Adrienne R. Hughes

Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight : Scottish Childhood Overweight Treatment Trial (SCOTT)

OBJECTIVE. The objective of this study was to determine whether a generalizable best-practice individualized behavioral intervention reduced BMI z score relative to standard dietetic care among overweight children. METHODS. The design consisted of an assessor-blinded, randomized, controlled trial involving 134 overweight children (59 boys, 75 girls; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years) who were randomly assigned to a best-practice behavioral program (intervention) or standard care (control). The intervention used family-centered counseling and behavioral strategies to modify diet, physical activity, and sedentary behavior. BMI z score, weight, objectively measured physical activity and sedentary behavior, fat distribution, quality of life, and height z score were recorded at baseline and at 6 and 12 months. RESULTS. The intervention had no significant effect relative to standard care on BMI z score from baseline to 6 months and 12 months. BMI z score decreased significantly in both groups from baseline to 6 and 12 months. For those who complied with treatment, there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months. There were significant between-group differences in favor of the intervention for changes in total physical activity, percentage of time spent in sedentary behavior, and light-intensity physical activity. CONCLUSIONS. A generalizable, best-practice individualized behavioral intervention had modest benefits on objectively measured physical activity and sedentary behavior but no significant effect on BMI z score compared with standard care among overweight children. The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention, although such treatments may not be realistic for many health care systems.

Quality of life in a clinical sample of obese children

Objectives:To measure health-related quality of life (HRQoL) in a clinical sample of obese children by child self-report and parent-proxy report; to compare quality of life assessments provided by obese children and their parents; to assess differences in quality of life between the obese clinical sample and healthy control children.Design:Pairwise comparison of obese children matched for age, gender and socio-economic status with non-obese controls.Subjects:One hundred and twenty-six obese children (body mass index (BMI) ⩾98th centile) and 71 lean control children (BMI <85th centile). Controls were matched with 71 children from the obese clinical group (mean age 8.6, standard deviation (s.d.) 1.9 years; 33 M/38 F).Measurement:The Paediatric Quality of Life Inventory (UK) version 4 was self-administered to parents and to children aged 8–12 years and interview was administered to children aged 5–7 years. This questionnaire assessed physical, social, emotional and school functioning from which total, physical and psychosocial health summary scores were derived.Results:In the obese clinical group (n=126), parent proxy-reported quality of life was low for all domains. In the obese clinical group, parent-reported scores were significantly lower than child self-reported scores in all domains except physical health and school functioning. Parent-proxy reports were significantly higher for healthy controls than obese children in all domains (median total score 85.2 vs 64.7; 95% confidence interval (CI) 15.6, 24.1). For child self-reports, only physical health was significantly higher for healthy controls than obese children (median score 81.3 vs 75.0; 95% CI 3.1, 12.5).Conclusions:HRQoL is impaired in clinical samples of obese children compared to lean children, but the degree of impairment is likely to be greatest when assessed using the parent perspective rather than the child perspective.

A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study

Aim  To evaluate the effect of exercise consultation on promotion of physical activity in people with Type 2 diabetes.

Parents’ journey through treatment for their child’s obesity: a qualitative study

Background: Treatment for childhood obesity is characterised by patient non-attendance and drop-out, and widespread failure to achieve weight maintenance. Qualitative methods may improve our understanding of patient perceptions and so improve treatment for childhood obesity. Aim: To provide insight into the perceptions of parents of obese children as they “journey” from pre-treatment to end of treatment. Methods: We used purposive sampling and studied 17 parents of children (mean (SD) age 8.4 (2.1) years) attending 6-month outpatient treatments for obesity (BMI>98th percentile). Parent’s perceptions were explored by in-depth interviews, analysed using Framework methods. Results: Parents were characterised as being unaware of their child’s weight, in denial or actively seeking treatment. Parents were consistently motivated to enter treatment due to perceived benefits to their child’s self-esteem or quality of life, and weight outcomes appeared typically less important. During treatment parents felt there was a lack of support for lifestyle changes outside the clinic, and noted that members of the extended family often undermined or failed to support lifestyle changes. Parents generally felt that treatment should have continued beyond 6 months and that it had provided benefits to their child’s well-being, self-esteem and quality of life, and this is what motivated many to remain engaged with treatment. Discussion: This study may help inform future treatments for childhood obesity by providing insights into the aspects of treatment of greatest importance to parents. Future treatments may need to consider providing greater support for lifestyle changes within the extended family, and may need to focus more on psycho-social outcomes.

