Pediatric Overweight Research Articles

Internal Regulation and Eating: Comment on a Pediatric Overweight Prevention Program

T he article by Slusser et al. ‘‘Pediatric overweight prevention through a parent training program for 2–4 year old Latino children,’’ published in Childhood Obesity in February, 2012, indicates that the intervention included Ellyn Satter’s ‘‘.philosophy of internal regulation related to eating,’’ among the other intervention materials. In her 1996 article ‘‘Internal regulation and the evolution of normal growth as the basis for prevention of obesity in children,’’ Satter pointed out that when parents do their jobs with feeding, children do their jobs with eating and growing. To support internal regulation, parents and caregivers need to trust the ‘‘children’s innate growth processes and inclinations for [food consumption] and movement that support those tendencies.’’ From Satter’s perspective, desirable growth is consistent growth at any percentile level. Intervention from the Trust perspective, ‘‘identifies and resolves factors that disrupt homeostasis and establishes consistent and positive eating and activity’’ to allow the child to restore the growth pattern that is natural and expected for them. In contrast, the Bright Futures curriculum, Traffic Light Diet, and American Academy of Pediatrics (AAP) childhood obesity prevention Expert Committee recommendations attempt to get the child’s BMI to go down to a lower percentile by controlling food selection and manipulating the caloric density of the child’s diet—essentially by getting the child to undereat and lose weight. In my view, the intervention by Slusser et al. straddles the Trust versus Control paradigm as described by Satter. On the one hand, this intervention recommends mothers ‘‘implement consistent daily routines centered on eating..’’ On the other hand, it attempts to indirectly control the child’s energy intake by manipulating dietary caloric density emphasizing healthy foods. Author Disclosure Statement

No association between childcare and obesity at age 4 in low‐income Latino children

Previous studies have found an association between early entry to childcare and risk for overweight and obesity at 3 years of age. These studies, however, have been conducted primarily with higher income White populations or have found increased risk in the children of educated mothers. To assess the relationship between timing of entry to childcare and duration of childcare and pediatric overweight and obesity in a high risk population. Using data from a longitudinal cohort of low-income Latino children in San Francisco, we evaluated the association between time of entry to childcare, hours in childcare, and risk for overweight and obesity at age 4. Similarly, we evaluated the relationship between these same childcare parameters and body mass index Z score and risk of having a waist circumference (WC) percentile ≥90th at 4 years of age. In contrast with previous studies, we found no association between being in childcare at 4 years of age or number of hours per week in childcare and risk for childhood overweight, obesity or WC ≥90th percentile at age 4. Additionally, we found no association between age of entry to childcare (≤6 months or ≤12 months of age) with risk for overweight or obesity at age 4. Future studies need to further evaluate the differential impact of childcare on early childhood obesity in relation to race/ethnicity and lower socioeconomic status. Low-income children may not be at increased risk for obesity in relation to early childcare exposure.

Prevalence of overweight and obesity in a population of childhood leukemia patients and survivors.

324 Background: Overweight and obesity (BMI>95 percentile) in the pediatric population has become a prominent problem. The prevalence of pediatric obesity has increased from 5% in 1976-1980 to 17% among children and adolescents in 2007-2008. The presence of obesity in survivors of certain childhood cancers has been identified as a late effect of therapy, especially in survivors of ALL and brain tumors. Obesity prevalence following treatment for ALL ranges from 11-57%. The long-term health consequences of obesity include diabetes mellitus, hypertension, cardiovascular disease, metabolic syndrome and certain cancers. Kaiser Permanente (KP) tracks pediatric BMI as part of routine health maintenance. There is an initiative to promote Healthy Eating and Active Living (HEAL) and reduce childhood obesity. As part of this initiative the HEAL clinic provides a multi-disciplinary weight management program for the general adolescent population at KP Los Angeles Medical Center (LAMC). Methods: A chart review was conducted using the electronic medical record system at LAMC. 99 records, 22 current patients and 77 survivors of ALL, were identified and reviewed for Body Mass Index (BMI) and compared to the general pediatric population of KP in Southern California. Results: See Table. 57 leukemia patients and survivors were identified as overweight or obese, which is a 57.5% prevalence rate. This is significantly higher than the rate of pediatric overweight and obesity of 37.1% in the KP Southern California general population. Conclusions: The use of an electronic medical record system confirms a higher prevalence of overweight and obesity in the ALL patients and survivors at KP LAMC than the general pediatric population in Southern California. The intervention piloted by the HEAL clinic has been adapted to treat this group of overweight and obese cancer patients and survivors. [Table: see text]

