Treatment Of Overweight In Children Research Articles

Sovrappeso e obesità in età pediatrica: un intervento pragmatico nelle cure primarie

Paediatric clinics are in a unique position to detect chronic diseases, identify at-risk individuals, educate families and implement early preventive interventions. This article aims to provide evidence on how and with what strategies the AUSL of Reggio Emilia has built a programme to combat overweight and obesity in childhood by involving a network of services, starting with paediatricians. A variety of approaches have been taken to address the problem of promoting healthy lifestyles. The BMIF project (Very Fit Children) focuses on early detection and treatment of overweight children using motivational interviewing to help families change their lifestyles. First, second and third level interventions provide treatment for children with obesity according to defined care pathways. Anticipatory guides on responsive feeding and the BeBa (Children's Wellbeing) app promote healthy lifestyles. Effectiveness and equity were the guiding principles for the choices made. This required time and a significant effort, but it also resulted in greater support from both operators and decision-makers.

Psychological intervention programs for children with overweight and obesity: Systematic review

Currently obesity is a public health problem that is characterized by being a chronic disease, caused by various factors ranging from genetic, metabolic or sociocultural problems.
 Objective: To analyze psychological interventions for overweight and obesity, in children, with favorable results in the participants.
 Method: A systematic review was carried out on the internet based on articles published in Crossref and PubMed by using keywords such as “interventions for overweight children”, “Children obesity interventions”, “psychological interventions in children”.
 Results: In a first revision, 79 psychological programs applied in children were found, when reviewing the programs, it was found that only 19 had favourable results in the participants.
 Conclusion: The interventions had positive results; however, it will be necessary to design more adequate interventions for obese and overweight people, and contribute more to the solution of these public health problems.

The effect of diet, exercise, and lifestyle intervention on childhood obesity: A network meta-analysis

Trials investigating the efficacy of different interventions for overweight children are limited and controversial. Therefore, the aim of this study is to perform a network meta-analysis on the efficacy of various interventions for children with obesity (an average age of 6-12 years old). We obtained the data of trials reporting pre-post obesity relevant outcomes (e.g. BMI, BMI z-score, percent body fat, or percent overweight) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), PubMed, and Web of Science databases (completed before February 25, 2019) and included at least one pair of direct comparison groups. The mean difference of outcomes and their associated 95% CI were used to determine the efficacy. The P-score was calculated to illustrate the rank probability of various treatments for different outcomes using a network meta-analysis. Our meta-analysis included 24 studies that evaluated the interventions for childhood obesity. All 24 trials had no high risk of bias. Interventions such as exercise without parents (E w/o P); diet with parents (D w/P); and diet, exercise, and lifestyle with parents (D+E+L w/P) were significantly effective for children with obesity when compared with no intervention. E w/o P exhibited the highest P-score, with the D w/P and D+E+L w/P ranks having P-scores of 0.7486 and 0.5464, respectively. Moreover, the results indicate that E w/o P, D w/P, and D+E+L w/P were significantly effective treatments for children with obesity when compared with no intervention.

7-Year follow-up of a lifestyle intervention in overweight children: Comparison to an untreated control group

We present the 7-year follow-up analysis in overweight children and adolescents, who had participated originally in a randomized control trial of a lifestyle intervention. We compared them to an untreated population-based control group to demonstrate the effectiveness of the intervention. Degree of overweight (BMI-SDS) was determined in 32 overweight children (mean age 11.5±1.5yrs, 65.6% females, mean BMI 23.7±1.5kg/m2) at onset of intervention (T0), end of 6-month intervention (T1), 12 months (T2) and 7 years after end of intervention (T3). A total of 76 overweight children derived from a representative national population survey served as control group. The participants in the intervention group reduced significantly their BMI-SDS between T0-T1 (mean±standard deviation-0.28±0.28, p<0.001) and demonstrated no significant changes between T1-T2 (mean±standard deviation-0.10±0.34) and between T2-T3 (median+0.07; interquartile range:-0.54-0.62). BMI-SDS at T3 was significantly (p=0.015) lower compared to T0. At T3, 46.8% of the participants in the intervention were normal-weight. The reduction in BMI-SDS between T0-T3 was significantly (p=0.043) greater in the intervention group (median-0.26; interquartile range-0.87-0.23 BMI-SDS) compared to the control group (mean±standard deviation-0.05±0.77). The lifestyle intervention led to a significant reduction of overweight in the 7-year follow-up period. This decrease in BMI-SDS was significantly greater than the changes in BMI-SDS in a control group. This study is registered at clinicaltrials.gov (NCT00422916).

