Ann M. Davis

Brain Responses to Food Logos in Obese and Healthy Weight Children

OBJECTIVE To evaluate brain activation in response to common food and nonfood logos in healthy weight and obese children. STUDY DESIGN Ten healthy weight children (mean body mass index in the 50th percentile) and 10 obese children (mean body mass index in the 97.9th percentile) completed self-report measures of self-control. They then underwent functional magnetic resonance imaging while viewing food and nonfood logos. RESULTS Compared with the healthy weight children, obese children showed significantly less brain activation to food logos in the bilateral middle/inferior prefrontal cortex, an area involved in cognitive control. CONCLUSION When shown food logos, obese children showed significantly less brain activation than the healthy weight children in regions associated with cognitive control. This provides initial neuroimaging evidence that obese children may be more vulnerable to the effects of food advertising.

Branding and a child’s brain: an fMRI study of neural responses to logos

Branding and advertising have a powerful effect on both familiarity and preference for products, yet no neuroimaging studies have examined neural response to logos in children. Food advertising is particularly pervasive and effective in manipulating choices in children. The purpose of this study was to examine how healthy children’s brains respond to common food and other logos. A pilot validation study was first conducted with 32 children to select the most culturally familiar logos, and to match food and non-food logos on valence and intensity. A new sample of 17 healthy weight children were then scanned using functional magnetic resonance imaging. Food logos compared to baseline were associated with increased activation in orbitofrontal cortex and inferior prefrontal cortex. Compared to non-food logos, food logos elicited increased activation in posterior cingulate cortex. Results confirmed that food logos activate some brain regions in children known to be associated with motivation. This marks the first study in children to examine brain responses to culturally familiar logos. Considering the pervasiveness of advertising, research should further investigate how children respond at the neural level to marketing.

Ability to Delay Gratification and BMI in Preadolescence

Delay of gratification tasks require an individual to forgo an immediate reward and wait for a more desirable delayed reward. This study used an ecologically valid measure of delayed gratification to test the hypothesis that preadolescents with higher BMI would be less likely to delay gratification. Healthy Hawks is a 12‐week educational/behavioral obesity intervention at the University of Kansas Medical Center. Each week, children earn a point if they complete their goals worksheet. They can spend that point immediately on a small toy prize or save points to use on a larger prize. We retrospectively calculated the percentage of points saved over the 12 weeks for 59 children (28 females) ages 8–12 years old (mean = 10.29 ± 1.39). Spearman correlation revealed that higher BMI percentile was associated with reduced point savings (r = 0.33, P = 0.01). Similarly, obese preadolescents saved significantly fewer points than healthy weight (HW) and overweight preadolescents (t (57) = 3.14, P < 0.01). Results from our ecologically valid measure support the theory that obese children are less likely to delay gratification than overweight and HW children. Even for nonfood rewards, preadolescent children with higher BMIs prefer the immediate reward over a delayed, larger reward. This has implications for developing specific strategies within obesity treatments aimed at improving delayed gratification.

Pediatric Obesity Attitudes, Services, and Information Among Rural Parents: A Qualitative Study

The objective of this study was to learn more about the attitudes concerning pediatric obesity among rural parents, the barriers these parents face in trying to help their children attain a healthy weight status, and the pediatric weight loss services currently available in small rural communities. A series of eight qualitative focus groups were conducted with 21 parents of overweight rural children in third through fifth grade. Eight saturated themes resulted indicating that parents (i) believe overweight children are lazy, (ii) are concerned about the weight of their children, (iii) believe that some individuals will be overweight no matter what they do, and (iv) have tried a variety of techniques to help their children lose weight. Barriers to helping their children lose weight unique to their rural status included lack of weight loss resources in their community, lack of exercise facilities, and lack of low‐fat or low‐calorie options in grocery stores. Rural families of overweight children encounter many barriers to healthier living, some of which are unique to their rural status.

iPhone App Adherence to Expert-Recommended Guidelines for Pediatric Obesity Prevention

BACKGROUND Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of childrens exercise and nutrition smartphone apps. METHOD Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity. RESULTS App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed. CONCLUSIONS Current childrens diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability

To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine. Seventeen families were randomly assigned to one of two conditions (physician visit, TeleMedicine). Measures included feasibility, satisfaction and intervention outcome measures such as BMI percentile, and nutrition and activity behaviours. Measures were completed at baseline, post-treatment and at 1-year follow-up. Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive. Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group. A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers. Due to the small sample size, null findings regarding intervention outcome should be interpreted with caution. Future research should focus on methods to increase the impact of this intervention on key outcome variables.

