Management Of Childhood Overweight Research Articles

Effectiveness and cost-effectiveness of a 1-year dietary and physical activity intervention of childhood obesity—study protocol for a randomized controlled clinical trial

BackgroundWe investigate and try to find out the optimal duration and intensity for the treatment and content useful for clinical work. The aim of our study is to evaluate the effects of lifestyle intervention on the management of childhood overweight and to explore the factors that contribute to the outcome, as well as the costs for the health care system. The hypotheses of the study are that lifestyle intervention is efficient in reducing BMI-SDS and thus effective in preventing overweight from progressing to obesity, and it is also cost-effective.Methods and analysesWe aim to recruit 80 children and they randomize either to an intervention group or a control group with standard care. The intervention group receives intensive, family-based diet, and physical activity counseling, delivered by a multidisciplinary team of a pediatrician, a nurse, and a clinical nutritionist. The control group does not receive any lifestyle intervention during the study. The inclusion criteria are age of 6–12 years, weight-for-height ≥ + 40% or ≥ + 30%, and increasing curve. All participants fill out the study questionnaires and plasma samples are taken at baseline and at 12 months. Outcome variables will be compared between intervention and control groups.DiscussionIf the effects of this lifestyle intervention are positive and it is also cost-effective, the implication of our study will be of great importance to the treatment of childhood obesity and to improve the health care system.Trial registrationClinicalTrials.gov NCT06126679. Registered on 25 October 2028 in Finland.ORCID: 0009-0009-6659-5290.

Association between cardiovascular risk and maternal perception of BMI in Peruvian schoolchildren.

In the modern era, the maternal perception of children's nutritional status has emerged as a critical area of study, given its potential influence on nutritional interventions and long-term child health. The relationship between this perception and children's Body Mass Index (BMI) by age is particularly intriguing, as it may reveal discrepancies between perception and reality. The aim of this study was to evaluate Peruvian mothers' perception of their children's Body Mass Index (BMI) in relation to age and to determine how this perception associates with the children's cardiovascular risk. The study also analyzed sociodemographic factors that might influence this perception. The study included 130 mothers of schoolchildren aged 5 to 11 from a school in Lima. Mothers' perceptions of their children's weight were assessed using pictograms, and sociodemographic characteristics were collected through a questionnaire. Weight and height measurements were taken to calculate BMI, and waist circumference was measured to classify cardiovascular risk. A total of 57.4% of the schoolchildren presented with excess malnutrition, and 51.5% of the mothers incorrectly classified the actual BMI/Age of their children (kappa 0.11; p ≤ 0.05). Additionally, it was found that the schoolchild's age is associated with the mother's failure to accurately perceive her child's weight (OR 1.59). Lastly, there was a significant association between maternal perception and cardiovascular risk (p ≤ 0.05). There is a significant discrepancy between maternal perception and the actual nutritional status of children, which can increase cardiovascular risk. It is necessary to implement intervention and education strategies targeted at parents to enhance the recognition and management of childhood overweight and obesity.

Who is responsible for assessing children\u2019s weight status? \u2013 a qualitative study of health professionals in regional Australia

BackgroundCurrently in Australia there is a lack of clarity regarding routine assessment of primary school aged children’s weight status despite it being the first step in the identification of overweight and obesity. The National Health and Medical Research Council Obesity Guidelines recommend primary health care professionals include routine weight status assessment in consultations with children yet research suggests this rarely occurs in practice.This study aimed to determine the views of primary health care professionals regarding routine weight status assessment in primary school aged children and to establish the barriers to assessing children’s weight status.MethodsUsing the case study of a regional town, Rockhampton, purposeful sampling was used to represent the key primary health care settings and professional groups. Interviews were conducted with 31 health professionals. Data were collected and analysed guided by two frameworks, the Capability, Opportunity, Motivation and Behaviour and Theoretical Domains Frameworks.ResultsEight themes emerged from data and these were relevant to the three levels of influence on the routine weight status of assessment, system, setting and individual. System level themes related to having a formalised program for the undertaking of routine weight status assessment in primary school aged children, increasing the population’s awareness about the importance of the weight status check and limited public health services available for management of childhood overweight and obesity. Setting level theme regarded the location where routine weight status in primary school aged children could be undertaken. Four themes at the individual level of influence on the routine weight status assessment related to the primary health professionals’ roles, barriers to assessing children’s weight status, methods of weight status assessment and starting a weight related conversations with families.ConclusionThe Government, primary health care services, professional organisations and associations as well as health professionals must commit to long-term implementation of the Obesity Guidelines. Immediate action to improve the undertaking of routine weight status assessment in children must be taken by each health service and health professional. Strategies should aim to positively affect motivation to assess children’s weight status as it is the central component in creating change in practice.

