Elisabeth M. Seburg

A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions.

Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n = 2722) and full-text review (n = 177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.

Healthy Homes/Healthy Kids: A randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5–10 year olds☆☆★

Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.

Household Factors, Family Behavior Patterns, and Adherence to Dietary and Physical Activity Guidelines Among Children at Risk for Obesity

OBJECTIVE To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. DESIGN Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. PARTICIPANTS A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95). MAIN OUTCOMES MEASURED Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). ANALYSIS Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance. RESULTS Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). CONCLUSIONS AND IMPLICATIONS Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect childrens weight-related behaviors and growth trajectories.

Concern about Child Weight among Parents of Children At-Risk for Obesity.

OBJECTIVES This study investigated the relationship between parental concern about child weight and weight-related child behaviors, parenting practices, and household characteristics. METHODS Parent-child dyads (N=421) enrolled in a randomized, controlled obesity prevention trial were evaluated at baseline. RESULTS Parental concern regarding child weight was associated with greater use of restrictive and monitoring feeding practices and lower total child energy intake. CONCLUSIONS Parents expressing greater concern about child weight were more likely to report engaging in strategies to regulate their childs dietary intake, some of which may inadvertently have negative consequences. Intervention strategies that activate parental concern about child weight should include guidance and support for engaging in feeding practices that support healthful child eating patterns and growth.

Eating behaviors and quality of life in preadolescents at risk for obesity with and without abdominal pain

Objectives: We evaluated eating behaviors and quality of life (QOL) in preadolescent children at risk for obesity, with and without abdominal pain (AP). Methods: Participants were parent–child dyads enrolled in a randomized, controlled obesity prevention trial. The children were between 5 and 10 years of age and at risk for obesity (70th–95th percentile of body mass index, n = 420). Parents completed measures of their childs eating behaviors, QOL, AP, and bowel function and their own depression status, concern about child weight, and feeding practices. Childrens height and weight were also measured. Results: Children with frequent AP (≥2/month, n = 103) were compared with children reporting infrequent AP (<2/month, n = 312). Age and body mass index did not differ between groups, but AP was more prevalent in girls. Child emotional overeating and parental depression scores were higher in the frequent AP group (P < 0.01), and child QOL was lower (P < 0.01). In multivariable analysis, female gender (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.20–3.97), emotional overeating (OR 2.28, 95% CI 1.37–3.81), and parental depression (OR 1.23, 95% CI 1.12–1.35) were associated with more frequent AP. Secondary analyses were completed for children who met Rome III criteria for irritable bowel syndrome. Conclusions: Clinicians working with children with AP at risk for obesity should consider assessing for and, when appropriate, addressing parent and child factors that could exacerbate AP.

Objectively coding intervention fidelity during a phone-based obesity prevention study.

BACKGROUND Childhood obesity prevention studies have yielded disappointing results. Understanding intervention fidelity is necessary in explaining why interventions are (or are not) successful and ultimately improving future intervention. In spite of this, intervention fidelity it is not consistently reported in the obesity prevention literature. The purpose of the current study was to develop and utilize a coding protocol to objectively assess intervention fidelity in a phone-based obesity prevention study for parents of preschool-aged children. FINDINGS Both interventionists and independent coders completed session fidelity measures including time spent on target areas (media use, physical activity, etc.) and components of goal setting quality. Coders also rated participant engagement. Agreement between ratings by interventionists and coders, fidelity levels and changes in fidelity components over time are presented. Coders and interventionists showed high agreement when reporting time spent discussing different target areas. Interventionists consistently rated themselves higher than independent coders on measures of goal quality. Coder ratings of session quality were initially high, but some components declined slightly across the eight sessions. CONCLUSIONS Future directions for intervention fidelity measurement and analysis are discussed, including utilizing changes in fidelity measures over time to predict study outcomes. Obtaining a more in-depth understanding of intervention fidelity has the potential to strengthen obesity interventions.

Chapter 24 – Behavioral Risk Factors for Overweight and Obesity: Diet and Physical Activity

Abstract Understanding the determinants of obesity and developing appropriate prevention and treatment strategies require an in-depth examination of behavioral risk factors for obesity. The goal of this chapter is to review available data regarding the prevalence of overweight and obesity and the modifiable dietary and physical activity behavioral determinants of obesity that are potential targets for obesity prevention and treatment interventions. We begin with an examination of dietary factors that contribute to the development of overweight and obesity. Multiple factors that influence food intake will be discussed, including total energy intake, specific eating patterns, and environmental and societal influences. We then discuss physical activity factors, including exercise self-efficacy, social support, and access to exercise opportunities. The review will focus on behavioral risk factors for obesity in both children and adults.

Parent Choice in a Pediatric Obesity Prevention Intervention

Background There is value in having parents choose which behaviors to address in obesity interventions, but it is unknown whether they choose behaviors that will effectively impact healthy growth. This study assessed whether child behaviors or parent intention to change behaviors were associated with behaviors parents chose to discuss. Methods Parent intention to change specific behaviors and time spent discussing behaviors was coded during intervention sessions. Results Child activity, screen-time, energy intake, breakfast, and family meals were associated with time spent discussing these behaviors. Fewer associations were seen between parent intention and time spent discussing these behaviors. Conclusions Results suggest that in interventions allow choice, parents may choose to discuss the weight-related behaviors their children need to address.