Behavioural measures of child's eating temperament and their link with BMI

Rothbart's model of temperament, defined as individual differences in reactivity and self-regulation, has a strong heuristic value with applications in a wide variety of children's outcomes. Our objective was to test Rothbart's model applied to children's food behaviours and BMI outcome through behavioural measures. Our hypotheses, according to Rothbart's model, were as follows: (i) self-regulation in eating modulates appetite reactivity; (ii) appetite reactivity increases the risk of excess BMI, whereas self-regulation in eating limits this risk. One hundred and four children aged between 7 and 12 years completed four behavioural tasks to assess scores for two components of appetite reactivity (i.e. appetite arousal and appetite persistence) and two components of self-regulation in eating (i.e. self-regulation in eating without hunger and self-regulation in eating speed). Their heights and weights were measured in order to calculate their BMI-for-age. T-tests and regression analysis were used to verify our hypotheses. None of the scores of self-regulation in eating was directly associated with BMI but we observed a significant impact of self-regulation in eating without hunger on appetite arousal (p-value = 0.04), together with a modest but significant association between appetite persistence and BMI (p-value = 0.02). We can thus conclude that our behavioural measures could be used for the determination of the child's eating temperament. Further studies are needed to investigate how to use these measures to improve the treatment of overweight in children.

Effectiveness of family-based weight management interventions in childhood obesity: an umbrella review protocol.

The main objective of this umbrella review is to identify the effectiveness of family-based interventions that target overweight or obesity in children aged 18 years and under. The umbrella review intends to compare and summarize existing systematic reviews of experimental studies that address a range of family-based interventions for overweight children. Family-based is defined as the involvement of first- or second-degree relatives or carers who are cohabiting under one roof. The second objective of this umbrella review is to identify strategies that are effective in improving children's body weight or body mass index (primary outcomes) and, where applicable, changes in child/family behavior, including dietary intake or physical activity.The review questions are as follows: What is the effectiveness of family-based behavioral or lifestyle weight management interventions for overweight children? What are the strategies or characteristics of effective interventions in combating child obesity?

Body Mass Index Mediates the Effects of Low Income on Preschool Children's Executive Control, with Implications for Behavior and Academics.

Children from low-income backgrounds are more likely to have cognitive impairments, academic problems, and obesity. Biological mechanisms for the relationship between adiposity and neurocognitive functioning have been suggested, but the direction of effects is unclear. The relations among income, BMI, and cognitive-behavioral functioning were modeled longitudinally. Children (n = 306) were assessed at 36-39 months (Time 1; T1) and 63-67 months (Time 4; T4) through anthropometry, measures of executive control (EC), delay ability (DA), and questionnaires on academic readiness, social competence, and behavioral adjustment. Income was positively related to T1 EC and DA and negatively related to T1 BMI. T1 BMI was negatively related to T4 EC, after controlling for T1 EC, but was unrelated to changes in DA. Neither T1 EC nor DA was related to changes in BMI. T4 EC predicted greater academic readiness and social competence and lower adjustment problems at T4. T4 BMI was related to higher T4 adjustment problems. There was an indirect effect of income on T4 EC through T1 BMI. There were indirect effects of T1 BMI on academic readiness, social competence, and adjustment through T4 EC. Children who were obese at T1 had a 19% lower rate of growth of EC, compared to nonobese children. BMI mediates the effect of income on children's EC and has negative implications for academic readiness, social competence, and behavioral adjustment. The dual impact of obesity and cognitive-behavioral problems underscores the importance of early identification of and intervention for overweight children which could have neurocognitive and social-emotional benefits. What's New: BMI mediates the effect of income on preschoolers' executive control (EC) and has negative implications for academic readiness and behavioral adjustment. EC and delay ability did not predict changes in BMI. Early identification of, and intervention for, overweight children may have neurocognitive and social-emotional benefits.