Utilising the Project ECHO® model of education to empower health professional in the management of Childhood Overweight and Obesity

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

How is children's weight status assessed for early identification of overweight and obesity? - Narrative review of programs for weight status assessment.

Assessment of a child's weight status is the first step in the management of childhood overweight and obesity. We reviewed routine assessment programs to inform early and routine identification of childhood overweight and obesity to address this global health issue. Twelve electronic databases were searched (Scopus, Web of Science, Wiley, ScienceDirect, PsycINFO, PsycARTICLES, PsycEXTRA, CINAHL, Primary Search, MEDLINE, ERIC, Academic Search Elite) for universal programs for weight status assessment of children aged 4-12 in Organization for Economic Co-operation and Development - countries, which included more than one assessment and parents receiving feedback. Of 1638 papers found via database searches, and 18 additional records identified through other sources, 26 were included. Reference to five countries' programs for weight status assessment was found in the results: Australia, Sweden, the Netherlands, the United Kingdom and the United States. All of these programs were implemented in a school setting. Lack of services, stakeholder collaboration, parental awareness and engagement and government funding need to be improved for this health check to be undertaken as a part of an ongoing program. This review is about the implementation of similar programs. Early identification of risk for overweight and obesity allows families that require help to connect with available health services.

The Chronic Care Model to Improve Management of Childhood Obesity.

One-third of children in the United States are overweight or obese. Comorbidities continue into adulthood if a healthy weight is not established. While expert guidelines for management of this condition are recognized, provider adherence to guidelines is lacking. The purpose of this quality improvement project was to evaluate the effectiveness of the chronic care model (CCM) on improving primary care provider identification, prevention, and management of childhood overweight and obesity. A pre- and postintervention chart audit was completed to evaluate documentation of 20 assessment measures included in expert guidelines. A chi-square analysis was conducted to assess differences. Statistically significant improvements were found in documentation of parental obesity, family medical history, sleep assessment, endocrine assessment, and weight classification as a diagnosis. Use of the CCM had a positive impact on provider adherence to expert guidelines. Furthermore, not all aspects of the CCM must be used to see statistically significant improvements.

School based prevention and management of childhood overweight and obesity

School based prevention and management of childhood overweight and obesity

Identification, Prevention, and Management of Childhood Overweight and Obesity in a Pediatric Primary Care Center

Background In the United States, overweight/obesity among youth has reached epidemic proportions. The purpose of this project was to (1) examine primary care provider adherence to American Academy of Pediatrics guidelines; (2) compare adherence based on patients' weight classification, age, race, and gender; and (3) identify areas for improvement in health care delivery. Methods A retrospective chart audit and feedback quality improvement project was conducted with a stratified random sample of 175 charts of 6- to 19-year-olds seen for well-child visits. Frequencies of provider adherence were reported. χ(2) Analyses of weight classification, age, race, or gender influence on adherence was calculated. Results After discussion with the primary care providers, 5 areas were identified as priorities for change (diagnosis based on BMI, parental history of obesity, sleep assessment, endocrine assessment, and attendance of patients at the follow-up visit). Conclusion Cost-efficient, feasible strategies to improve provider adherence to recommendations for identification, prevention and management of childhood overweight and obesity were identified.

