Crystal S. Lim

Systematic Review and Meta-Analysis of Comprehensive Behavioral Family Lifestyle Interventions Addressing Pediatric Obesity

PURPOSE To conduct a meta-analysis of randomized controlled trials examining the efficacy of comprehensive behavioral family lifestyle interventions (CBFLI) for pediatric obesity.  METHOD Common research databases were searched for articles through April 1, 2013. 20 different studies (42 effect sizes and 1,671 participants) met inclusion criteria. Risk of bias assessment and rating of quality of the evidence were conducted.  RESULTS The overall effect size for CBFLIs as compared with passive control groups over all time points was statistically significant (Hedges g = 0.473, 95% confidence interval [.362, .584]) and suggestive of a small effect size. Duration of treatment, number of treatment sessions, the amount of time in treatment, child age, format of therapy (individual vs. group), form of contact, and study use of intent to treat analysis were all statistically significant moderators of effect size. CONCLUSION CBFLIs demonstrated efficacy for improving weight outcomes in youths who are overweight or obese.

Randomized clinical trial of distraction for infant immunization pain

&NA; Distraction has been shown to be an effective technique for managing pain in children; however, few investigations have examined the utility of this technique with infants. The goal of the current study was to investigate the effectiveness of movie distraction in reducing infants’ immunization distress. Participants were 136 infants (range = 1–21 months; M = 7.6 months, SD = 5.0 months) and their parents, all of whom were recruited when presenting for routine vaccinations. The parent–child dyads were randomly assigned to either a Distraction or Typical Care control condition. Infant and adult behaviors were assessed using a visual analog scale and a behavioral observation rating scale. Results indicated parents in the Distraction group engaged in higher rates of distraction than those in the Typical Care group, whereas there was no difference in the behavior of nurses in the Distraction and Typical Care groups. In addition, infants in the Distraction group displayed fewer distress behaviors than infants in the Typical Care group both prior to and during recovery from the injection. Findings suggest that a simple and practical distraction intervention can provide some distress relief to infants during routine injections.

An examination of comorbid asthma and obesity: assessing differences in physical activity, sleep duration, health-related quality of life and parental distress

Abstract Objective: Compare youth with comorbid asthma and obesity to youth with obesity only to determine if differences exist in body mass index, dietary intake, levels of physical activity, sleep duration and health-related quality of life. Levels of parent distress were also compared. Methods: Participants included 248 children (n = 175 in Obesity group; n = 73 in Asthma + Obesity group) with a BMI ≥ 85th percentile for age and gender, and their participating parent(s) or legal guardian(s). Measures of child height and weight were obtained by study personnel and Z-scores for child body mass index were calculated using age- and gender-specific norms. Child physical activity and sleep duration were measured via accelerometers. Dietary intake, health-related quality of life and parent distress were assessed via self-report. Results: The Asthma + Obesity group evidenced significantly higher body mass index scores, and had lower sleep duration. There was a non-statistically significant trend for lower levels of physical activity among children in the Asthma + Obesity group. Dietary intake, health-related quality of life and parent distress did not differ between groups. Conclusions: Youth with comorbid asthma and obesity are at increased risk for negative health and psychosocial difficulties compared to youth who are overweight or obese only. Professionals providing treatment for youth with asthma are encouraged to assess the implications of weight status on health behaviors and family psychosocial adjustment.

Pain and Pain Management

People interpret their pain according to their particular life experiences, values and beliefs. If you value stoicism for religious or cultural reasons you should discuss the matter with your religious leader or a pastoral carer. None of the major religions urges its followers to reject pain-killers (analgesics) in terminal illness. If you think that it is weak to ‘give in’ to pain, you might consider whether analgesia will free your energy for more important things.

Peer Victimization and Depressive Symptoms in Obese Youth: The Role of Perceived Social Support

This study examined whether social support moderates the relation between peer victimization and depressive symptoms in children who are obese. Participants were 96 children 8 to 17 years of age (M = 12.8, SD = 1.8) attending a pediatric obesity clinic. Children completed self-report measures. Results indicated that for obese girls peer social support significantly moderated the association between peer victimization and depression, but this result was not found for obese boys. Partial support was found that peer social support buffered the relation between peer victimization and depressive symptoms in obese children. However, important gender differences were found.

