Cynthia A. Danford

Self-weighing in weight management: a systematic literature review.

Regular self‐weighing, which in this article is defined as weighing oneself regularly over a period of time (e.g., daily, weekly), is recommended as a weight loss strategy. However, the published literature lacks a review of the recent evidence provided by prospective, longitudinal studies. Moreover, no paper has reviewed the psychological effects of self‐weighing. Therefore, the objective is to review the literature related to longitudinal associations between self‐weighing and weight change as well as the psychological outcomes.

The Assessment and Non-Pharmacologic Treatment of Procedural Pain From Infancy to School Age Through a Developmental Lens: A Synthesis of Evidence With Recommendations.

UNLABELLED The 2011 IOM report stated that pain management in children is often lacking especially during routine medical procedures. The purpose of this review is to bring a developmental lens to the challenges in assessment and non-pharmacologic treatment of pain in young children. METHOD A synthesis of the findings from an electronic search of PubMed and the university library using the keywords pain, assessment, treatment, alternative, complementary, integrative, infant, toddler, preschool, young, pediatric, and child was completed. A targeted search identified additional sources for best evidence. RESULTS Assessment of developmental cues is essential. For example, crying, facial expression, and body posture are behaviors in infancy that indicate pain: however in toddlers these same behaviors are not necessarily indicative of pain. Preschoolers need observation scales in combination with self-report while for older children self-report is the gold standard. Pain management in infants includes swaddling and sucking. However for toddlers, preschoolers and older children, increasingly sophisticated distraction techniques such as easily implemented non-pharmacologic pain management strategies include reading stories, watching cartoons, or listening to music. DISCUSSION A developmental approach to assessing and treating pain is critical. Swaddling, picture books, or blowing bubbles are easy and effective when used at the appropriate developmental stage and relieve both physical and emotional pain. Untreated pain in infants and young children may lead to increased pain perception and chronic pain in adolescents and adults. Continued research in the non-pharmacological treatment of pain is an important part of the national agenda.

Cardiovascular disease risk factors are elevated in urban minority children enrolled in head start.

BACKGROUND The prevalence of obesity and overweight persists in the preschool population, despite some prevention and treatment advances, particularly in minorities. Investigating the prevalence of dyslipidemia and the effect of family health may also guide the focus of intervention efforts. METHODS Anthropometric data were collected from urban minority preschool children (n=161; 42% female) enrolled in USDA Head Start. Blood was collected by finger prick and analyzed with the Cholestech LDX Analyzer (Cholestech Corporation, Hayward, CA). Caregivers provided a self-reported family health history for cardiovascular diseases (CVDs). RESULTS By BMI percentile, 8% of the children were underweight (UW), 54% healthy weight (HW), 10% overweight (OW), and 28% obese (OB). One of every 5 children had borderline or high-risk levels for total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides based on the National Cholesterol Education Program categories. In OW/OB children only, BMI was positively correlated with TC (r(61)=0.428; p=0.001) and LDL (r(58)=0.395; p=0.005). Child BMI was also associated with family comorbid diseases (r(159)=0.177; p=0.025). UW/HW children with a family history of CVD had significantly higher LDL than UW/HW children without a family history of CVD (p=0.001). Step-wise regression analysis revealed that BMI (p=0.005) plus family history of heart attack (p=0.018) were significant predictors of blood TC levels. CONCLUSION Continued efforts to treat and prevent elevated weight are urgently needed for minority preschoolers. Attention to CVD screening may be an important target in school, community, and healthcare arenas for minority populations regardless of weight status.

Socio-demographic, anthropometric, and psychosocial predictors of attrition across behavioral weight-loss trials.