Pilot Study on the Management of Childhood Overweight: A Pound of Cure

Primary care clinicians (PCCs), despite regular access to families with young children, lack a cohesive model for approaching office visits regarding excess weight. Using the 2007 Expert Committee's Recommendations, a set of clinician guidelines on the standard of care for managing childhood obesity, we developed high quality intervention tools for PCC use to direct behavior modification in families with children 2 to 11 years old. We piloted modularized counseling sessions with accompanying educational handouts. To date, we have interviewed 77 families on the counseling sessions and resources. The feedback we obtained guided development of office visit modules and of parental educational materials. On average, motivated families that returned to the clinic needed to complete only 3 to 4 modules, setting 3 goals per visit, to successfully incorporate recommendations into the child's daily life. Of families that returned for follow up visits 41.5%, 37.7%, 13%, and 5.2%, of families completed 2, 3, 4, or 5 office visits respectively. Additionally, of families that attended follow up visits 50%, 37.9%, 60% and 75% of children reduced their BMI percentile as they attended the 2nd, 3rd, 4th, and 5th office visits, respectively. In total, 47% of children attending office visits have either maintained or reduced their BMI.Grant Funding Source : Medical Mutual of Ohio

Screening and Counseling for Childhood Obesity: Results from a National Survey

To examine family physicians' beliefs and practices about using body mass index (BMI) percentiles to screen for childhood overweight and obesity. Surveys about management of childhood overweight were mailed to 1800 American Academy of Family Physician members in 2006. 729 surveys were returned; 445 were eligible. Most (71%) members were familiar with BMI guidelines; 41% were familiar with American Academy of Family Physician recommendations about overweight. Most (78%) had tools available to calculate BMI; fewer have enough time for overweight screening (55%), and only 45% reported computing BMI percentile at most or every well visit for children older than 2. Having an electronic health record increased BMI screening rates. Family physicians felt prepared to discuss weight, but only 43% believed their counseling was effective and many (55%) lack community or referral services. Most (72%) wanted simple diet and exercise recommendations for patients. Reimbursement for weight-related services is insufficient: 86% say that patients cannot pay for services not covered by insurance. Factor analysis identified clinician self-efficacy, resources, and reimbursement as factors related to calculating BMI percentiles. BMI is underutilized by family physicians. Most believe they should try to prevent overweight and have tools to use BMI, but clinicians have few resources available for treatment, have low self-efficacy, and report inadequate reimbursement.

Adoption of body mass index guidelines for screening and counseling in pediatric practice.

The purpose of this study was to examine pediatrician implementation of BMI and provider interventions for childhood overweight prevention and treatment. Data were obtained from the American Academy of Pediatrics (AAP) Periodic Survey of Fellows No. 65, a nationally representative survey of AAP members. Surveys that addressed the provision of screening and management of childhood overweight and obesity in primary care settings were mailed to 1622 nonretired US AAP members in 2006. One thousand five (62%) surveys were returned; 677 primary care clinicians in active practice were eligible for the survey. Nearly all respondents (99%) reported measuring height and weight at well visits, and 97% visually assess children for overweight at most or every well-child visit. Half of the respondents (52%) assess BMI percentile for children older than 2 years. Most pediatricians reported that they do not have time to counsel on overweight and obesity, that counseling has poor results, and that having simple diet and exercise recommendations would be helpful in their practice. Pediatricians in large practices and those who had attended continuing medical education on obesity were more familiar with national expert guidelines, were more likely to use BMI percentile, and had higher self-efficacy in practices related to childhood and adolescent overweight and obesity. Multivariate analysis revealed that pediatricians with better access to community and adjunct resources were more likely to use BMI percentile. BMI-percentile screening in primary pediatric practice is underused. Most pediatricians believe that they can and should try to prevent overweight and obesity, yet few believe there are good treatments once a child is obese. Training, time, and resource limitations affect BMI-percentile use. Awareness of national guidelines may improve rates of BMI-percentile use and recognition of opportunities to prevent childhood and adolescent obesity.

Research around practice partnerships: an example of building partnerships to address overweight and obesity in children

Prevention and management of childhood overweight and obesity is a health priority for governments and communities throughout the developed world. A conceptual model, Research around Practice in Childhood Obesity (RAPICO), has been developed to guide capacity building in a coordinated ‘bench to fieldwork’ initiative to address this public health problem. Translation of research findings into sustainable responses with optimal fit requires consideration of context-specific relevance, cost-effectiveness, feasibility and levels of available support. The RAPICO model uses program theory to describe a framework for progressing practitioner–community–research partnerships to address low, medium and high levels of risk for childhood overweight and obesity within community settings. A case study describing the development of a logic model to inform risk-linked responses to childhood overweight and obesity is presented for the Ipswich community in south-east Queensland.

