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Kane RM, Lowe M, Fish LJ, Makarushka C, Zullig LL, Mitchell NS. A Mixed-Methods Feasibility Study Linking a Community-Based Weight Loss Program with an African American Breast Cancer Support Group. J Gen Intern Med 2024:10.1007/s11606-024-08714-w. [PMID: 38886323 DOI: 10.1007/s11606-024-08714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/27/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Ryan M Kane
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 710 W. Main St., Durham, NC, 27701, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Melissa Lowe
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Nia S Mitchell
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 710 W. Main St., Durham, NC, 27701, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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Savage JS, Moore AM, Kling SMR, Marini M, Hernandez E, Franceschelli Hosterman J, Hassink S, Paul IM, Bailey-Davis L. Coordination Between Primary Care and Women, Infants, and Children to Prevent Obesity for Infants from Low-Income Families: A Pragmatic Randomized Clinical Trial. Child Obes 2023; 19:515-524. [PMID: 36367983 DOI: 10.1089/chi.2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Rapid weight gain during infancy is associated with risk for later obesity, yet little research to date has examined the effect of a responsive parenting (RP) intervention with care coordination between pediatric primary care providers and Women, Infants, and Children nutritionists on infant weight. Methods: The Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study is a pragmatic, randomized clinical trial for mothers and infants (n = 288) designed to examine the effect of a patient-centered RP intervention that used advanced health information technology strategies to coordinate care to reduce rapid infant weight gain compared with standard care. General linear models examined intervention effects on infant conditional weight gain scores, weight-for-age z scores, BMI, and overweight status (BMI-for-age ≥85th percentile) from birth to age 6 months, and mothers' use of food to soothe from age 2 to 6 months. Results: There were no intervention effects on infant conditional weight gain scores or overweight status at 6 months. Infants in the RP intervention had lower mean weight-for-age z scores [M = -0.04, standard error (SE) = 0.04 vs. M = 0.05, SE = 0.04; p = 0.008] and lower mean BMI (M = 16.05, SE = 0.09 vs. M = 16.24, SE = 0.09; p = 0.03) compared with standard care. Mothers' use of emotion-based food to soothe was lower in the RP intervention compared with standard care from age 2 to 6 months [M difference = -0.32, standard deviation (SD) = 0.81 vs. 0.00, SD = 0.90; p = 0.01]. Conclusions: This pragmatic, patient-centered RP intervention did not reduce rapid infant weight gain or overweight but was associated with modestly lower infant BMI and reduced mothers' use of emotion-based food to soothe. Trial Registration: clinicaltrials.gov identifier: NCT03482908.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Samantha M R Kling
- Evaluation Sciences Unit, Division of Primary Care Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michele Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Erika Hernandez
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | | | - Sandra Hassink
- Nemours Children's Health (Emeritus), Wilmington, DE, USA
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Lisa Bailey-Davis
- Population Health Sciences, Obesity Institute, Geisinger, Danville, PA, USA
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3
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James A, Afable A, Bayoumi N, Dhuper S. Evaluation of a Childhood Obesity Program Serving a High-Need Population in Brooklyn, New York Using Survival Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095723. [PMID: 37174241 PMCID: PMC10178259 DOI: 10.3390/ijerph20095723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/29/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
In this study, we used survival analysis to evaluate whether contact hours intensity was associated with a reduction in time to improvement of various BMI metrics over a 5-year follow-up period at the Live Light Live Right pediatric obesity program in Brooklyn, New York. This was a single-center retrospective longitudinal study of 406 patients during 2010-2016. Participants were categorized based on hours of exposure to Live Light Live Right's interventions; high contact hours (≥50 h) vs. low contact hours (<50 h). At baseline, 88% of patients in the high contact hour group had severe obesity and the mean age for this group was 10.0 ± 2.66. High contact hours were independently associated with a shorter time to BMI improvement in the sample. There was also a significant association between high contact hours and a longer duration in the improved state. Survival analysis was successful in evaluating the efficacy of the Live Light Live Right Program and demonstrated a positive association between greater intervention intensity and a healthier metabolic profile. Patients' active engagement in a robust treatment model exemplified by Live Light Live Right is recommended to address the childhood obesity crisis in central Brooklyn.