Disordered Eating and Health-Related Quality of Life in Overweight and Obese Children

OBJECTIVES To examine disordered eating and associations with health-related quality of life (HRQOL) in rural overweight/obese (OW/OB) children. METHODS Cross-sectional analyses were conducted with 272 rural OW/OB children aged 8-12 years (M = 10.36; SD = 1.39). Child anthropometrics, demographics, disordered eating attitudes, unhealthy weight control behaviors (UWCBs), and HRQOL were measured. Relationships between these variables were analyzed using bootstrapped multiple linear regressions. RESULTS Clinically significant disordered eating attitudes were endorsed by 17% of the sample, and the majority endorsed UWCBs. Disordered eating attitudes and weight status were the most common predictors of HRQOL. Disordered eating attitudes and UWCBs were negatively related to emotional HRQOL but were unrelated to social, school, or physical HRQOL. CONCLUSIONS Disordered eating is a serious and relevant problem in OW/OB children living in rural areas and may be indicative of impairments in emotional functioning. Early intervention may reduce the risk for eating disorders and associated negative sequelae.

A Pilot Study Examining a Group-Based Behavioral Family Intervention for Obese Children Enrolled in Medicaid: Differential Outcomes by Race

This pilot study examined the efficacy of a behavioral family intervention (BFI) to address weight management in obese children from economically disadvantaged backgrounds. Forty children, ages 6 to 12, and their parents enrolled in Medicaid were assigned to a BFI or an individual standard of care condition. Assessments were completed at baseline, posttreatment, and 9-month follow up. There were no differences in weight outcomes across treatment conditions. However, there were trends to suggest differences in weight change by child race. Specifically, children identified as African American benefited less from the BFI than Caucasian children. Implications for practice and research are discussed.

The Community-based Healthy-lifestyle Intervention for Rural Preschools (CHIRP) study: Design and methods

The CHIRP study is a two-arm, pilot randomized controlled trial assessing the effectiveness of a behavioral family weight management intervention in an important and at-risk population, overweight young children, 3 to 6 years of age, and their parents from underserved rural counties. Participants will include 96 parent-child dyads living in rural counties in north central Florida. Families will be randomized to one of two conditions: (a) behavioral family based intervention or (b) a waitlist control. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4), and follow-up (month 10). Assessments and intervention sessions will be held at the Cooperative Extension office in each participating rural county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, and parent BMI. This study is unique because (1) it is one of the few randomized controlled trails examining a behavioral family intervention to address healthy habits and improved weight status in young overweight and obese children, (2) addresses health promotion in rural settings, and (3) examines intervention delivery in real world community settings through the Cooperative Extension Service offices. If successful, this research has potential implications for medically underserved rural communities and preventative health services for young children and their families.

Executive Function and Dysregulated Eating Behaviors in Pediatric Obesity

Objective To examine the association between caregiver proxy report of executive function (EF) and dysregulated eating behavior in children with obesity. Methods Participants were 195 youth with obesity aged 8-17 years, and their legal guardians. Youth height, weight, demographics, depressive symptoms, eating behaviors, and EF were assessed cross-sectionally during a medical visit. Analyses of covariance, adjusted for child age, gender, race/ethnicity, standardized BMI, depressive symptoms, and family income were used to examine differences in youth EF across caregiver and youth self-report of eating behaviors. Results Youth EF differed significantly by caregiver report of eating behavior but not youth self-report. Post hoc analyses showed that youth with overeating or binge eating had poorer EF than youth without these eating behaviors. Conclusions Executive dysfunction, as reported by caregivers, in youth with obesity may be associated with dysregulated eating behaviors predictive of poor long-term psychosocial and weight outcomes. Further consideration of EF-specific targets for assessment and intervention in youth with obesity may be warranted.

Depressive Symptoms, Ethnic Identity, and Health-Related Quality of Life in Obese Youth

OBJECTIVE Examine relations between depressive symptoms, ethnic identity, and health-related quality of life (HRQOL) in overweight or obese (OV/OB) children. METHODS A total of 166 OV/OB 8- to 17-year-olds (M = 12.94 years; 86.7% obese; 50.6% racial/ethnic minority) attending an outpatient pediatric obesity medical clinic participated. Children completed the Childrens Depression Inventory-Short Form, Multigroup Ethnic Identity Measure (MEIM), and Pediatric Quality of Life Inventory. RESULTS Increased depressive symptoms significantly predicted reduced total, physical, and psychosocial HRQOL. For minority OV/OB youth only, MEIM Affirmation/Belonging moderated depressive symptoms and total HRQOL (effect = -2.59, t = -2.24, p = .027; R(2) overall model = 0.315) and depressive symptoms and psychosocial HRQOL (effect = -3.01, t = -2.47, p = .015; R(2) overall model = 0.331). CONCLUSIONS Depressive symptoms are negatively associated with HRQOL. In minority OV/OB youth, high ethnic identity may be protective when depressive symptoms are minimal. Ethnic identity and other cultural factors are important to consider in psychosocial treatments for pediatric obesity.