School-Based Health Center Providers' Treatment of Overweight Children

This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (N=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p<0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.

FTO Gene: Association to Weight Regain after Lifestyle Intervention in Overweight Children

Objective: Polymorphisms in intron 1 of the ‘fat mass and obesity-associated' (FTO) gene are associated with weight status. We hypothesized that the risk allele at a polymorphism in intron 1 of FTO is associated with weight regain after end of lifestyle intervention. Methods: We longitudinally analyzed the changes of weight status as BMI-SDS in 346 unrelated overweight children (mean age 10.6 ± 2.6 years, 45% male, mean BMI-SDS 2.39 ± 0.49) both at the end of a 1-year lifestyle intervention and 1 year after the end of this intervention. We genotyped the obesity risk SNP rs9939609 at FTO by ARMS-PCR. Results: The children reduced their BMI-SDS (-0.29 ± 0.33; p < 0.001) during intervention and increased their BMI-SDS between the end of intervention and 1 year later (+0.10 ± 0.41; p < 0.001). The obesity risk allele at FTO SNP rs9939609 was not associated with BMI-SDS reduction during the lifestyle intervention (p = 0.622), but with weight regain 1 year after end of the intervention in multiple linear regression analyses adjusted for age, sex, pubertal stage, and baseline BMI-SDS (Bonferroni corrected p = 0.002). Conclusions: The obesity risk allele at a polymorphism in intron 1 of FTO was associated with weight regain 1 year after a 1-year lifestyle intervention.

Effectiveness of a one-year multi-component day-camp intervention for overweight children: study protocol of the Odense overweight intervention study (OOIS)

BackgroundChildhood overweight has noticeable psychological and social consequences for the child and leads to an increased risk of mortality and morbidity later in life. With the high prevalence of overweight in children and adolescents, it is important to identify effective approaches for the prevention and treatment of overweight in children and young individuals. The primary aim of the study is to assess the effect of an intensive day-camp intervention on body mass index (BMI) in overweight children.MethodsThe Odense Overweight Intervention Study is a semi-blinded randomized controlled trial. Overweight children from the Municipality of Odense, Denmark, were invited to participate in the trial. Based on power calculations 98 participants were found to be sufficient to randomize in order to find an effect of minimum 1.5 BMI points. Gender-stratified concealed block randomization with a ratio of 1:1 and random block sizes of two, four, and six ensured balance between study arms. The intervention consisted of a six-week multi-component day camp including increased physical activity, healthy diet and health education followed by 46 weeks of family-based habitual intervention. The standard care arm was offered two weekly hours of physical activity training for six weeks. The outcomes were measured at baseline and at six-week and 52-week follow-ups. Furthermore, BMI will be assessed again at 48-month follow-up. Test personnel were kept blinded. The intervention effect will be evaluated using mixed model analyses. During 2012 and 2013, 115 children were enrolled in the study. Fifty-nine children were randomized to the day-camp intervention arm and 56 to the standard intervention arm.DiscussionThis study will provide novel information about the long-term health effects of an intense day-camp intervention program on overweight children, due to the design and the follow-up period. Moreover, it will add to the knowledge on designing and implementing feasible camp settings for preventing overweight in children.Trial registrationNCT01574352 at http://clinicaltrials.gov on the 8th of March 2012.

Intervention in Overweight Children Improves Body Mass Index (BMI) and Physical Activity

