Motivating Children and Adolescents in Obesity Treatment

Correlation between self-management, psychological cognitive impairment, and quality of life in elderly chronic obstructive pulmonary disease patients

BACKGROUND

The correlation conclusions between self-management, frailty, and quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients are inconsistent.

AIM

To comprehensively assess the current status of self-management, psychological cognitive impairment, and QoL in elderly patients with COPD.

METHODS

Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024. The study utilized demographic information and clinical characteristics, self-management behavior, occurrence of psychological cognitive impairment, and QoL as evaluated through general information questionnaires, the COPD patient self-management scale, simple frailty scale, simple mental status scale, clinical dementia assessment scale, and the clinical COPD assessment test questionnaire. This research aims to describe the current status and correlations among self-management behavior, cognitive impairment occurrence, and QoL.

RESULTS

The average score for self-management behavior in elderly COPD patients was 136.00 (119.00, 164.50), indicating a moderate level overall. There were 98 cases of cognitive impairment, accounting for 31.4%, with a mental status score of 3 (2, 3.75). The average QoL score was 24 (19, 28), indicating a low level. Additionally, there was a negative correlation between total self-management behavior score and cognitive impairment occurrence (r = -0.589, P < 0.001), and QoL total score (r = -0.409, P < 0.001). Cognitive impairment occurrence was positively correlated with QoL total score (r = 0.345, P < 0.001). Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients (P < 0.05).

CONCLUSION

The self-management behavior of elderly patients with COPD is at a moderate level. However, the occurrence of cognitive impairment is high and significantly influenced by disease course, level of self-management, and mental status. The QoL is low, emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients, actively reduce the occurrence of cognitive impairment, and mitigate the impact of the disease on QoL.

Use of Extrinsic Motivators to Improve the Body Mass Index of Obese or Overweight Adolescents: A Systematic Review

BACKGROUND

The prevalence of overweight and obesity is increasing at an alarming rate in children and adolescents worldwide. Given the dimension of the problem, treatments of childhood obesity are recognized as of extreme importance. Current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity.

OBJECTIVE

The purpose of this systematic review is to evaluate the use of extrinsic motivators in improving the BMI of obese or overweight adolescents.

METHODS

The inclusion criteria were as follows: 1) overweight or obese adolescents, 2) intervention using extrinsic motivators, 3) outcome variables related to weight status. The exclusion criteria were associated chronic disease. The search process was conducted in PubMed and Web of Science (last searched on 23/04/2023). The risk of bias was evaluated independently by two authors with the Cochrane's tools: RoB2 (RCT), ROBINS-I and ROBINS-E.

RESULTS

From 3,163 studies identified, 20 articles (corresponding to 18 studies) were included in the analysis. The studies differ in study design, sample size, follow-up duration, outcomes reported, and extrinsic motivators used. Most of the studies had videogames or apps as intervention. Nine studies (50%) showed a statistically significant decrease of BMI. The most used extrinsic motivators were "Motivation" (n=13), "Feedback" (n=10) and "Rewards" (n=9), and the ones that seem to have a higher impact on decreasing BMI are "Reminders" (100%) and "Peer-support" (80%).

CONCLUSIONS

The heterogeneity of studies makes analysis difficult. No study has evaluated the extrinsic motivators in isolation. Most of the studies have a moderate or high risk of bias. The extrinsic motivators that seem to be more useful are "Reminders" and "Peer-support", but more studies are needed, namely well designed RCTs, homogeneity in BMI measure and extrinsic motivators definitions, and longer duration to better understand long-term impact of extrinsic motivators on weight management success.

CLINICALTRIAL

Development of a checklist to assess potentially effective components in combined lifestyle interventions for children with overweight or obesity

BACKGROUND

In the Netherlands, Combined Lifestyle Interventions (CLIs), offered in primary care, aim to reduce the number of children with overweight or obesity. CLIs are carried out by a multidisciplinary team and focus on dietary advice and guidance, exercise and behaviour change. These CLIs are not uniformly designed and vary in protocols to suit the local circumstances. Due to the variation in content of CLIs it is difficult to investigate their effectiveness. To enable a proper evaluation of CLIs, we first need to unravel the 'black boxes' of CLIs by identifying the various potentially effective components.

