child Health J 2013; 18:563-74. [DOI: 10.1007/s10995-013-1273-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Jago R, Sebire SJ, Turner KM, Bentley GF, Goodred JK, Fox KR, Stewart-Brown S, Lucas PJ. Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children: Teamplay. Int J Behav Nutr Phys Act 2013; 10:31. [PMID: 23510646 PMCID: PMC3598924 DOI: 10.1186/1479-5868-10-31] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many children spend too much time screen-viewing (watching TV, surfing the internet and playing video games) and do not meet physical activity (PA) guidelines. Parents are important influences on children's PA and screen-viewing (SV). There is a shortage of parent-focused interventions to change children's PA and SV. METHODS Teamplay was a two arm individualized randomized controlled feasibility trial. Participants were parents of 6-8 year old children. Intervention participants were invited to attend an eight week parenting program with each session lasting 2 hours. Children and parents wore an accelerometer for seven days and minutes of moderate-to-vigorous intensity PA (MVPA) were derived. Parents were also asked to report the average number of hours per day that both they and the target child spent watching TV. Measures were assessed at baseline (time 0) at the end of the intervention (week 8) and 2 months after the intervention had ended (week 16). RESULTS There were 75 participants who provided consent and were randomized but 27 participants withdrew post-randomization. Children in the intervention group engaged in 2.6 fewer minutes of weekday MVPA at Time 1 but engaged in 11 more minutes of weekend MVPA. At Time 1 the intervention parents engaged in 9 more minutes of weekday MVPA and 13 more minutes of weekend MVPA. The proportion of children in the intervention group watching ≥ 2 hours per day of TV on weekend days decreased after the intervention (time 0 = 76%, time 1 = 39%, time 2 = 50%), while the control group proportion increased slightly (79%, 86% and 87%). Parental weekday TV watching decreased in both groups. In post-study interviews many mothers reported problems associated with wearing the accelerometers. In terms of a future full-scale trial, a sample of between 80 and 340 families would be needed to detect a mean difference of 10-minutes of weekend MVPA. CONCLUSIONS Teamplay is a promising parenting program in an under-researched area. The intervention was acceptable to parents, and all elements of the study protocol were successfully completed. Simple changes to the trial protocol could result in more complete data collection and study engagement.
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Affiliation(s)
- Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
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Pearson ES, Irwin JD, Burke SM. The Children's Health and Activity Modification Program (C.H.A.M.P.): participants' perspectives of a four-week lifestyle intervention for children with obesity. J Child Health Care 2012; 16:382-94. [PMID: 23045293 DOI: 10.1177/1367493512446239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To date, there is a paucity of qualitative research examining the influence of community-based interventions for childhood obesity on the participants themselves. This study explored the experiences of children who participated in the Children's Health and Activity Modification Program (C.H.A.M.P.), a four-week day camp for children with obesity aged 8-14, in order to uncover key program elements for positive behavior change. Following the intervention, children (n = 36) participated in focus groups where they were asked about their experiences pertaining to physical activity and nutrition, what it was like to be part of a team, and how they felt about themselves. Findings revealed that participants perceived C.H.A.M.P. as helpful (e.g. in making healthier food choices, being more active, and feeling more confident and self-aware). This pilot study offers unique insights into the perspectives of children with obesity. Results are discussed with respect to future program development and research for childhood obesity treatment.