Childhood obesity is a growing epidemic in family medicine with few clinical treatment options. We implemented and evaluated a group office-visit intervention by family physicians for overweight children and their parents, emphasizing nutrition and physical activity within a resiliency psychosocial model. The intervention lasted for 3 months, with half of the children crossing over to intervention after 6 months in the study. Participants included 35 children who met eligibility criteria of being in third through fifth grades and having a body mass index (BMI) above the 85th percentile. The 3-month, 12-session intervention, "Choices," included topics on nutrition, physical activity, and resiliency. The sessions were developed for delivery by a family physician and a nutritionist who received training in positive psychology and resilience skills. Main outcome measures were BMI z scores for age and sex and z scores for weight by age and sex, as well as qualitative interviews to understand individual and family processes. The intervention resulted in a significant effect on one primary outcome, BMI z score (-0.138 per 9 months [P = .017]) and a trend toward significance on the weight for age z score (-0.87 per 9 months [P = .09]). The net shift of activity from the low metabolic equivalents (METs) to the high METs had an intervention effect of 2.84 METs (P = .037). Families reported lasting changes in behaviors and attitudes. The innovative approach used in this study demonstrated modest efficacy in reducing BMI z score, changing physical activity levels, and possibly shifting family dynamics.

No impact of obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children

An obesity risk allele at the NEGR1 locus was shown to be associated with weight regain after a lifestyle intervention in obese adults. Independent confirmation and studies in children are lacking. Therefore, we analyzed the impact of this and 11 additional obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children. We longitudinally analyzed the changes in weight status as body mass index standard deviation score (BMI-SDS) in 282 overweight children (10.6 ± 2.5 years, 47% male, BMI 27.1 ± 3.9 kg/m2) both at the end of a 1-year lifestyle intervention and at 1 year after the end of intervention. We genotyped obesity risk single nucleotide polymorphisms (SNPs) derived from genome-wide association studies in or in proximity to the following genes: NEGR1, TNKS, SDCCAG8, FTO, MC4R, TMEM18, PTER, MTCH2, SH2B1, MAF, NPC1, and KCTD15. The children reduced their BMI-SDS (-0.28 ± 0.35; p<0.001) during intervention and increased their BMI-SDS between the end of intervention and 1 year later (+0.05 ± 0.36; p=0.027). None of the SNPs including NEGR1 was related significantly to weight regain. We found no evidence for effects of any of the GWAS-based obesity marker alleles on weight regain in the course of 1 year after an intervention.

In Pursuit of the “Goldilocks Principle” - Finding the Right Fit Community-Level Intervention for Overweight Children: The YMCA and Seattle Children's Hospital Experience with Act! Actively Changing Together

For many families, perceived extremes of intensive weight loss programsmay be aversive. Since 2004, the ACT! Actively Changing Together program has aimed to strike a balance or “just right” level of participation to engage diverse, low-income families in healthy behavior changes, while also being affordable to continually operate in the community. Improvement efforts are ongoing to develop a sustainablemodel focused on secondary prevention. We evaluated outcomes after changes to the programweremade to increase sustainability, reach more youth and reduce costs. Between 2010-2011, youth aged 8-14 years and their parents enrolling in ACT! at 10 geographically and demographically diverse sites were eligible for this pre-post study. Groups met 90 minutes weekly for 12 weeks. Outcome measures assessed pre and post program included BMI z-score, health behaviors, quality of life (PedsQL), and fitness. Process measures included attendance and satisfaction. Group means were compared by paired T-test. From 100 youth, 73% percent completed the program (attending week 11 ). Complete pre-post data were available for 62 youth and 65 parents. BMI z-score decreased for 37% of youth, and stabilized for 48%. Parents’ report of their home nutrition and activity environments and role modeling behaviors improved (p 0.01). PedsQL youth (p 0.01) and parent (p 0.01) reports also improved. Overall results were comparable to data from the longer, more resource-intensive program (30 sessions).We found promising health and behavioral improvements among ACT! participants in a shorter version of our original program. ACT! successfully engaged families and can be readily disseminated in similar settings.