Improving Providers' Assessment and Management of Childhood Overweight: Results of an Intervention

Pediatric primary care providers' adherence to recommendations for the assessment and management of childhood overweight is low. There are scarce data addressing how to improve provider practices. This study evaluated the effect of provider training and office-based tool dissemination on pediatric providers' assessment and management of childhood overweight. Provider practices before and after training and office-based tool dissemination were compared. Participants were resident and faculty providers at 6 urban, community-based primary care clinics affiliated with an academic medical center. Three months after completion of two 1-hour training sessions, clinic sites were provided with tools in bulk, and office staff were coached to distribute the tools during patient encounters. Provider practices were ascertained by medical record abstraction at baseline and at 3 and 6 months. The proportion of medical records with documentation of recommended practices, including recording of body mass index percentile (BMI%), obtaining a nutrition-activity history, and providing nutrition-activity counseling, was compared with chi(2) tests and logistic regression. During the initial 3 months after training, provider documentation of recommended practices did not significantly improve compared with baseline. During the subsequent 3 months, after office-based distribution of tools, provider documentation of recommended practices improved significantly compared with baseline (28.8% vs 11.6% for BMI% [P < .001], 80.2% vs 49.8% for nutrition-activity history [P < .001], and 47.7% vs 33.3% for nutrition-activity counseling [P < .001]). Pediatric providers' adherence to recommendations for the assessment and management of childhood overweight may improve with provider training linked to the office-based distribution of tools to promote performance of recommendations.

Message from Griffin P. Rodgers, M.D., M.A.C.P., Director, NIDDK, on the Institute’s Obesity Research

Message from Griffin P. Rodgers, M.D., M.A.C.P., Director, NIDDK, on the Institute’s Obesity Research

Recognition and management of childhood overweight and obesity by clinicians

(i) To determine the ability of general practitioners (GPs) and paediatricians to correctly identify children as overweight or obese by visual cues alone; (ii) to describe the current management practices of overweight and obese children by these practitioners; and (iii) to compare these with National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines. Forty-four GPs and 29 paediatricians participated in the study. Respondents completed a questionnaire based on a series of body images, rating the size of the child as acceptable weight, overweight or obese and indicating the likelihood of carrying out a series of management options. There was considerable variation in ability to rate images correctly with the total number of correct responses being 72% and 68%, respectively, for GPs and paediatricians. There were statistically significant differences in management between GPs and paediatricians in terms of conducting appropriate anthropometry and screening for co-morbidities, with paediatricians performing closer to the NHMRC Clinical Practice Guidelines. GPs and paediatricians have the opportunity to screen children for overweight and obesity during their everyday practice. Accurate determination of weight status cannot be performed by visualisation alone and all children should have height and weight measured and correctly interpreted. Some areas of current GP and paediatrician management of overweight and obese children fall short of the NHMRC clinical guidelines and areas for improvement are highlighted in this paper.

Regulation of body mass and management of childhood overweight

Obesity has become an increasingly important public health problem. Recent evidence suggests that obesity has become a close second to tobacco use as a preventable cause of death in the United States. During the past decade an increase in the prevalence of type 2 diabetes in adolescents has been observed. The association of type 2 diabetes and obesity is well established and most adolescents with type 2 diabetes have body mass index (BMI) in a range that would already be considered obese in an adult. Childhood overweight is also associated with the atherosclerotic process. In the Bogalusa autopsy study, Berenson et al. found that the extent of fatty streaks and fibrous plaques in the aorta and coronary arteries was associated with BMI. There are three modalities currently available for the treatment of overweight in children and adolescents, including behavioral approaches, pharmacologic approaches, and surgical approaches. Surgical intervention may be considered if the BMI > or = 40 kg/m2 and a severe medical comorbidity including type 2 diabetes, obstructive sleep apnea or pseudotumor cerebri, or if the BMI is > or = 50 kg/m2 and comorbid conditions such as hypertension, dyslipidemia, or the metabolic syndrome are present. Behavioral intervention is usually made by a psychologist, behavioral therapist, dietician, or exercise physiologist. There is evidence that the effect of behavioral therapy for weight loss in childhood will be longer lasting than that seen in adults.