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Bentley GF, Goodred JK, Jago R, Sebire SJ, Lucas PJ, Fox KR, Stewart-Brown S, Turner KM. Parents' views on child physical activity and their implications for physical activity parenting interventions: a qualitative study. BMC Pediatr 2012; 12:180. [PMID: 23167910 PMCID: PMC3536679 DOI: 10.1186/1471-2431-12-180] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Establishing healthy physical activity (PA) behaviours in early childhood is important for future PA behaviours. Parents play a central role in young children's PA. However, there is currently little research on parenting interventions to increase child PA. This study was formative work to inform the content of a pilot randomised-controlled trial. METHODS In-depth telephone interviews were carried out with 32 parents of 6 to 8 year old children residing in two areas that varied in their socio-economic characteristics, in Bristol, UK. Data were analysed thematically using a framework approach. RESULTS Most parents described their child as being active or very active and indicated that they did not perceive a need for an increase in their child's PA. Parents used a variety of visual cues to make this judgement, the most common being that they perceived their child as having lots of energy or that they did not view them as overweight. Parents reported environmental factors such as monetary cost, time constraints, lack of activity provision and poor weather as the main barriers to their child's PA. Parental support and child's enjoyment of PA appeared to be important facilitators to children participating in PA. CONCLUSION Improving parents' knowledge of the PA recommendations for children, and increasing their awareness of the benefits of PA beyond weight status may be an important first step for a parenting PA intervention. Although parents commonly perceive environmental factors as the main barriers to their child's PA, parental concern about low levels of child PA, their capacity to support behaviour change, child motivation, self confidence and independence may be key areas to address within an intervention to increase child PA. Effective methods of helping parents address the latter have been developed in the context of generic parenting programmes.
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Affiliation(s)
- Georgina F Bentley
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna K Goodred
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Simon J Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Patricia J Lucas
- Centre for Research in Health and Social Care, School for Policy Studies, University of Bristol, Bristol, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - Katrina M Turner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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45
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Østbye T, Krause KM, Stroo M, Lovelady CA, Evenson KR, Peterson BL, Bastian LA, Swamy GK, West DG, Brouwer RJN, Zucker NL. Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study. Prev Med 2012; 55:188-95. [PMID: 22705016 PMCID: PMC3439558 DOI: 10.1016/j.ypmed.2012.06.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2-5 years old) dyads in North Carolina (2007-2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight. METHOD The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized. RESULTS Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (-0.24 vs. 0.01, p<0.001) and TV snacks (-.069 vs. -0.24, p=0.001). There were also improvements in emotional feeding (p=0.03), mother's sugary beverage (p=0.03) and fruit/vegetable (p=0.04) intake, and dinners eaten in front of TV (p=0.01); these differences were not significant after adjustment for multiple comparisons. CONCLUSION KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.
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Affiliation(s)
- Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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46
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Jago R, Steeds JK, Bentley GF, Sebire SJ, Lucas PJ, Fox KR, Stewart-Brown S, Turner KM. Designing a physical activity parenting course: parental views on recruitment, content and delivery. BMC Public Health 2012; 12:356. [PMID: 22591593 PMCID: PMC3390270 DOI: 10.1186/1471-2458-12-356] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/16/2012] [Indexed: 12/02/2022] Open
Abstract
Background Many children do not engage in sufficient levels of physical activity (PA) and spend too much time screen-viewing (SV). High levels of SV (e.g. watching TV, playing video games and surfing the internet) and low levels of PA have been associated with adverse health outcomes. Parenting courses may hold promise as an intervention medium to change children’s PA and SV. The current study was formative work conducted to design a new parenting programme to increase children’s PA and reduce their SV. Specifically, we focussed on interest in a course, desired content and delivery style, barriers and facilitators to participation and opinions on control group provision. Methods In-depth telephone interviews were conducted with thirty two parents (29 female) of 6–8 year olds. Data were analysed thematically. An anonymous online survey was also completed by 750 parents of 6–8 year old children and descriptive statistics calculated. Results Interview participants were interested in a parenting course because they wanted general parenting advice and ideas to help their children be physically active. Parents indicated that they would benefit from knowing how to quantify their child’s PA and SV levels. Parents wanted practical ideas of alternatives to SV. Most parents would be unable to attend unless childcare was provided. Schools were perceived to be a trusted source of information about parenting courses and the optimal recruitment location. In terms of delivery style, the majority of parents stated they would prefer a group-based approach that provided opportunities for peer learning and support with professional input. Survey participants reported the timing of classes and the provision of childcare were essential factors that would affect participation. In terms of designing an intervention, the most preferred control group option was the opportunity to attend the same course at a later date. Conclusions Parents are interested in PA/SV parenting courses but the provision of child care is essential for attendance. Recruitment is likely to be facilitated via trusted sources. Parents want practical advice on how to overcome barriers and suggest advice is provided in a mutually supportive group experience with expert input.