INEQUALITIES IN LIFESTYLE BEHAVIOURS, DIETARY HABITS AND FAMILIAL FACTORS AMONG NORMAL WEIGHT, OVERWEIGHT OR OBESE CHINESE CHILDREN AND ADOLESCENTS

ObjectivesPaediatric obesity has become a global public health problem. Data on the lifestyle behaviours, dietary habits and familial factors of overweight and obese children and adolescents are limited. The present...

An Examination of the Development, Components and Evaluation of Hospital-Based Pediatric Overweight and Obesity Treatment Programs

An Examination of the Development, Components and Evaluation of Hospital-Based Pediatric Overweight and Obesity Treatment Programs

Dietary intake of overweight and obese children attending a weight‐loss program

Low diet quality is associated with the risk of overweight/obesity in adults but limited data is available on the effects in children. To improve the understanding of the role of diet on childhood obesity, we conducted a cross‐sectional observational pilot study in 5–11 year oldsattending the the Pediatric Overweight Education and Research Program (POWER) at Riley Hospital for Children, Indiana University, Indianapolis IN. Dietary intake was assessed using two 24‐hour recalls and mean intake of total energy, foodgroups, fiber, macro‐; and selected micronutrients was estimated. Results showed a mean daily intake of 1,503 kcals; 1.8, 1.6, 5.4, 0.9, 2.5 and 1.3 servings of fruits, vegetables, grains, whole grains, dairy, and meat, respectively. Thus, the diets of the children in this study were still deficient in fruits, vegetables, and whole grains, which led to fiber consumption levels below the recommendations. The foods consumed that contributed most of the fiber intake in this population were sweetened ready‐to‐eat cereals, fruits (apples, pears, pineapple, banana), fast‐food pizza, and meat sandwhiches. In conclusion, improving diet quality by increasing intake of fiber‐rich foods could possibly help support the establishing of healthy weight in this population.Grant Funding Source : Purdue University PDT grant

Developmental origins of obesity: Early feeding environments, infant growth, and the intestinal microbiome

Pediatric overweight and obesity are growing problems worldwide, with increasing prevalence among even infants and young children. The refractory nature of early overweight necessitates identifying the factors contributing to early excess weight gain for successful intervention. Early feeding practices may be particularly important in shaping long-term vulnerability to obesity. How and what infants are fed can influence weight gain, adiposity, and energy metabolism during infancy and across the life course through a number of interacting physiological and behavioral pathways. This article argues that these biological mechanisms interact with the social and behavioral context of infant feeding to create differential vulnerability to later obesity. This article reviews recent research on the potential mechanisms linking infant feeding and risk of later obesity, focusing on the emerging role of microflora colonization. The nutritive and non-nutritive components of breastmilk, formula and solid foods and the practices surrounding feeding shape the infant metabolome, programming growth rates and body composition, altering metabolism and physiology, promoting differential microfloral colonization, and shaping behavioral responses to foods and eating. The occurrence of chronic disease precursors at increasingly younger ages and the tendency of overweight young children to become overweight adolescents and adults underscore the importance of understanding this complex early exposure and intervening early to prevent the development of obesity in increasingly weight-promoting environments.

Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods

Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; NourishingOurUnderstanding ofRole modeling toImproveSupport andHealth), targeting racially diverse parents of overweight children (ages 6–11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI≥the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial.

Systematic review of family and home‐based interventions targeting paediatric overweight and obesity

The family and home environment is a highly influential psychosocial antecedent of paediatric obesity. The purpose of this investigation was to systematically analyze family and home-based randomized control trials aimed at treating overweight and obesity in children ages 2-7 years. In gathering materials for this review, a search of Cumulative Index to Nursing and Allied Health, MEDLINE, Education Resources Information Center, Psychology and Behavioural Sciences Collection and CENTRAL databases was conducted for the time frame of January 2001 to August 2011. The data extraction spanned three phases resulting in a total of nine interventions that met the specified inclusion criteria. Among the identified studies, eight produced significant outcomes. The majority of the programmes incorporated educational sessions targeting parents as the primary modality for intervention delivery. Less than one-quarter of the interventions included home visitations; however, all of the interventions included home-based activities to reinforce behaviour modification. Only three of the interventions applied social and behavioural theory, and only two interventions employed process evaluation. Additional research is needed to gauge the efficacy of the home and family milieu for treating paediatric obesity.