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Affiliation(s)
- Alecia James
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Aimee Afable
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Nagla Bayoumi
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Sarita Dhuper
- Department of Pediatrics, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
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Niknam M, Omidvar N, Eini-Zinab H, Kalantari N, Olazadeh K, Amiri P. Improving community readiness among Iranian local communities to prevent childhood obesity. BMC Public Health 2023; 23:344. [PMID: 36793004 PMCID: PMC9931445 DOI: 10.1186/s12889-023-15163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Community Readiness Intervention for Tackling Childhood Obesity (CRITCO) is a theory-based intervention being developed to improve the readiness of an Iranian urban population to engage in childhood obesity prevention programs. This study aimed to explore changes in readiness of intervention and control local communities from diverse socio-economic areas of Tehran. METHODS This study was a seven-month quasi-experimental intervention implemented in four intervention communities and compared with four controls. Aligned strategies and action plans were developed around the six dimensions of community readiness. The Food and Nutrition Committee was established in each intervention community to make collaborative efforts among different sectors and assess the fidelity of the intervention. The pre-and post- readiness change was explored through interviews with 46 community key informants. RESULTS The total readiness of intervention sites increased by 0.48 units (p < 0.001) and shifted to the next higher level, from preplanning to the preparation stage. At the same time, the readiness of control communities decreased by 0.39 units (p < 0.001), although their readiness stage remained unchanged, reflecting the fourth stage. Also, a sex-dependent CR change was observed, such that the girls' schools showed a more remarkable improvement in interventions and less decline in controls. The readiness stages of interventions significantly improved for four dimensions related to community efforts, knowledge of the efforts, knowledge of childhood obesity issue, and leadership. Furthermore, the readiness of control communities significantly decreased on three of six dimensions related to community effort, knowledge of efforts, and resources. CONCLUSIONS The CRITCO successfully improved the readiness of intervention sites for addressing childhood obesity. It is hoped that the present study can be a spark for developing readiness-based childhood obesity prevention programs in Middle Eastern and other developing countries. TRIAL REGISTRATION The CRITCO intervention was registered at Iran Registry for Clinical Trials ( http://irct.ir ; IRCT20191006044997N1) on 11/11/2019.
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Affiliation(s)
- Mahdieh Niknam
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran.
| | - Hassan Eini-Zinab
- grid.411600.2Department of Community Nutrition, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran
| | - Naser Kalantari
- grid.411600.2Department of Community Nutrition, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran
| | - Keyvan Olazadeh
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran.
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 202] [Impact Index Per Article: 202.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:190440. [PMID: 36622135 DOI: 10.1542/peds.2022-060641] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sarah E Hampl
- Children's Mercy Kansas City Center for Children's Healthy Lifestyles & Nutrition, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Medical Center of Dallas, Dallas, Texas
| | - Christopher F Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kimberly C Avila Edwards
- Children's Health Policy & Advocacy, Ascension; Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas
| | - Ihuoma Eneli
- Department of Pediatrics, The Ohio State University, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Robin Hamre
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, University of Florida Health Sciences Center-Jacksonville, Jacksonville, Florida
| | | | - Eneida Mendonca
- Departments of Pediatrics and Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marc P Michalsky
- Department of Pediatric Surgery, The Ohio State University, College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Nazrat Mirza
- Children's National Hospital, George Washington University, Washington, DC
| | - Eduardo R Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Lobczowska K, Banik A, Forberger S, Kaczmarek K, Kubiak T, Neumann-Podczaska A, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Bekker MPM, Zeeb H, Luszczynska A. Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity. BMC Public Health 2022; 22:1055. [PMID: 35619065 PMCID: PMC9137101 DOI: 10.1186/s12889-022-13340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. Methods Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. Results Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). Conclusions These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13340-4.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Krzysztof Kaczmarek
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Agnieszka Neumann-Podczaska
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, bode 60, 6700 EW, Wageningen, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland. .,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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Soltero EG, O'Connor TM, Thompson D, Shaibi GQ. Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents. Curr Obes Rep 2021; 10:332-341. [PMID: 34263434 PMCID: PMC9116051 DOI: 10.1007/s13679-021-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity. RECENT FINDINGS Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.