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Affiliation(s)
- Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
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47
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Straker LM, Smith KL, Fenner AA, Kerr DA, McManus A, Davis MC, Fielding AM, Olds TS, Hagger MS, Smith AJ, Abbott RA. Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University's Activity, Food and Attitudes Program--CAFAP) among overweight adolescents. BMC Public Health 2012; 12:471. [PMID: 22721261 PMCID: PMC3439288 DOI: 10.1186/1471-2458-12-471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 06/13/2012] [Indexed: 02/07/2023] Open
Abstract
Background Current estimates place just under one quarter of adolescents in Australia as overweight or obese. Adolescence has been identified as a critical period for the development of obesity, yet despite this recognition, there is limited systematic research into or evaluation of interventions for overweight adolescents. Reviews have concluded that there is a substantive evidence gap for effective intervention, but physical activity, lifestyle change and family involvement have been identified as promising foci for treatment. Methods This paper reports on the development of a staggered-entry, waitlist controlled clinical trial to assess the impact of a multidisciplinary intervention aiming to change the poor health trajectory of overweight adolescents and help them avoid morbid obesity in adulthood—Curtin University’s Activity, Food and Attitudes Program (CAFAP). 96 adolescents, aged 11–16 years, and parents, will attend twice weekly during an 8 week intensive multidisciplinary program with maintenance follow-up focussed on improving activity, food and attitude habits. Follow-up assessments will be conducted immediately after completing the intensive program, and at 3, 6 and 12 months post intensive program. Main outcomes will be objectively-measured physical activity, sedentary behaviour and activity behaviours; food intake (measured by 3 day diary) and food behaviours; body composition, fitness and physical function; mental and social well-being (quality of life, mood and attitudes), and family functioning. Discussion This trial will provide important information to understand whether a community based multidisciplinary intervention can have short and medium term effects on activity and food habits, attitudes, and physical and mental health status of overweight adolescents. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611001187932.
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Affiliation(s)
- Leon M Straker
- School of Physiotherapy, Curtin University, Perth, Australia.
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48
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Dearth-Wesley T, Gordon-Larsen P, Adair LS, Zhang B, Popkin BM. Longitudinal, cross-cohort comparison of physical activity patterns in Chinese mothers and children. Int J Behav Nutr Phys Act 2012; 9:39. [PMID: 22472289 PMCID: PMC3420306 DOI: 10.1186/1479-5868-9-39] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 03/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence comparing adult and child physical activity (PA) trends and examining parent-child PA associations within a newly industrialized country setting. PA research within a newly industrialized country setting is particularly important given the negative effects of rapid urbanization, socioeconomic growth, and technological advances on PA behaviors. The purpose of our study was to examine trends and associations in PA behaviors in Chinese mother-child pairs and to investigate relationships between PA behaviors and socioeconomic variables in this dyad. METHODS We studied PA behaviors in 2 separate cohorts of mother-child pairs (n = 353) followed over a 2-4 year time period using longitudinal data from the China Health and Nutrition Survey (2000 COHORT: 2000-2004; 2004 COHORT: 2004-2006). Comparable mother-child PA behaviors included total metabolic equivalent hours per week (MET-hrs/wk) from active commuting, leisure-time sports, and sedentary behaviors. Logistic regression models were used to examine associations between mother and child PA and relationships between PA behaviors and socioeconomic variables. RESULTS Children experienced increases in active commuting and leisure-time sports activities with increasing child age, whereas mothers experienced temporal declines in active commuting and minimal change in leisure-time sports activity. Sedentary behavior was high for children and mothers over time. Mother-child associations were positive for active commuting and leisure-time sports activities and negative for sedentary behavior (P < 0.05). Maternal education was associated with a greater likelihood of high leisure-time sports activity and high sedentary behavior in mothers but not in children (P < 0.05). CONCLUSION Efforts to reduce sedentary behavior in Chinese mothers and children are imperative. While increased leisure-time and active commuting activities in children is encouraging, continued PA promotion in children and more intensive efforts to promote leisure-time sports and active commuting in mothers is needed.