The role of the GP in prevention, management and treatment of overweight children: a ‘big’ problem

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SDCCAG8 Obesity Alleles and Reduced Weight Loss After a Lifestyle Intervention in Overweight Children and Adolescents

Genome-wide association analyses (GWAS) contributed to the detection of a number of single-nucleotide polymorphisms (SNPs) associated with obesity. However, little is known about the impact of the obesity-risk alleles on weight loss-related phenotypes after lifestyle interventions. A recent meta-analysis of GWAS reported five genomic loci near or in the genes FTO, MC4R, TMEM18, SDCCAG8, TNKS/MSRA that were associated with obesity in children and adolescents. Here, we analyzed the effect of the 10 SNPs representative of the five loci on measures of weight loss and cardiometabolic risk after a 1-year lifestyle intervention in 401 children and adolescents (mean age 10.74 years; 55.4% female; mean BMI 27.42 kg/m(2), mean BMI-standard deviation score (SDS) 2.37). For confirmation of one locus genotyping of three intronic SNPs in SDCCAG8 was performed in 626 obese adults who completed the 10-week hypoenergetic diet program. Intronic variants of SDCCAG8, which are associated with early onset obesity, are associated with reduced weight loss after a 1-year lifestyle intervention in overweight children and adolescents even after adjusting for age, sex, baseline measurement, or multiple testing (all P < 10(-6)). However, our results could not be confirmed in 626 obese adults undertaking a hypoenergetic diet intervention.

Prevention of Overweight in Infancy (POI.nz) study: a randomised controlled trial of sleep, food and activity interventions for preventing overweight from birth.

BackgroundRapid weight gain during the first three years of life predicts child and adult obesity, and also later cardiovascular and other morbidities. Cross-sectional studies suggest that infant diet, activity and sleep are linked to excessive weight gain. As intervention for overweight children is difficult, the aim of the Prevention of Overweight in Infancy (POI.nz) study is to evaluate two primary prevention strategies during late pregnancy and early childhood that could be delivered separately or together as part of normal health care.Methods/DesignThis four-arm randomised controlled trial is being conducted with 800 families recruited at booking in the only maternity unit in the city of Dunedin, New Zealand. Mothers are randomised during pregnancy to either a usual care group (7 core contacts with a provider of government funded "Well Child" care over 2 years) or to one of three intervention groups given education and support in addition to "Well Child" care: the Food, Activity and Breastfeeding group which receives 8 extra parent contacts over the first 2 years of life; the Sleep group which receives at least 3 extra parent contacts over the first 6 months of life with a focus on prevention of sleep problems and then active intervention if there is a sleep problem from 6 months to 2 years; or the Combination group which receives all extra contacts. The main outcome measures are conditional weight velocity (0-6, 6-12, 12-24 months) and body mass index z-score at 24 months, with secondary outcomes including sleep and physical activity (parent report, accelerometry), duration of breastfeeding, timing of introduction of solids, diet quality, and measures of family function and wellbeing (parental depression, child mindedness, discipline practices, family quality of life and health care use). This study will contribute to a prospective meta-analysis of early life obesity prevention studies in Australasia.DiscussionInfancy is likely to be the most effective time to establish patterns of behaviour around food, activity and sleep that promote healthy child and adult weight. The POI.nz study will determine the extent to which sleep, food and activity interventions in infancy prevent the development of overweight.Trial RegistrationClinical Trials NCT00892983Prospective meta-analysis registered on PROSPERO CRD420111188. Available from http://www.crd.york.ac.uk/PROSPERO

Effectiveness of lifestyle intervention in overweight children

Therapy of choice in obese children and adolescents is lifestyle intervention based on nutrition education, behavioural treatment and exercise treatment. Its efficacy even after the end of intervention has been proven by several randomised-controlled trials and meta-analyses including a recent Cochrane review. However, randomised-controlled trials are likely to overestimate the effectiveness. Studies under normal day-to-day circumstances demonstrated only a very moderate effect on weight loss (<10% success rate 2 years after the onset of intervention). A reduction of >0·5 SDS-BMI (which means a stable weight over 1 year in growing children) is associated with an improvement of cardiovascular risk factors, while improvements of quality of life seem independent of the degree of weight loss. Younger children and less overweight children particularly profit from lifestyle interventions in contrast to extremely obese adolescents. Recent studies demonstrated that involving parents is crucial for success, suggesting that parents and children and not children alone should be the primary target of interventions. Failures in weight reduction are attributed not only to a lack of motivation but also to other aspects particular to the genetic background. The techniques, more than the contents, of an intervention influence the treatment outcome. Besides behavioural therapy, systemic and solution-focused treatments are important. Future longitudinal research should focus on the identification of which children and adolescents profit from which kind of intervention, in order to be able to tailor specific treatment approaches. Studies under normal day-to-day circumstances are necessary to prove the benefit of this kind of intervention.