Incidence of obesity during childhood and adolescence in a large contemporary cohort.

Background and Aims Timing of obesity development during childhood and adolescence is unclear, hindering preventive strategies. The primary aim of the present study was to quantify the incidence of overweight and obesity throughout childhood and adolescence in a large contemporary cohort of English children (the Avon Longitudinal Study of Parents and Children, ALSPAC; children born 1991–1992). A secondary aim was to examine the persistence of overweight and obesity. Methods Longitudinal data on weight and height were collected annually from age 7–15 years in the entire ALSPAC cohort (n = 4283), and from 3 to 15 years in a randomly selected subsample of the cohort (n = 549; ‘Children in Focus’ CiF). Incidence of overweight and obesity (BMI (Body mass index) at or above the 85th and 95th centiles relative to UK reference data) was calculated. Risk ratios (RR) for overweight and obesity at 15 years based on weight status at 3, 7, and 11 years were also calculated. Results In the entire cohort, four-year incidence of obesity was higher between ages 7 and 11 years than between 11 and 15 years (5.0% vs 1.4% respectively). In the CiF sub-sample, four-year incidence of obesity was also highest during mid-childhood (age 7–11 years, 6.7%), slightly lower during early childhood (3–7 years, 5.1%) and lowest during adolescence (11–15 years 1.6%). Overweight and obesity at all ages had a strong tendency to persist to age 15 years as indicated by risk ratios (95% CI (Confidence interval)) for overweight and obesity at 15 years from overweight and obesity (relative to healthy weight status) at 3 years (2.4, 1.8–3.1), 7 years (4.6, 3.6–5.8), and 11 years (9.3, 6.5–13.2). Conclusion Mid–late childhood (around age 7–11 years) may merit greater attention in future obesity prevention interventions.

Effect of an exercise consultation on maintenance of physical activity after completion of phase III exercise-based cardiac rehabilitation

Background Many patients do not maintain physical activity levels after completion of phase III exercise-based cardiac rehabilitation. Design This study determined the effect of an exercise consultation on maintenance of physical activity and cardiorespiratory fitness 12 months after completion of a phase III exercise programme. Seventy cardiac patients were randomized to the experimental (exercise consultation and exercise information) or control groups (exercise information only). Methods Outcomes recorded at baseline, 6 and 12 months were: physical activity (stage of change, 7-day recall, accelerometer), cardiorespiratory fitness, lipids, quality of life, anxiety and depression. Results Both groups were regularly active at baseline. The between-group difference for the change in total activity (min/week) assessed by the 7-day recall was significant from baseline to 12 months [98% confidence interval (CI) −295, −20]. Total activity was maintained in the experimental group (98% CI −63, 154) and significantly decreased in the control group (115 min/week; 98% CI −228, −28) from baseline to 12 months. The between-group difference for the change in accelerometer counts/week was not significant from baseline to 6 (98% CI −1143 720, 607430) or 12 months (98% CI −1131 128, 366 473). A comparable, significant decrease in peak oxygen uptake occurred from baseline to 12 months in experimental (1.8 ml/kg per min; 98% CI −3.2, −0.3) and control participants (2.3 ml/kg per min; −3.8, −0.8). Lipids, quality of life, anxiety and depression were normal at baseline and did not significantly change in either group over time. Conclusion Exercise consultation was effective in maintaining self-reported physical activity, but not peak oxygen uptake, for 12 months after completion of phase III. Eur J Cardiovasc Prev Rehabil 14: 114-121

Habitual physical activity and sedentary behaviour in a clinical sample of obese children