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Affiliation(s)
- Tracy Dearth-Wesley
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Penny Gordon-Larsen
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda S Adair
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bing Zhang
- National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, 100050, China
| | - Barry M Popkin
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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49
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Robertson W, Thorogood M, Inglis N, Grainger C, Stewart-Brown S. Two-year follow-up of the 'Families for Health' programme for the treatment of childhood obesity. Child Care Health Dev 2012; 38:229-36. [PMID: 21463350 DOI: 10.1111/j.1365-2214.2011.01237.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The high prevalence of obesity in children in the UK warrants continuing public health attention. 'Families for Health' is a family-based group programme for the treatment of childhood obesity. Significant improvements in body mass index (BMI) z-score (-0.21, 95% CI: -0.35 to -0.07, P = 0.007) and other health outcomes were seen in children at a 9-month follow-up. AIM To undertake a 2-year follow-up of families who attended 'Families for Health' in Coventry, to assess long-term outcomes and costs. METHODS 'Families for Health' is a 12-week programme with parallel groups for parents and children, addressing parenting skills, healthy lifestyles and emotional well-being. The intervention was delivered at a leisure centre in Coventry, England, with 27 overweight or obese children aged 7-13 years (18 girls, 9 boys) and their parents, from 21 families. A 'before-and-after' evaluation was completed with 19 (70%) children followed up at 2 years. The primary outcome was change in BMI z-score from baseline; secondary outcomes were children's quality of life, parent-child relationships, eating/activity habits and parents' mental health. Costs to deliver the intervention and to families were recorded. RESULTS Mean change in BMI z-score from baseline was -0.23 (95% CI: -0.42 to -0.03, P = 0.027) at the 2-year follow-up and eight (42%) children had a clinically significant reduction in BMI z-score. Significant improvements were seen in children's quality of life and eating habits in the home, while there were sustained reductions in unhealthy foods and sedentary behaviour. Fruit and vegetable consumption and parent's mental health were not significantly different at 2 years. Costs of the programme were £517 per family (£402 per child), equivalent to £2543 per unit reduction in BMI z-score. CONCLUSIONS Improvements in BMI z-score and certain other outcomes associated with the 'Families for Health' programme were sustained at the 2-year follow-up. 'Families for Health' is a promising new childhood obesity intervention, and a randomized controlled trial is now indicated.
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Affiliation(s)
- W Robertson
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
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50
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Teder M, Mörelius E, Bolme P, Nordwall M, Ekberg J, Timpka T. Family-based behavioural intervention programme for obese children: a feasibility study. BMJ Open 2012; 2:e000268. [PMID: 22389357 PMCID: PMC3293142 DOI: 10.1136/bmjopen-2011-000268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To assess a 2-year family-based behavioural intervention programme against child obesity. DESIGN Single-group pre- and post-intervention feasibility study. SETTING Swedish paediatric outpatient care. PARTICIPANTS 26 obese children aged 8.3-12.0 years and their parents who had consented to actively participate in a 2-year intervention. INTERVENTIONS 25 paediatric outpatient group sessions over a 2-year period with parallel groups for children and parents. The basis for the programme was a manual containing instructions for tutor-supervised group sessions with obese children and their parents. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was change in standardised body mass index between baseline and after 36 months. The secondary outcome measures were change in the waist:height ratio, metabolic parameters and programme adherence. The participants were examined at baseline and after 3, 12 and 24 months of therapy and at follow-up 12 months after completion of the programme. RESULTS The primary outcome measure, standardised body mass index, declined from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) (p<0.001) at follow-up 12 months after completion of the programme. There was no change in the waist:height ratio. Biomedical markers of blood glucose metabolism and lipid status remained in the normal range. 96% of the families completed the programme. CONCLUSIONS This feasibility study of a 2-year family-based behavioural intervention programme in paediatric outpatient care showed promising results with regard to further weight gain and programme adherence. These findings must be confirmed in a randomised controlled trial with longer follow-up before the intervention programme can be implemented on a larger scale.
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Affiliation(s)
- Marie Teder
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Per Bolme
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Paediatric Clinic, Vrinnevi Hospital, Norrköping, Sweden
| | - Maria Nordwall
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Paediatric Clinic, Vrinnevi Hospital, Norrköping, Sweden
| | - Joakim Ekberg
- Department of Medical and Health Sciences, Section of Social Medicine and Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Toomas Timpka
- Department of Medical and Health Sciences, Section of Social Medicine and Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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