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Affiliation(s)
- Erica G Soltero
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA.
| | - Teresia M O'Connor
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Deborah Thompson
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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Burkhart L, Pellegrini CA, Jones K, LaVela SL. Strategies used by providers to support individuals with spinal cord injury in weight management: a qualitative study of provider perspectives. Spinal Cord Ser Cases 2021; 7:65. [PMID: 34326307 DOI: 10.1038/s41394-021-00426-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN This is a descriptive qualitative study. OBJECTIVES To explore recommended strategies employed by healthcare providers to support individuals with SCI in weight management. SETTING Fourteen veteran administration hospitals in the United States and the Shirley Ryan AbilityLab (SRALab) SCI Model Systems in Illinois. METHODS Semi-structured interviews were conducted with interprofessional SCI providers involved in weight management with individuals living with SCI. Thematic analysis methods were used. RESULTS A total of 25 interprofessional providers were interviewed. Providing clinical expertise to assist in weight management included (1) checking progress or status of weight over time, (2) monitoring and tracking other health-related indicators, (3) stressing weight-related health risks, (4) providing education, (5) encouraging healthy behaviors, and (6) identifying and accessing resources. Fostering provider-patient relationships included (1) establishing and maintaining rapport and (2) tailoring/individualizing weight management treatment. Coordinating a team approach included (1) involving a dietitian or nutritionist, (2) communicating the same message, and (3) involving the informal caregiver/family. CONCLUSION Weight management strategies should incorporate patient preferences and goals, informed through provider expert and personalized clinical advice, and supported within the context of interprofessional team collaboration that includes caregivers and family.
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Affiliation(s)
- Lisa Burkhart
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA. .,Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA.
| | - Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kayla Jones
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Sherri L LaVela
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Shinall JB, Schlundt DG, Sullivan MH, Frank HJ, Po’e EK, Sommer EC, Bonnet KR, Burgess LE, Barkin SL, Haws KL. Identifying meaningful dietary intake and physical activity questions for individual and population health. Clin Obes 2021; 11:e12435. [PMID: 33412615 PMCID: PMC9257901 DOI: 10.1111/cob.12435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
We aimed to identify valid screening questions for adults regarding physical activity and dietary behaviours that (a) were correlated with BMI, (b) were deemed by patients and providers to be relevant to clinical care, and (c) have utility for longitudinal understanding of health behaviours in populations. The goal was to identify screening questions that could be implemented at annual health care visits. First, we identified dietary behaviour questions and solicited patient input. Next, we tested both physical activity and dietary behaviour questions in a large sample to test their potential utility. Finally, we used cognitive interviews with patients and physicians to narrow our assessment for clinical settings. We present a parsimonious and reliable six-question scale of physical activity and dietary behaviours for research settings, as well as a three-question scale for clinical settings. We demonstrate a robust relationship between these measures and obesity. Additionally, we present evidence that these measures may serve as a useful red flag for patients before they develop obesity. We provide a concise and useful tool for assessing patients' physical activity and dietary behaviours in a variety of research settings. We also highlight the importance of incorporating this tool into the clinical intake flow for inclusion in patients' Electronic Health Record.