Direction of the association between body fatness and self-reported screen time in Dutch adolescents

BackgroundScreen time has been associated with pediatric overweight. However, it is unclear whether overweight predicts or is predicted by excessive amounts of screen time. The aim of this study was to examine the direction of the association between screen time and body fatness in Dutch adolescents.MethodsLongitudinal data of 465 Dutch adolescents (mean age at baseline 13 years, 53% boys) was used. Body fatness (objectively measured BMI, four skin folds and waist- and hip circumference), self-reported time spent watching TV and computer use, and aerobic fitness (shuttle run test) were assessed in all participants at three time points during 12 months. Multi-level linear autoregressive analyses was used to examine whether screen time predicted body fatness in the following time period and whether body fatness predicted screen time. Analyses were performed for boys and girls separately and adjusted for ethnicity and aerobic fitness.ResultsTime spent TV viewing did predict changes in BMI and hip circumference in boys, but not in girls, in the subsequent period. Computer time significantly predicted increases in skinfolds in boys and girls and increases in BMI in girls. Body fatness did not predict any changes in screen time.ConclusionThe present study only partly supports the widely posited hypothesis that higher levels of screen time cause increases in body fatness. In addition, this study demonstrates that high levels of body fatness do not predict increases in screen time.

Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions.

Childhood obesity is currently one of the most prevailing and challenging public health issues among industrialized countries and of international priority. The global prevalence of obesity poses such a serious concern that the World Health Organization (WHO) has described it as a “global epidemic.” Recent literature suggests that the genesis of the problem occurs in the first years of life as feeding patterns, dietary habits, and parental feeding practices are established. Obesity prevention evidence points to specific dietary factors, such as the promotion of breastfeeding and appropriate introduction of nutritious complementary foods, but also calls for attention to parental feeding practices, awareness of appropriate responses to infant hunger and satiety cues, physical activity/inactivity behaviors, infant sleep duration, and family meals. Interventions that begin at birth, targeting multiple factors related to healthy growth, have not been adequately studied. Due to the overwhelming importance and global significance of excess weight within pediatric populations, this narrative review was undertaken to summarize factors associated with overweight and obesity among infants and toddlers, with focus on potentially modifiable risk factors beginning at birth, and to address the need for early intervention prevention.

Nurse practitioner attitudes and treatment practices for childhood overweight: How do rural and urban practitioners differ?

Pediatric overweight and obesity has become an epidemic problem of our nation. Nurse practitioners (NPs) are exposed to overweight pediatric patients on a regular basis. The purpose of this study was to investigate NP attitudes toward pediatric overweight and obesity and explore their current diagnosis and treatment practices. Differences between rural and urban NPs were also investigated. Survey data were gathered from 1088 family and pediatric NPs from the American Academy of Nurse Practitioners member list randomly. Only family and pediatric NPs were included in the sample. NPs in the sample believed that pediatric overweight and obesity are problems in need of treatment, but also reported not assessing and diagnosing the condition per current guidelines. Initiation of treatment was reported at very low rates. Rural NPs reported having fewer referral resources than urban NPs. NPs are in an ideal position to properly assess, diagnose, and treat pediatric overweight and obesity. The findings suggest that more education on these topics is necessary for NPs. Rural NPs reported fewer referral services, and may need to have more knowledge about how to provide obesity treatment services in their own practice settings due to this disparity.

