Obesity-related Behaviors Research Articles

Familial Environment and Overweight/Obese Adolescents’ Physical Activity

(1) Background: Family environments can impact obesity risk among adolescents. Little is known about the mechanisms by which parents can influence obesity-related adolescent health behaviours and specifically how parenting practices (e.g., rules or routines) and/or their own health behaviours relate to their adolescent’s behaviours. The primary aim of the study explored, in a sample of overweight/obese adolescents, how parenting practices and/or parental modeling of physical activity (PA) behaviours relate to adolescents’ PA while examining the moderating role of parenting styles and family functioning. (2) Methods: A total of 172 parent-adolescent dyads completed surveys about their PA and wore an accelerometer for eight days to objectively measure PA. Parents completed questionnaires about their family functioning, parenting practices, and styles (authoritative and permissive). Path analysis was used for the analyses. (3) Results: More healthful PA parenting practices and parental modeling of PA were both associated with higher levels of adolescents’ self-reported moderate-vigorous physical activity (MVPA). For accelerometer PA, more healthful PA parenting practices were associated with adolescents’ increased MVPA when parents used a more permissive parenting style. (4) Conclusions: This study suggests that parenting practices and parental modeling play a role in adolescent’s PA. The family’s emotional/relational context also warrants consideration since parenting style moderated these effects. This study emphasizes the importance of incorporating parenting styles into current familial interventions to improve their efficacy.

Parental and peer social support is associated with healthier physical activity behaviors in adolescents: a cross-sectional analysis of Texas School Physical Activity and Nutrition (TX SPAN) data

BackgroundParental and peer support can influence children’s physical activity; however, these associations have not been fully examined in a multi-ethnic population across early and late adolescence. The objective of this study was to examine associations between perceived parental/peer social support, perceived parental disapproval for not exercising, and physical activity/screen time behaviors among a multi-ethnic sample of adolescents.MethodsThe Texas School Physical Activity and Nutrition (TX SPAN) survey is a cross-sectional statewide probability-based survey, used to assess obesity-related behaviors such as diet and physical activity. The SPAN 2009–2011 study measured 8th and 11th grade students using a self-report questionnaire with established psychometric properties, along with objectively measured height and weight. Associations were examined using multiple logistic and linear regression.ResultsFor every 1-point increase in parental physical activity support, adolescents had 1.14 higher odds of engaging in five or more days of moderate physical activity per week (p < 0.001), and 1.12 higher odds of engaging in three or more days of vigorous physical activity per week (p < 0.001). For every 1-point increase in peer physical activity support, adolescents had 1.17 higher odds of engaging in five or more days of moderate physical activity per week (p < 0.001), and 1.15 higher odds of engaging in three or more days of vigorous physical activity per week (p < 0.001).ConclusionsParental and peer social support is associated with positive physical activity behaviors in adolescents. Strategies to focus on parent and peer support should be integral to intervention programs designed to increase physical activity in adolescents in middle and high schools.

Physical Activity, Screen Time, and Sleep in Children With ADHD.

Background: Children with attention deficit hyperactivity disorder (ADHD) are at increased risk for poor health and obesity. The authors describe obesity-related movement behaviors in children with ADHD, determine higher risk groups, and compare with children with other disorders. Methods: Physical activity (PA), sleep, and screen time of children with ADHD (aged 6-18y) were compared with recommendations and with behaviors of children with autism, asthma, and a normative group using 2011 National Survey of Child Health data. Results: Approximately one-third of children with ADHD participated in daily PA and half in sports in the past year. Older children with ADHD were less likely to get daily PA, get enough sleep, and limit screen time to <2hours per day. Obese children had lower odds of daily PA. Children who had lower socioeconomic status, or severe ADHD, had lower odds of sports participation. Children with ADHD had 50% lower odds of sports participation than children with asthma. Conclusions: Children with ADHD did not engage in recommended amounts of PA, sleep, and screen time. Children with ADHD who are older, poor, obese, and/or with more severe symptoms are at higher risk for suboptimal movement behaviors. These domains represent novel treatment targets in ADHD youth.

Time is overestimated in obesity: A cohort study.