Objective:To objectively measure habitual physical activity and sedentary behaviour in a clinical sample of obese children and to compare with age- and sex-matched non-obese controls.Design:Pairwise comparison of obese children matched for age and gender with non-obese controls.Subjects:A total of 116 obese children (body mass index (BMI)⩾98th centile) and 53 non-obese control children (BMI<85th centile). Controls were matched with 53 of the obese children (mean age 8.6, s.d. 2.0 years; 25 M and 28 F).Measurement:Habitual physical activity and sedentary behaviour were measured over a 7-day period using CSA accelerometers. Total physical activity (mean accelerometry count per minute (c.p.m.)), percentage of monitored time in sedentary behaviour, light and moderate to vigorous intensity physical activity (MVPA) were compared.Results:Obese children (n=116) spent on average 80.4% of their monitored time in sedentary behaviour and 2.5% of their monitored time in MVPA. Total activity (mean c.p.m.) was significantly higher in the non-obese group (n=53) than the obese group (n=53), 729 vs 648 c.p.m.; 95% confidence interval (CI) 7, 155. Time spent in sedentary behaviour averaged 80.9% (s.d. 6.6) in the obese group and 79.3% (s.d. 6.2) in the non-obese group, with no significant between-group difference (95% CI −3.9, 0.6). Light intensity activity was similar in the obese and non-obese groups (15.9 vs 17.3%; 95% CI −0.3, 3.0). Participation in MVPA was significantly higher in the non-obese vs obese group (3.9 vs 2.4%; 95% CI 0.6, 2.0).Conclusion:This study supports the hypothesis that a clinical sample of obese children is less physically active than non-obese children, although the difference in total activity and MVPA between the groups was small.

Timing of adiposity rebound and adiposity in adolescence

OBJECTIVES: To investigate associations between timing of adiposity rebound (AR; the period in childhood where BMI begins to increase from its nadir) and adiposity (BMI, fat mass) at age 15 years in the Avon Longitudinal Study of Parents and Children (ALSPAC). METHODS: The sample consisted of 546 children with AR derived in childhood and BMI and fat mass index (FMI; fat mass measured by dual-energy radiograph absorptiometry/height in m2) measured at 15 years. Multivariable linear regression models were based on standardized residuals of log BMI and log FMI to allow comparison of regression coefficients across outcomes. RESULTS: There were strong dose-response associations between timing of AR and both adiposity outcomes at 15 years independent of confounders. BMI was markedly higher in adolescence for those with very early AR (by 3.5 years; β = 0.70; 95% confidence interval [CI]: 0.33–1.07; P ≤ .001) and was also higher for those with early AR (between 3.5 and 5 years; β = 0.34; 95% CI: 0.08–0.59; P = .009) compared with those with later AR (>5 years) after full adjustment for a range of potential confounders. Similar magnitudes of association were found for FMI after full adjustment for confounders (compared with later AR: very early AR β = 0.74; 95% CI: 0.34–1.15; P ≤ .001; early AR β = 0.35; 95% CI: 0.07–0.63; P = .02). CONCLUSIONS: Early AR is strongly associated with increased BMI and FMI in adolescence. Preventive interventions should consider targeting modifiable factors in early childhood to delay timing of AR.

Exercise consultation improves short-term adherence to exercise during phase IV cardiac rehabilitation: a Randomized, controlled trial

This randomized-controlled trial demonstrates that an exercise consultation, based on the transtheoretic model of exercise behavior change, significantly improves short-term adherence to exercise.

Timing of Excess Weight Gain in the Avon Longitudinal Study of Parents and Children (ALSPAC)

OBJECTIVES: To test the hypothesis that most excess weight gain occurs by school entry in a large sample of English children, and to determine when the greatest gain in excess weight occurred between birth and 15 years. METHODS: Longitudinal data were collected annually from birth to 15 years in 625 children. Weight and BMI at each time point were expressed relative to UK 1990 growth reference as z scores. Excess weight gain was calculated as the group increase in weight and BMI z scores between specific time periods. RESULTS: Weight z score did not increase from birth to 5 years (mean difference: 0.04 [95% confidence interval (CI): −0.03–0.12] P = .30) but increased from 5 to 9 years (mean difference: 0.19 [95% CI: 0.14–0.23] P < .001). BMI z score increased from 7 to 9 years (mean difference: 0.22 [95% CI: 0.18–0.26] P < .001), with no evidence of a large increase before 7 years and after 9 years. CONCLUSIONS: Our results do not support the hypothesis that most excess weight gain occurs in early childhood in contemporary English children. Excess weight gain was substantial in mid-childhood, with more gradual increases in early childhood and adolescence, which indicates that interventions to prevent excess weight should focus on school-aged children and adolescents as well as the preschool years.