Conceptualising a socio-ecological understanding of paediatric overweight and obesity

Conceptualising a socio-ecological understanding of paediatric overweight and obesity

Overweight in School-Aged Children Associated With Emotional and Behavioral Difficulties: Results From a National Sample

To determine whether there is an association between perceived pediatric overweight and emotional/behavioral difficulties among children ages 4 to 17 years in the United States. A cross-sectional study Interview of an adult knowledgeable about a child's emotional and physical health. All statistical analyses were completed using SPSS 17.0. A total of 7096 noninstitutionalized children aged 4 to 17 years identified in the 2007 National Health Interview Survey. Included in the 2007 National Health Interview Survey were 7096 noninstitutionalized children aged 4 to 17 years. After controlling for age, gender, race, poverty status, education of mother, family structure, and health status, this study found that 7.4% of the children appeared to be overweight and 5.2% had emotional/behavioral difficulties. It also found that caregivers who indicated that their child had a problem with being overweight were more likely to report that the child experienced emotional/behavioral difficulties compared to caregivers who did not report perceived overweight in their child. Characteristics of the children most frequently reported to be overweight included Hispanic race, older children (ages 15-17 years), and those with higher poverty rates and poorer health status. The continual increase in pediatric overweight and associated emotional/behavioral difficulties suggests a need for replicable interventions that teach child caregivers to recognize and prevent overweight among vulnerable populations.

Common Perioperative Complications in the Pediatric Day Surgery Setting of a Patient with an Elevated BMI: A Resource Guide to the Literature on the Care of the Obese Pediatric Surgical Patient

The incidence of pediatric obesity is on the rise. Because pediatric overweight and obese patients are presenting for elective surgery in the day surgery setting, there are concerns regarding perioperative complications in this population. Although there is a paucity of studies specific to the pediatric population, respiratory symptoms, airway management concerns, prolonged postanesthesia care unit (PACU) stays, and increased emesis are significantly more common in pediatric patients with an elevated body mass index (BMI).1 This resource guide will provide assistance to nurses and other healthcare providers to increase their awareness of the perioperative complications of pediatric patients with an elevated BMI in the day surgery setting.

Obesity Prevention and Treatment

Obesity Prevention and Treatment

The Clinical Nurse Leader: Playing an Integral Role in the Prevention and Treatment of Pediatric Overweight and Obesity

Childhood obesity rates continue to rise across the United States. With the increased availability of snack foods and greater portion sizes, children have increased caloric intake, snack more often, and eat more high-fat foods. Decreased physical activity and increased sedentary behavior result in less active children. Children can suffer from comorbidities such as hyperlipidemia, hypertension, type 2 diabetes mellitus, and sleep disorders (e.g., sleep apnea, insomnia). Obesity may be a result of unhealthy lifestyle choices. The clinical nurse leader (CNL) can play a key role in educating children and families. The CNL is a nurse with high-level critical thinking skills, leadership and case management abilities, who is well qualified to work on the complex issues that affect children with overweight or obesity and their families. CNLs can help to identify children and adolescents who are overweight or obese, coordinate their care, and assist their families to promote optimal health.

The importance of long-term follow-up in child and adolescent obesity prevention interventions

Pediatric overweight and obesity continues to be a major public health concern. Once established it is difficult to treat; therefore well-designed and evaluated prevention interventions are vitally important. There is considerable evidence to suggest that obesity prevention initiatives can change children's behaviours and weight status over the short- or medium-term; however, there is far less evidence on which to judge the impact over the longer term. In response to the rise in short- and medium-term obesity prevention studies for children and adolescents over recent years, the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network highlight five points as to why the dearth of obesity prevention studies with long-term follow-up should be urgently addressed. Furthermore, recommendations to strengthen the evidence base and outline key implications for research design in this area and the support required for long-term follow-up studies are detailed.

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.

Validation and application of a novel method of measuring non-response bias in school-based surveys of paediatric overweight and obesity

To validate a method of estimating non-response bias to a school-based survey based on body mass index (BMI). A population survey of Australian students in Kindergarten and Grades 2, 4, 6, 8 and 10 (N=5 407) was conducted in 2004, and height and weight measured. Teachers matched the height and weight of all students who were selected to participate, but who were not measured (non-participating students) and of half of the students whose height and weight had been measured based on comparisons with the remaining half of measured students. Among those students whose height and weight had been both measured and estimated based on matching with the most similar student, percent agreement between the BMI categories based on measured and estimated values was calculated to determine the validity of the estimated BMI value. The prevalence of overweight and obesity among participating and non-participating students was compared to determine the magnitude of non-response bias. For more than 88% of classes, percent agreement between BMI categories based on estimated and measured height and weight was >60%. The differences in the prevalence of overweight and obesity between participating and non-participating students were all less than one percentage point. Most teachers were able to validly match students based on their height and weight, allowing estimation of and adjustment for non-response bias among non-participating students.