Food addiction and high impulsivity are common traits in obesity. In accordance with the evidence that time is overestimated in patients with a history of impulsivity and/or drug addiction, we tested the hypothesis that duration is overestimated in obesity. A total of 92 obese participants and 182 healthy controls completed a timing task of visual stimuli. In line with our prediction, obese participants overestimated the duration of the displayed visual stimuli than controls. Our result has potential clinical implications in the field of obesity, as it suggests a potential contribution of this cognitive dysfunction in the emergence and maintenance of obesity-related behaviour.

Personality-obesity associations are driven by narrow traits: A meta-analysis.

Obesity has inconsistent associations with broad personality domains, possibly because the links pertain to only some facets of these domains. Collating published and unpublished studies (N=14848), we meta-analysed the associations between body mass index (BMI) and Five-Factor Model personality domains as well as 30 Five-Factor Model personality facets. At the domain level, BMI had a positive association with Neuroticism and a negative association with Conscientiousness domains. At the facet level, we found associations between BMI and 15 facets from all five personality domains, with only some Neuroticism and Conscientiousness facets among them. Certain personality-BMI associations were moderated by sample properties, such as proportions of women or participants with obesity; these moderation effects were replicated in the individual-level analysis. Finally, facet-based personality "risk" scores accounted for 2.3% of variance in BMI in a separate sample of individuals (N=3569), 409% more than domain-based scores. Taken together, personality-BMI associations are facet specific, and delineating them may help to explain obesity-related behaviours and inform intervention designs. Preprint and data are available at https://psyarxiv.com/z35vn/.

Association between grandparent coresidence and weight change among first-grade Japanese children.

The prevalence of grandparent coresidence is increasing. However, the impact of grandparent coresidence on weight change among school-age children remains unclear. The objective of the study is to examine the association between grandparent coresidence and obesity-related behaviours and change in body mass index (BMI) z scores among school-age children. In total, 3422 caregivers of first-grade children in Adachi City, Tokyo, participated in surveys and health checkups in 2016 and 2017 with no change in their grandparent coresidence status (response rate: 80.1% and 81.4%, respectively). Association between grandparent coresidence and obesogenic dietary, physical activity, and screen-based sedentary behaviours was measured using Poisson regression with robust error variance analysis, while change in BMI z scores was determined by linear regression and adjusting for potential covariates. Grandparent coresidence was associated with increased prevalence rate (PR) of irregular snack foods intake (PR: 1.38, 95% confidential interval (CI): 1.19, 1.61); however, children who live with grandparents showed a lower BMI z scores in the second grade (coefficient: -0.048, 95% CI: -0.094 to -0.0013) after adjustment for BMI z scores in the first grade, family sociodemographics, and obesogenic behaviours. Grandparent coresidence is associated with lower BMI z scores among early primary school-age Japanese children living in urban areas.

Parent-Perceived Stress and Its Association With Children's Weight and Obesity-Related Behaviors.

IntroductionPsychosocial stress is associated with obesity in adult and pediatric populations, but few studies have examined the relationship between parent-perceived stress and risk of child obesity and related behaviors.MethodsWe studied 689 pairs of parents and children aged 2 to 12 in Massachusetts with a body mass index (BMI) at or above the 85th percentile. Recruitment occurred from June 2014 to March 2015, and data collection ended in March 2016. We asked parents about their perceived stress and categorized responses as low, moderate, or high. We examined associations of parents’ stress with children’s BMI, expressed as a percentage of the 95th percentile (%BMIp95), and obesity-related behaviors by using multivariable regression models adjusted for child and parent characteristics. We stratified results by race/ethnicity, annual household income, and the child’s age.ResultsIn fully adjusted models, the association between high versus low parent-reported stress and children’s %BMIp95 remained significant only for children in low-income households (β = 5.12; 95% confidence interval [CI], 0.94–9.30) and for non-Hispanic black children (β = 7.76; 95% CI, 1.85–13.66). Parents with high or moderate stress versus low stress were less likely to report that their children met recommendations for fast-food consumption (high stress, prevalence ratio [PR] = 0.79; 95% CI, 0.65–0.96; moderate stress, PR = 0.70; 95% CI, 0.59–0.82), but parents with high versus low stress were more likely to report meeting daily physical activity recommendations (PR = 1.21; 95% CI, 1.01–1.45).ConclusionAmong children with overweight or obesity, parent-perceived stress was associated with fast-food consumption and physical activity. Parent-perceived stress was associated with child %BMIp95 among children in low-income households and non-Hispanic black children. Obesity interventions should consider parent-perceived stress and potential differences in the nature of stress experienced by parents of different racial/ethnic and socioeconomic backgrounds.