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Affiliation(s)
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Mikaela H. Sullivan
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | | | - Eli K. Po’e
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan C. Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Laura E. Burgess
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shari L. Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly L. Haws
- Vanderbilt University, Owen School of Management, Nashville, Tennessee
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Fernández CR, Lee J, Duroseau N, Vargas-Rodriguez I, Rieder J. Child Health Behaviour and Parent Priorities for a School-Based Healthy Lifestyle Programme. HEALTH EDUCATION JOURNAL 2021; 80:361-372. [PMID: 35747426 PMCID: PMC9217183 DOI: 10.1177/0017896920972152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this study was to characterise parents' concerns for their children's health behaviours and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents' priorities for a school-based healthy lifestyle programme. DESIGN Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events. SETTING School for children aged 5-14 years in The Bronx, New York City, USA. METHODS Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman's correlation measured associations between motivators and barriers and programme priorities. RESULTS Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing BMI and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education (rs ≥ .41, p ≤ .01), physical activity classes (rs ≥ .29, p ≤ .04) and child involvement in programme decision-making (rs ≥ .43, p ≤ .01) priorities. Consistency-, child resistance-, and home rules-related barriers were associated with nutrition education (rs ≥ .37, p=.02), physical activity classes (rs ≥ .32, p = .02), and child involvement (rs ≥ .40, p ≤ .02) priorities. CONCLUSIONS Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.
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Affiliation(s)
- Cristina R Fernández
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet Lee
- Department of Pediatrics, Mount Sinai Health System, New York, NY, USA
| | - Nathalie Duroseau
- Adolescent Medicine Fellow, Department of Pediatrics, Mount Sinai Health System, New York, NY, USA
| | | | - Jessica Rieder
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY, USA
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Horstman CM, Ryan DH, Aronne LJ, Apovian CM, Foreyt JP, Tuttle HM, Williamson DA. Return on Investment: Medical Savings of an Employer-Sponsored Digital Intensive Lifestyle Intervention, Weight Loss. Obesity (Silver Spring) 2021; 29:654-661. [PMID: 33759385 PMCID: PMC8252728 DOI: 10.1002/oby.23117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to determine the medical cost impact and return on investment (ROI) of a large, commercial, digital, weight-management intensive lifestyle intervention (ILI) program (Real Appeal). METHODS Participants in this program were compared with a control group matched by age, sex, geographic region, health risk, baseline medical costs, and chronic conditions. Medical costs were defined as the total amount paid for all medical expenses, inclusive of both the insurers' and the study participants' responsibility. RESULTS In the 3 years following program registration, the intent-to-treat (ITT) cohort had significantly lower medical expenditures than the matched controls, with an average of -$771 or 12% lower costs (P = 0.002). Among 4,790 ITT participants, a total savings of $3,693,090 compared with total program costs of $1,639,961 translated into a 2.3:1 ROI. Program completers (n = 3,990), who attended more sessions than the overall ITT group, had greater mean weight loss (-4.4%), greater cost savings (-$956 or 14%), and an ROI of 2.0:1 over the 3-year time frame compared with matched controls. CONCLUSIONS The findings demonstrated that the digital weight-management ILI was associated with a significantly positive ROI. Employers and payers willing to cover the cost of an ILI that produces both weight loss and demonstrated cost benefits can improve health and save money for their population with overweight or obesity.