An exploration of body dissatisfaction and perceptions of Black and White girls enrolled in an intervention for overweight children

Silhouette measures are one approach to assessing body dissatisfaction in children, although little is known about their use among racially diverse, overweight girls seeking weight-loss treatment. This study assessed racial differences in body dissatisfaction and body size perceptions of 58 girls (ages 6–11, 66% Black, 34% White) participating in a randomized trial for pediatric overweight. Body dissatisfaction did not differ between races; 99% of girls reported an ideal figure smaller than their current one. Black girls selected a larger silhouette to represent their ideal body size, and most girls in both racial groups underestimated their actual size. Outcomes strengthen the argument that, despite an overall preference for a larger body size, obesity might mitigate cultural factors that protect Black girls from body dissatisfaction. Additional research is needed to enhance understanding of children's body size perceptions and dissatisfaction to inform assessment and treatment of pediatric obesity and associated disordered eating symptoms.

An effective lifestyle intervention in overweight children: One-year follow-up after the randomized controlled trial on “Obeldicks light”

Lifestyle interventions address primarily obese children, while interventions tailored to overweight but not obese children are scarce. The effectiveness of the lifestyle intervention "Obeldicks light" based on physical activity training, nutrition education, and behavior counseling for overweight children and their parents has been demonstrated by a randomized controlled trial. Here, we present the 12 months follow-up analysis of these children after end of intervention. Degree of overweight (BMI and SDS-BMI), waist circumference, skinfold thickness, bioimpedance analyses (BIA), and blood pressure were determined in 76 overweight (BMI>90(th)≤97(th) percentile) children (mean age 11.8±1.8years, 67% females, mean BMI 24.3±1.9kg/m(2)) participating in the evaluation study of "Obeldicks light" at onset of intervention (T0), end of 6 months intervention (T1), 6 months after end of intervention (T2) and 12 months after end of intervention (T3). Comparisons were performed on an intention-to-treat approach. The drop-out rate was 4% in the intervention period and additional 3% during follow-up. The children reduced significantly (p<0.001) their SDS-BMI in the intervention period between T0 and T1 (-0.27±0.23; p<0.001). This SDS-BMI reduction remained stable at T2 (T0-T2:-0.26±0.31; p<0.001) and T3 (T0-T3:-0.26±0.39; p<0.001). SDS-BMI reductions were independent from age and gender. Body fat measured by skinfold thickness and BIA, waist circumference, and blood pressure decreased significantly in the intervention period and remained stable in the follow-up period as well. The lifestyle intervention "Obeldicks light" was effective in reducing degree of overweight, fat mass, waist circumference, and blood pressure both at end of intervention and in a 12 months follow-up period.

Using mixed methods to examine the influence of maternal perception on child weight and feeding practices of Latino WIC mothers

Childhood obesity rates have risen dramatically in the US, and at particular risk are immigrant Latino children. Public health practitioners agree that dietary treatment of overweight in children alone is usually unsatisfactory. Early prevention through careful attention to both diet and factors influencing dietary behaviors is a more viable public health option. The purpose of this mixed methods study was to assess how maternal perception influences child feeding practices among Latino WIC mothers. Data were drawn from two sources: the Children's Health Information Research Project (CHIRP) data on overweight and non‐overweight children, and qualitative data from a sub‐set of 20 WIC participants and 16 para‐professional staff. Descriptive statistics, chi‐square and thematic analyses were completed. We found more than 70% of mothers of 3–5 year old overweight children considered their child to be of normal weight. More than 20% of mothers of normal weight children identified their child as too thin or underweight. Narratives revealed that mothers' perception of healthy weight was not based on anthropometrics but a function of the child's ability to be as active as other children without “running out of breath”. We will present this and other salient findings, and discuss the need for health professionals to bridge this disconnect when designing obesity prevention programs for low‐income Latino children.Grant Funding Source: Supported by AHA #09PRE2390123