Assessment of the Effectiveness of a Computerised Decision-Support Tool for Health Professionals for the Prevention and Treatment of Childhood Obesity. Results from a Randomised Controlled Trial.

We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6–12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children’s hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and −4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by −0.1 and −0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by −0.4 kg/m2. However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.

Road map towards a harmonized pan-European surveillance of obesity-related lifestyle behaviours and their determinants in children and adolescents.

To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and-once in place-will facilitate health reporting and monitoring of national and international health targets.

Sibship, physical activity, and sedentary behavior: a longitudinal, observational study among Mexican-heritage sibling dyads

BackgroundShared genetic and environmental factors suggest that family relationships are important predictors of obesity-related behaviors, yet little is known about how siblings influence physical activity and sedentary behaviors. This study examined physical activity and sedentary behavior between sibling dyads across summer and fall time points and determined if birth order and gender modify the relationship between sibling behaviors.MethodsMexican-heritage families residing in colonias along the United States-Mexico border were recruited using promotoras de salud to participate in summer and school year surveys. Eighty-seven sibling dyads had complete data for the physical activity sub-study: 21 older brother-younger brother, 21 older brother-younger sister, 23 older sister-younger brother, and 22 older sister-younger sister dyads. Physical activity and sedentary behavior were measured using a validated 7-day recall instrument to create summary measures of weekly active, moderate-to-vigorous physical activity (MVPA) metabolic equivalents (MET), sitting, and screen time minutes. We used linear regression analyses to examine changes over time and the association between older and younger sibling behavior.ResultsDuring summer, older siblings (mean age = 11.2 years) reported 1069 active minutes and 1244 sitting minutes per week; younger siblings (mean age = 8.3 years) reported 1201 active minutes and 1368 sitting minutes per week. Younger brothers reported fewer active minutes (mean = − 459.6; p = 0.01) and fewer MVPA MET-minutes (mean = − 2261.7; p = 0.02) of physical activity during the fall. Within all 87 dyads, older sibling physical activity was significantly associated with younger sibling active minutes (B = 0.45;p = 0.004) and MET-minutes (B = 0.45;p = 0.003) during summer but not fall; older sibling sedentary behavior was significantly associated with younger sibling sitting (B = 0.23;p = 0.01) and screen time minutes (B = 0.23;p = 0.004) during fall but not summer. After stratifying by gender dyad groups, younger brother behavior was strongly associated with older brother behavior at both time points.ConclusionYounger siblings appear to emulate the physical activity behaviors of their older siblings during non-school summer months and sedentary behaviors of older siblings during school-time fall months, especially older brother-younger brother dyads. Family-based interventions to increase physical activity and decrease sedentary behavior are growing in popularity, but more work is needed to understand the role of sibling influences.

An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial.

BackgroundElectronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children.ObjectiveThis study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy.MethodsThe Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection.ResultsA total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes.ConclusionsThe trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power.Trial RegistrationAustralian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).

Nutrition provider confidence in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study.

ObjectiveThe multi-sector, multi-level Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study resulted in improvements in obesity risk factors among children age 2–4 years enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC). The goal of this study was to examine whether the MA-CORD intervention increased WIC provider confidence in their ability to identify childhood obesity and obesity-related behaviors.MethodsAs part of the MA-CORD intervention conducted from 2012 to 2015, we implemented WIC practice changes focused on childhood obesity prevention within two Massachusetts communities. We examined changes in provider confidence to assess childhood obesity risk factors and practice frequency among WIC practices located in MA-CORD intervention communities over a 3-year period, compared to non-intervention sites. We measured provider confidence on a continuous scale using questions previously developed to assess provider and parent confidence to make weight-related behavior change (range 0 to 24).ResultsThere were 205 providers at baseline and 165 at follow-up. WIC providers at intervention sites reported greater confidence in their ability to identify childhood obesity and obesity-related behaviors compared to the usual care sites (β = 1.01, standard error = 0.13). These findings persisted after adjusting for provider gender, years in practice, highest education level, and WIC position.ConclusionsThe MA-CORD intervention was associated with increased WIC provider confidence to assess children's obesity risk. Interventions that increase confidence in assessing obesity-related behaviors may have salutary effects within WIC programs that serve low-income families.