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Affiliation(s)
| | - Donna H. Ryan
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
| | - Louis J. Aronne
- Division of Endocrinology, Diabetes and MetabolismComprehensive Weight Control CenterWeill Cornell MedicineNew YorkNew YorkUSA
| | - Caroline M. Apovian
- Section for Endocrinology, Diabetes, Nutrition and Weight ManagementNutrition and Weight Management CenterBoston Medical CenterSchool of MedicineBoston UniversityBostonMassachusettsUSA
| | - John P. Foreyt
- Behavioral Medicine Research CenterBaylor College of MedicineHoustonTexasUSA
| | | | - Donald A. Williamson
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
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Ramanadhan S, Daly J, Lee RM, Kruse GR, Deutsch C. Network-Based Delivery and Sustainment of Evidence-Based Prevention in Community-Clinical Partnerships Addressing Health Equity: A Qualitative Exploration. Front Public Health 2020; 8:213. [PMID: 32671008 PMCID: PMC7332771 DOI: 10.3389/fpubh.2020.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Increased delivery of evidence-based preventive services can improve population health and increase health equity. Community-clinical partnerships offer particular promise, but delivery and sustainment of preventive services through these systems face several challenges related to service integration and collaboration. We used a social network analysis perspective to explore (a) the range of contributions made by community-clinical partnership network members to support the delivery of evidence-based preventive services and (b) important influences on the ability of these partnerships to sustain service delivery. Methods: Data come from an implementation evaluation of the Prevention and Wellness Trust Fund initiative, which supported nine Massachusetts communities to coordinate delivery of evidence-based prevention and address inequities in hypertension, pediatric asthma, falls among older adults, or tobacco use. In 2016, we conducted semi-structured interviews with (a) leadership teams representing nine community-level partnerships and (b) practitioners from four high-implementation partnerships (n = 23). We managed data using NVivo11 and utilized a framework analysis approach. Results: Key network contributions for delivery of evidence-based preventive services included creating referrals, delivering services, providing links to community members, and administration and leadership. Less emphasized contributions included wraparound services, technical assistance, and venue provision. Implementers from high-implementation partnerships also highlighted contributions such as program adaptation, creating buy-in, and sharing information to improve service delivery. Expected drivers of program sustainability included the ability to develop a business case, ongoing network facilitation, technology support, continued integrated action, and sufficient staffing to maintain programming. Conclusion: The study highlights the need to take a long-term, infrastructure-focused approach when designing community-clinical partnerships. Strategic partnership composition, including identifying sources of necessary network contributions, in conjunction with efforts from the outset to link systems, align effort, and build a long-term funding structure can support the required coordinated action around preventive services needed to improve health equity.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - James Daly
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Gina R. Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Charles Deutsch
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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De Giuseppe R, Di Napoli I, Porri D, Cena H. Pediatric Obesity and Eating Disorders Symptoms: The Role of the Multidisciplinary Treatment. A Systematic Review. Front Pediatr 2019; 7:123. [PMID: 31024868 PMCID: PMC6463004 DOI: 10.3389/fped.2019.00123] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
The prevalence of obesity in children/adolescents has increased worldwide during the past 30 years, becoming a significant public health concern; prevention, and management of pediatric obesity onset is one of the most critical public health goals for both industrialized and developing countries. Pediatric obesity has been identified as a risk factor for various psychopathologies, including eating disorders (ED). Although it has been demonstrated that a comprehensive multidisciplinary treatment (MT), with small steps and practical approaches to lifestyle change, can be an effective treatment for children and adolescents with obesity, to the best of our knowledge, this is the first systematic review investigating the effect of MT on the development, progression or decrease of ED symptoms (EDS) in this target population. PubMed and Web of Science databases were searched (last search on 18 February 2019) according to a predetermined search strategy, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement. Original studies published in English examining the effect of MT on pediatric overweight/obesity, paying particularly attention at the development of EDS, were eligible for inclusion. Seven hundred and forty-four records have been identified; nine articles with study quality ranging from weak to moderate have been included. MTs were heterogeneous in nature including length, number, frequency and type of sessions, parent-involvement and use of technology, besides several psychometric questionnaires were used to screen for EDS, since there are no standardized criteria. In 3 studies there was a significant decrease in external and emotional eating and in four studies a significant increase in restraint eating post MT. Two studies found a significant decrease of binge eating symptoms and other two studies showed an improvement of self-perception, weight, and shape concern. A statistical significant decrease in BMI, BMIz, BMISDS, and adjusted BMI was observed after all MTs, except one. A narrative summary of the evidences reported highlighted the positive impact of MT on the EDS. Moreover, since weight loss post MTs was not necessarily related to EDS, clinicians should also look for the presence of EDS and treat them accordingly.
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Affiliation(s)
- Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Ilaria Di Napoli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
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Kahan S, Kyle TK. Finding Adequate Scale for Obesity Care. Obesity (Silver Spring) 2018; 26:1253. [PMID: 30138544 DOI: 10.1002/oby.22260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/22/2018] [Accepted: 05/20/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Scott Kahan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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