Preventing attrition is a major concern in behavioral weight loss intervention studies. The purpose of this analysis was to identify baseline and six-month predictors associated with participant attrition across three independent clinical trials of behavioral weight loss interventions (PREFER, SELF, and SMART) that were conducted over 10 years. Baseline measures included body mass index, Barriers to Healthy Eating, Beck Depression Inventory-II (BDI), Hunger Satiety Scale (HSS), Binge Eating Scale (BES), Medical Outcome Study Short Form (MOS SF-36 v2) and Weight Efficacy Lifestyle Questionnaire (WEL). We also examined early weight loss and attendance at group sessions during the first 6 months. Attrition was recorded at the end of the trials. Participants included 504 overweight and obese adults seeking weight loss treatment. The sample was 84.92% female and 73.61% white, with a mean (± SD) age of 47.35 ± 9.75 years. After controlling for the specific trial, for every one unit increase in BMI, the odds of attrition increased by 11%. For every year increase in education, the odds of attrition decreased by 10%. Additional predictors of attrition included previous attempts to lose 50-79 lbs, age, not possessing health insurance, and BES, BDI, and HSS scores. At 6 months, the odds of attrition increased by 10% with reduced group session attendance. There was also an interaction between percent weight change and trial (p<.001). Multivariate analysis of the three trials showed education, age, BMI, and BES scores were independently associated with attrition (ps ≤ .01). These findings may inform the development of more robust strategies for reducing attrition.

Parenting Efficacy Related to Childhood Obesity: Comparison of Parent and Child Perceptions

The aim of this study was to explore child and parent perceptions of parenting efficacy related to child BMI. This descriptive, cross-sectional study recruited 27 parent-child dyads participating in a healthy eating/activity intervention. Parent and child perceptions of parenting efficacy were measured using a version of the Tool to Measure Parenting Self-Efficacy (TOPSE). Paired sample t test and correlational statistics were used. Parents and children had similar perception of parenting efficacy. Child report of parenting efficacy and child BMI was significant. Exploring perceptions of parenting efficacy will help individualize family-focused intervention programs to prevent obesity in children.

African American Preschool Children's Physical Activity Levels in Head Start

The purpose of this study was to describe the physical activity levels of urban inner city preschoolers while attending Head Start, the federally funded preschool program for children from low-income families. Participants were 158 African American children. Their physical activity during Head Start days was measured using programmed RT-3 accelerometers. Results revealed that the children spent the most time in sedentary and light physical activity, while their participation in moderate-to-vigorous physical activities was low. Given the sedentary class format and limited physical space for the Head Start programs observed, we suggest adding a structured physical activity component to Head Start schools to fight the overweight and obesity crisis.

Association between Self-Weighing and Percent Weight Change: Mediation Effects of Adherence to Energy Intake and Expenditure Goals.

BACKGROUND To date, no investigators have examined electronically recorded self-weighing behavior beyond 9 months or the underlying mechanisms of how self-weighing might impact weight change. OBJECTIVE Our aims were to examine electronically recorded self-weighing behavior in a weight-loss study and examine the possible mediating effects of adherence to energy intake and energy expenditure (EE) goals on the association between self-weighing and weight change. DESIGN This was a secondary analysis of the self-efficacy enhancement arm of the Self Efficacy Lifestyle Focus (SELF) trial, an 18-month randomized clinical trial. PARTICIPANTS/SETTING The study was conducted at the University of Pittsburgh (2008-2013). Overweight or obese adults with at least one additional cardiovascular risk factor were eligible. INTERVENTION Participants in the self-efficacy enhancement arm were given a scale (Carematix, Inc) and instructed to weigh themselves at least 3 days per week or every other day. The scale date- and time-stamped each weighing episode, storing up to 100 readings. MAIN OUTCOME MEASURES Weight was assessed every 6 months. Adherence to energy intake and EE goals was calculated on a weekly basis using paper diary data. STATISTICAL ANALYSES PERFORMED Linear mixed modeling and mediation analyses were used. RESULTS The sample (n=55) was 80% female, 69% non-Hispanic white, mean (standard deviation) age was 55.0 (9.6) years and body mass index (calculated as kg/m2) was 33.1 (3.7). Adherence to self-weighing declined over time (P<0.001). From baseline to 6 months, there was a significant mediation effect of adherence to energy intake (P=0.02) and EE goals (P=0.02) on the association between adherence to self-weighing and percent weight change. Mediation effects were not significant during the second and third 6-month periods of the study. CONCLUSIONS Objectively measured adherence to self-weighing declined over 18 months. During the first 6 months, self-weighing directly impacted weight change and indirectly impacted weight change through changes in energy intake and EE.