Sleep duration and quality are associated with eating behavior in low-income toddlers

ObjectiveThe present study examined whether different sleep health parameters (duration, timing, and quality) are associated with obesity-related eating behaviors including emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness, and eating in the absence of hunger (EAH), during toddlerhood. DesignAmong 134 low-income 33-month-old children, parents reported on child sleep parameters, including sleep quality (Children's Sleep Wake Scale; CSWS) and usual bedtimes and wake times on weekdays and weekends (weeknight sleep duration, weekday-to-weekend bedtime delay). Child eating behaviors were assessed using both observed and parent-report measures. Child Emotional Overeating, Food Responsiveness, Enjoyment of Food, and Satiety Responsiveness were measured by parent report using the Child Eating Behavior Questionnaire-Toddler. Observed child EAH was evaluated by measuring kilocalories of palatable foods consumed following a meal. Multivariable linear regression was used to examine the associations between sleep parameters and eating behaviors. ResultsPoorer child sleep quality was associated with greater Emotional Overeating (standardized β = −0.20 (SE 0.09), p < .05) and greater Food Responsiveness (β = −0.18 (SE 0.09), p < .05). Shorter child nighttime sleep duration was associated with greater EAH kcal consumed (standardized β = −0.22 (SE 0.09), p < .05). Child bedtime delay was not associated with any of the eating behaviors, and no child sleep variables were associated with either Enjoyment of Food or Satiety Responsiveness. ConclusionsShorter nocturnal sleep duration and poorer sleep quality during toddlerhood were associated with some, but not all, of the obesity-related eating behaviors. Poor sleep health may promote childhood obesity risk through different eating behavior pathways. As children growing up in poverty may experience greater sleep decrements, sleep duration and sleep quality may be important targets for intervention among low-income families with young children.

Sleep-an Essential Component of Obesity Screening and Counseling: A Policy Analysis of the Affordable Care Act.

The Patient Protection and Affordable Care Act (PPACA) has provided access to health care for millions of people in the United States. One of the most beneficial aspects of the PPACA is the obesity screening and counseling provision. Currently, it is estimated that over 39% of US adults are obese. Research has linked sleep disturbances to obesity and obesity-related behaviors. The purpose of this article is to advocate for evidence-based care through the inclusion of sleep disturbance screening and management under the PPACA obesity screening and counseling provision. An in-depth policy analysis of the PPACA was conducted to examine the feasibility of adding sleep screenings to the obesity screening and counseling provision available under current law. Findings suggest that the adoption of this policy would require stakeholder advocacy and educational reform. Implementation of the policy would require additional economic investments, but the long-term savings could be significant. A campaign to raise awareness regarding the association between sleep disturbance and obesity among the public and health care professionals would be essential. Policy implementation would require interprofessional collaboration when performing sleep disordered screening and management. Preventative health care for individuals who have not previously accessed the health care system has the potential to socially and economically benefit society if policies provide for evidence-based care. Sleep screening and counseling is essential under the PPACA to adequately address the US obesity crisis.

Perceived Parental and Peer Social Support Is Associated With Healthier Diets in Adolescents