METHODS

First of all we identified potentially effective components in literature. Subsequently we organized an online consultation with experts with diverse backgrounds and asked if they could add potentially effective components. These components were then assembled into a checklist meant to determine the presence or absence of potentially effective components in CLIs for children.

RESULTS

42 experts participated. We identified 65 potentially effective components for CLIs for children with overweight or obesity that we categorized into three themes: content, organisation and implementation.

CONCLUSIONS

Based on literature and expert opinions we developed a practical 65-item checklist to determine the presence of potentially effective components in a CLI. This checklist can be used in the development of CLIs as well as evaluation of CLIs.

Clinical interventions to increase vegetable intake in children

PURPOSE OF REVIEW

Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake.

RECENT FINDINGS

Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach.

SUMMARY

Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.

Perspectives of healthcare professionals on facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle

Objective

To explore the perspectives of healthcare professionals (HCPs) within an integrated care approach on the facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle.

Methods

Semi-structured interviews were conducted with eighteen HCPs working within a Dutch integrated care approach. The interviews were analyzed by performing a thematic content analysis.

Results

Main facilitators identified by HCPs were support from parents and the social network. Main barriers were first and foremost family's lack of motivation, which was singled out as a precondition for starting the behavior change process. Other barriers were child's socio-emotional problems, parental personal problems, lack of parenting skills, parental lack of knowledge and skills regarding a healthier lifestyle, parental lack of problem awareness and HCP's negative attitude. To overcome these barriers, main needs that HCPs suggested were a tailored approach in healthcare and a supportive HCP.

Conclusion

The HCPs identified the breadth and complexity of underlying factors of childhood obesity, of which the family's motivation was pointed out as a critical factor to address.

Innovation

Understanding the patient's perspective is important for HCPs to provide the tailored care needed to address the complexity of childhood obesity.

Implementation of physical activity on prescription for children with obesity in paediatric health care (IMPA): protocol for a feasibility and evaluation study using quantitative and qualitative methods

BACKGROUND

Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children's, parents', and healthcare providers' experiences of PAP.

METHODS

In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Västra Götaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months' follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory.

DISCUSSION

This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04847271 , registered 14 April 2021.

Physical Illiteracy and Obesity Barrier: How Physical Education Can Overpass Potential Adverse Effects? A Narrative Review

Environments lacking in stimuli together with ineffective physical education programs can lead to motor illiteracy, causing several adverse effects that could be worsened by unhealthy weight conditions (e.g., obesity). Obesity can be seen as an actual barrier for children and adolescents, especially for affective, behavioral, physical, and cognitive domains. In this context, condensing what the literature proposes could be useful in order to improve the understanding of the best intervention strategies (i.e., proper physical education programs) to manage the adverse effects of motor illiteracy in relation to the obesity barrier. The purpose of this narrative review is to improve the understanding on how physical education programs can counteract the adverse effects of physical illiteracy and obesity barrier across childhood and adolescence. Proper physical education programs should develop motor competence by fostering an individual’s awareness, self-perception, autonomous motivation, and muscular fitness on a realistic scenario (functional task difficulty related to his/her possibilities) in the attempt to counteract the adverse effects of the obesity barrier. Such programs should be designed without overlooking a proper multi teaching style approach.

Managing patients with obesity in the post COVID-19 world: Time to sharpen the saw

The clash of the dual pandemics - COVID-19 and obesity (Chua et al., 2020) [1], threatens to exponentially increase the rates of obesity, which is a risk factor for severe COVID-19 and death (Garg et al., 2020; Peng et al., 2020; Wu et al., 2020; Kass et al., 2020) [2-5]. We need to urgently find solutions to halt this vicious circle. Where do we begin? Our patients - who are often our best teachers. In my clinical practice, I have observed disparate responses among my patients in response to the pandemic. This highlighted the importance of understanding the factors underlying motivation and provided important clues on what clinicians can do to help our patients create a virtuous circle towards positive health outcomes.