Patterns of self-weighing behavior and weight change in a weight loss trial

Background/Objectives:Regular self-weighing has been associated with weight loss and maintenance in adults enrolled in a behavioral weight loss intervention; however, few studies have examined the patterns of adherence to a self-weighing protocol. The study aims were to (1) identify patterns of self-weighing behavior; and (2) examine adherence to energy intake and step goals and weight change by self-weighing patterns.Subjects/Methods:This was a secondary analysis of self-monitoring and assessment weight data from a 12-month behavioral weight loss intervention study. Each participant was given a scale that was Wi-Fi-enabled and transmitted the date-stamped weight data to a central server. Group-based trajectory modeling was used to identify distinct classes of trajectories based on the number of days participants self-weighed over 51 weeks.Results:The sample (N=148) was 90.5% female, 81.1% non-Hispanic white, with a mean (s.d.) age of 51.3 (10.1) years, had completed an average of 16.4 (2.8) years of education and had mean body mass index of 34.1 (4.6) kg m−2. Three patterns of self-weighing were identified: high/consistent (n=111, 75.0% self-weighed over 6 days per week regularly); moderate/declined (n=24, 16.2% declined from 4–5 to 2 days per week gradually); and minimal/declined (n=13, 8.8% declined from 5–6 to 0 days per week after week 33). The high/consistent group achieved greater weight loss than either the moderate/declined and minimal/declined groups at 6 months (−10.19%±5.78%, −5.45%±4.73% and −2.00%±4.58%) and 12 months (−9.90%±8.16%, −5.62%±6.28% and 0.65%±3.58%), respectively (P<0.001). The high/consistent group had a greater mean number days per week of adherence to calorie intake goal or step goal but not higher than the moderate/declined group.Conclusions:This is the first study to reveal distinct temporal patterns of self-weighing behavior. The majority of participants were able to sustain a habit of daily self-weighing with regular self-weighing leading to weight loss and maintenance as well as adherence to energy intake and step goals.

An integrative review of sleep interventions and related clinical implications for obesity treatment in children

PURPOSE Evidence has shown correlations between obesity and sleep in children. The purpose of this review was to identify sleep interventions that could be utilized in primary care settings to prevent obesity in children. RESULTS Three themes emerged: bedtime routines and environment; parental presence and graduated extinction; and health education. Effective strategies to improve sleep in children include consistent bedtime routine and self-soothing. CONCLUSION Health care professionals can provide innovative and prevention-based sleep education for parents early in a childs development. Education, related to sleep, and appropriate sleep strategies may help prevent obesity and its long-term consequences.

Reiki Therapy for Symptom Management in Children Receiving Palliative Care: A Pilot Study:

Background: Pain may be reported in one-half to three-fourths of children with cancer and other terminal conditions and anxiety in about one-third of them. Pharmacologic methods do not always give satisfactory symptom relief. Complementary therapies such as Reiki may help children manage symptoms. Objective: This pre–post mixed-methods single group pilot study examined feasibility, acceptability, and the outcomes of pain, anxiety, and relaxation using Reiki therapy with children receiving palliative care. Methods: A convenience sample of children ages 7 to 16 and their parents were recruited from a palliative care service. Two 24-minute Reiki sessions were completed at the children’s home. Paired t tests or Wilcoxon signed-rank tests were calculated to compare change from pre to post for outcome variables. Significance was set at P < .10. Cohen d effect sizes were calculated. Results: The final sample included 8 verbal and 8 nonverbal children, 16 mothers, and 1 nurse. All mean scores for outcome variables decreased from pre- to posttreatment for both sessions. Significant decreases for pain for treatment 1 in nonverbal children (P = .063) and for respiratory rate for treatment 2 in verbal children (P = .009). Cohen d effect sizes were medium to large for most outcome measures. Discussion: Decreased mean scores for outcome measures indicate that Reiki therapy did decrease pain, anxiety, heart, and respiratory rates, but small sample size deterred statistical significance. This preliminary work suggests that complementary methods of treatment such as Reiki may be beneficial to support traditional methods to manage pain and anxiety in children receiving palliative care.