ObjectiveInvestigate associations between perceived parental/peer support for a healthy diet and adolescent dietary behaviors using data from the 2009–2011 School Physical Activity and Nutrition (SPAN) survey. DesignA secondary analysis of SPAN, a cross-sectional statewide study using a validated self-administered questionnaire, assessed obesity-related behaviors. SettingProbability-based sample of Texas 8th- and 11th-grade students. ParticipantsA total of 6,716 8th- and 11th-grade students. Main Outcome MeasuresObtained by self-report and included sugary beverage consumption, fruit and vegetable intake, and SPAN healthy eating score. AnalysisMultiple logistic regression and linear regression were used to determine associations, controlling for demographic variables. ResultsFor every 1-point increase in parental support (range, 0–12), adolescents had 1.19 times higher odds of consuming ≥1 fruits or vegetables/d (P < .001) and 1.1 times lower odds of consuming ≥2 sugary beverages/d (P < .05), and had a SPAN healthy eating score (range, –100 to 100) that was 1.6 points higher (P < .001). For every 1-point increase in peer support, adolescents had 1.14 times higher odds of consuming ≥1 fruits and vegetables/d (P < .001) and a higher SPAN healthy eating score (P < .05). Conclusions and ImplicationsParental/peer support was associated with healthier dietary behaviors. Future research could conduct pre-post intervention studies to determine whether an increase in parental/peer support is associated with positive changes in healthier eating.

A systematic review of neighbourhood economic context on child obesity and obesity-related behaviours.

Childhood obesity is of great importance given a third of children in the USA are overweight or obese. Previous research has examined neighbourhood economic context in relation to children's obesity and obesity-rated behaviours. However, different definitions and measures of neighbourhood context make it difficult to compare findings and make definitive conclusions. This review is to synthesize studies assessing the associations between neighbourhood economic context and children's obesity or obesity-related behaviours. The review included 39 studies investigating the relationship between residential neighbourhood economic context and children's obesity, dietary habits or physical activity after controlling for family-level economic status. Studies reported mixed results in the relationship between neighbourhood economic indicators and child obesity outcomes. Of reviewed studies, 60% showed an inverse association between higher neighbourhood economic status and obesity, and 33% and 14% showed positive associations between higher neighbourhood economic status and healthy dietary habits or physical activity. Several studies suggested gender, age, race/ethnicity, individual-level economic status, rurality and social connectedness as moderators in the neighbourhood-obesity association. Findings suggest that, in order to move towards causal inferences and inform interventions, future research should examine neighbourhood impacts longitudinally and test theory-driven mediators and moderators to clarify the mechanisms by which neighbourhoods influence child obesity.

Brief tools to measure obesity-related behaviours in children under 5years of age: A systematic review.

Valid and reliable tools for measuring obesity-related behaviours in young children that are brief and can be administered quickly and cost-effectively in large-scale population studies are needed. The objectives of this systematic review were to describe brief tools that measure dietary intake, physical activity, sedentary behaviour, and sleep in young children. A systematic review of studies published in English in six databases (CINAHL, Medline, Embase, PsycINFO, HaPI, and Cochrane) prior to April 2018 was undertaken using the PROSPERO protocol and PRISMA guidelines. Included studies were those reporting the psychometric properties of brief (≤15 items) tools that measure dietary, activity, or sleep-related behaviours, alone or in combination, in children birth to 4.9years of age. The search identified 11379 papers, 200 full-text articles were screened for eligibility, and 12 met the inclusion criteria. Three studies measured two behavioural domains, while most assessed a single behaviour (three diet, five physical activity, one sleep, and none sedentary behaviour). Only two (one diet, one sleep) focused on the under 2 age group. Few studies assessed reliability, and validity and findings were mixed. There is a need to develop brief tools to measure early life obesity-related behaviours, particularly those assessing sedentary behaviour and sleep and tools that cover multiple domains.

Parental Activation and Obesity-Related Health Behaviors Among a Racially and Ethnically Diverse Population of Low-Income Pediatric Patients: Protocol for a Cross-Sectional Survey Study.