Randomized trial comparing two methods of increasing dietary calcium intake in children with inflammatory bowel disease

Objective: To examine the efficacy of behavioral intervention compared with enhanced standard of care nutrition intervention on increasing dietary calcium intake of children with inflammatory bowel disease. Method: Children aged 5 to 12 years old (N = 32) were randomly assigned to the behavioral intervention or enhanced standard of care conditions. Three-day food diaries collected on all participants at baseline and post-treatment were analyzed for dietary calcium intake. Results: Children in the behavioral intervention group achieved a significantly greater mean increase in dietary calcium intake (M= 984 mg) than children in the enhanced standard of care group (M = 274 mg) (P < 0.05). In the behavioral intervention group 81% of children achieved the daily calcium intake goal of 1500 mg/day compared with only 19% of children in the enhanced standard of care group, (P < 0.05). Conclusions: Behavioral modification appears to be significantly more effective than nutrition education alone in modifying calcium intake in children with inflammatory bowel disease.

Sensory processing issues in young children presenting to an outpatient feeding clinic.

Objectives: The aim of the study was to describe the relation between sensory issues and medical complexity in a series of patients presenting to an outpatient multidisciplinary feeding team for evaluation, by a standardized measure of sensory-processing abilities. Methods: A retrospective chart review of all of the patients seen from 2004 to 2009 on 2 key variables: medical diagnostic category and short sensory profile (SSP) score. Results: On the SSP, 67.6% of children scored in the clinical (“definite difference”) range. The most common diagnostic categories were developmental (n = 23), gastrointestinal (n = 16), and neurological (n = 13). Behavioral and cardiorespiratory medical diagnostic categories were significantly related to SSP total score and SSP definite difference score. Conclusions: Children who present for feeding evaluation do indeed tend to have clinically elevated scores regarding sensory processing, and these elevated scores are significantly related to certain medical diagnostic categories. Future research is needed to determine why these significant relations exist as well as their implications for treatment of feeding-related issues.

Treating rural paediatric obesity through telemedicine vs. telephone: Outcomes from a cluster randomized controlled trial

Objective The objective of the current study was to examine the feasibility of telemedicine vs. telephone for the delivery of a multidisciplinary weekly family-based behavioural group intervention to treat paediatric obesity delivered to families living in rural areas using a randomized controlled trial methodology. Methods 103 rural children and their families were recruited. Feasibility measures included participant satisfaction, session attendance and retention. Treatment outcome measures included child Body Mass Index z-score (BMIz), parent BMI, 24-hour dietary recalls, accelerometer data, the child behavior checklist and the behavioral pediatrics feeding assessment scale. Results Participants were highly satisfied with the intervention both via telemedicine and via telephone. Completion rates were much higher than for other paediatric obesity intervention programmes, and both methodologies were highly feasible. There were no differences in telemedicine and telephone groups on primary outcomes. Conclusion Both telemedicine and telephone intervention appear to be feasible and acceptable methods of delivering paediatric obesity treatment to rural children.

Empirically Supported Treatments for Feeding Difficulties in Young Children

Pediatric feeding problems are common among children and present severe issues for families. Unfortunately, treatment outcome studies with this population are sparse. The current study reviews the literature regarding treatment studies of children with severe feeding issues, provides an overview of empirically supported treatments for children who do eat orally, and finally summarizes interventions that attempt to reintroduce oral feeding to children who have been fed by gastrostomy tube or other non-oral feeding route.