BackgroundDespite a recent decline in the obesity prevalence among preschool-aged children, obesity remains disproportionately high among children from low-income racial or ethnic minority families. Promoting healthy lifestyles (eg, obesity-preventative behaviors) in primary care settings is particularly important for young children, given the frequency of preventative health visits and parent-provider interactions. Higher adoption of specific health behaviors is correlated with increased patient activation (ie, skill, confidence, and knowledge to manage their health care) among adults. However, no published study, to date, has examined the relationship between parental activation and obesity-related health behaviors among young children.ObjectiveThe goal of this study is to measure parental activation in low-income parents of preschoolers in 2 large health systems and to examine the association with diet, screen-time, and physical activity behaviors.MethodsWe will conduct a cross-sectional study of parents of preschool-aged patients (2-5 years) receiving primary care at multiple clinic sites within 2 large health care systems. Study participants, low-income black, Hispanic, and white parents of preschool-aged patients, are being recruited across both health systems to complete orally administered surveys.ResultsRecruitment began in December 2017 and is expected to end in May 2018. A total of 267 low-income parents of preschool-aged children have been enrolled across both clinic sites. We are enrolling an additional 33 parents to reach our goal sample size of 300 across both health systems. The data analysis will be completed in June 2018.ConclusionsThis protocol outlines the first study to fully examine parental activation and its relationship with parent-reported diet, physical activity, and screen-time behaviors among low-income preschool-aged patients. It involves recruitment across 2 geographically distinct areas and resulting from a partnership between researchers at 2 different health systems with multiple clinical sites. This study will provide new knowledge about how parental activation can potentially be incorporated as a strategy to address childhood obesity disparities in primary care settings.International Registered Report Identifier (IRRID)RR1-10.2196/9688

The Impact of a Healthy Weight Intervention Embedded in a Home-Visiting Program on Children's Weight and Mothers’ Feeding Practices

ObjectiveTo examine whether a healthy weight intervention embedded in the Parents as Teachers (PAT) home visiting program, which was previously found to improve mothers’ body mass index (BMI) and obesity-related behaviors, changed the BMI of preschool children or maternal feeding practices. MethodsThis stratified randomized trial included preschool-aged children at risk for overweight whose mothers were overweight or had obesity (n = 179). The Healthy Eating and Active Living Taught at Home (HEALTH) intervention was based on the Diabetes Prevention Program. Differences were examined using repeated-measures mixed-ANOVA models. ResultsCompared with PAT usual care, the HEALTH intervention had no effect on children's BMI or maternal feeding practices. However, combined analyses showed that children's BMI percentile decreased (P = .007), BMI z-scores were maintained (P = .19), and 3 of 8 feeding practices improved over time (P < .05). Conclusions and ImplicationsAdditional research is needed to assess the effectiveness of PAT to prevent preschool-age obesity using rigorous designs (eg, group-randomized trials) and to identify its active components. HEALTH is ready to be scaled up to prevent maternal weight gain through embedding within the national PAT program.

Does motivational interviewing improve the weight management process in adolescents? Protocol for a systematic review and meta-analysis

BackgroundData on the effects of motivational interviewing (MI) on modifying unhealthy lifestyles and promoting weight status during childhood is controversial. Adolescents are more prone to assume higher personal responsibilities for behavioral changes. This study aims to investigate whether MI will improve weight management process in adolescents.Methods/designA systematic review will be conducted on clinical trials, assessing the effect of MI on weight management processes in adolescents, aged 10 to 19 years. The primary objective is to assess the efficacy of MI in controlling weight-related measures in overweight and obese adolescents. Secondary objectives are assessing the efficacy of MI on obesity-related behaviors and cognitive abilities considering heterogeneity in outcomes of primary studies in different MI settings. Main data sources include MEDLINE/PubMed, Scopus, Embase, Web of Science, Cochrane, and PsycINFO from 1980 to May, 2018, with no language restrictions. Study selection, data extraction, and risk of bias assessment will be performed by two independent reviewers. A meta-analysis will be conducted on relevant outcomes. Data will be analyzed for outcome of interest using the 95% confidence interval (CI) of an estimate for dichotomous outcomes and mean differences (MDs) for continious outcomes. Cochrane’s Q statistic and the I2 statistic will be performed to evaluate the heterogeneity. Subgroup analysis and suitable analytical strategies will be conducted to identify the potential sources of heterogeneity. As we expect a high heterogeneity in our included studies, pooled risk ratios (RRs) and 95% CI will be calculated to estimate the overall effect sizes, using meta-regression models or finite mixture modeling through conducting random effect methods. GRADE system will be used to evaluate the certainty of evidence. We will also use subgroup analysis and the GRADE system to investigate the effect of methodological quality of primary studies on results of meta-analysis. Funnel plots and egger and beggs test and plot will be implemented to assess publication bias.DiscussionThe results of this systematic review will provide more insights regarding the effect of MI on weight management in adolescents and will be useful for future research and health promotion programs in this age group.Systematic review registrationPROSPERO 2017:CRD42017069813.