Elizabeth R. Pulgaron

Childhood obesity: a review of increased risk for physical and psychological comorbidities.

BACKGROUND Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities. OBJECTIVE The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally. METHODS PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities. RESULTS The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems. CONCLUSIONS The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical.

Obesity and Type 2 Diabetes in Children: Epidemiology and Treatment

The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.

A problem-solving intervention for children with persistent asthma: A pilot of a randomized trial at a pediatric summer camp

Background: Pediatric summer camps are emerging as a means to increase social support and improve childrens attitudes about their chronic illness. Because of the high rate of camp attendance, it may be feasible to implement interventions within that setting; however, it has yet to be determined what components of camp are beneficial. Objective: The objective of this pilot study was to determine the efficacy of a problem-solving intervention targeting disease management in improving psychosocial functioning of children with persistent asthma, over and above the benefits of participation in a pediatric summer camp. Methods: Fifty campers were randomly assigned to receive camp plus a nightly problem-solving intervention activity or camp as usual. Changes in self-reported asthma knowledge and problem-solving skills and self- and parent-reported child self- and social competence health-related quality of life were assessed thrice: before camp, on the last day of camp, and 3-months post-camp. Results: There were no significant differences between the problem-solving intervention group and the camp as usual group in change across psychosocial variables from before camp to last day of camp or before camp to 3-months post-camp. Increases in asthma knowledge and problem-solving were found 3-months post-camp when groups were combined. Conclusions: Although support was found for improvements in disease knowledge and problem-solving skills after camp participation, there were no identified benefits to the problem-solving intervention. Children with asthma who participated in camp were functioning at a high level in terms of knowledge, problem-solving, and social and self-competence, suggesting that interventions may be more effective if targeted to patients with identified problems with disease management.

Web-based family intervention for overweight children: A pilot study

BACKGROUND Research has shown the efficacy of family-based behavioral interventions for overweight children, but a major difficulty is access to effective treatment programs. The objective of this study was to develop and test the initial feasibility and efficacy of a web-based family program for overweight 8- to 12-year-old children. METHODS A website was created using concepts from effective family-based behavioral programs and input from focus groups with overweight children, parents, and pediatricians. The website provided information about obesity and healthy lifestyles, assessment of dietary and physical activity habits, interactive dietary and physical activity games, and instruction in goal-setting and monitoring of goals. Children selected a dietary and physical activity goal and a daily step goal with pedometers. Feasibility and pilot testing over 4 weeks was conducted with 24 overweight children referred by a physician. Outcomes were z-BMI, healthy eating and physical activity, and intrinsic motivation and self-efficacy for weight control. RESULTS Mean number of logins over the study period was 11.4 for the study sample. Eighteen families (75%) returned for the follow-up assessment. Pre-post analyses for these participants showed improvements in intrinsic motivation, (p=0.05), self-efficacy (p=0.025), physical activity (p=0.005), and healthy lifestyle behaviors (p=0.001). Comparisons between high and low users of the program indicated that high users reduced their BMI while low users increased their BMI over time (p=0.02); high users also improved their dietary intake relative to low users (p=0.04). Consumer satisfaction ratings were high. CONCLUSION These pilot findings suggest this is a feasible approach for treatment of overweight children and that children who used the web program frequently improved their BMI and dietary intake.

Mother-Father Informant Discrepancies Regarding Diabetes Management: Associations With Diabetes-Specific Family Conflict and Glycemic Control

OBJECTIVE To examine the relationship of mother-father informant discrepancies regarding diabetes management to diabetes-specific family conflict and glycemic control. METHODS One hundred thirty-six mothers and fathers of youth with Type 1 diabetes reported on the youths diabetes management, diabetes-specific family conflict, and amount of paternal involvement in diabetes care. Glycosylated hemoglobin A1c (HbA1c) was used to measure glycemic control. RESULTS As hypothesized, mother-father discrepancies regarding diabetes management were positively associated with frequency of diabetes-specific family conflict. Contrary to hypotheses, mother-father discrepancies regarding diabetes management predicted poorer glycemic control for youth with less involved fathers only. CONCLUSIONS Results highlight the importance of caregivers being consistent about pediatric illness management and support the idea that informant discrepancies represent an important window into the functioning of the family system.

Health-related quality of life and adaptive behaviors of adolescents with sickle cell disease: stress processing moderators.

The objective of this study was to examine resilience among adolescents with sickle cell disease (SCD), focusing on the interaction of health-related quality of life with stress processing to explain adaptive behavior. Forty-four adolescents with SCD completed paper-and-pencil measures of health-related quality of life, appraisals (hope), pain coping strategies (e.g. adherence), and adaptive behavior. Self-reported health-related quality of life was significantly associated with adaptive behavior, as was adherence. Findings for moderation were mixed. Pain coping strategies moderated the association of health-related quality of life with adaptive behavior such that at lower levels of Coping Strategies Questionnaire (CSQ) Adherence, better quality of life was associated with higher adaptive behavior. Similarly, at higher levels of hope, better quality of life was associated with higher adaptive behavior, and poorer quality of life was associated with lower adaptive behavior. Adolescents with SCD showed resilience, particularly in terms of personal adjustment, that may be explained by their appraisals and stress processing strategies. Interventions to support an optimistic or hopeful outlook and improve adherence to recommendations for medical management of sickle cell pain may result in improved resilience/adaptive behavior.

Measurement of Parental Self-Efficacy for Diabetes Management in Young Children

Self-efficacy is an important construct in diabetes management, especially for parents of young children. The Parental Self-Efficacy Scale for Diabetes Management (PSESDM) was adapted from the Perceived Diabetes Self-Management Scale (PDSMS) to measure parental self-efficacy for diabetes management of young children. The PSESDM was administered to 49 primary caregivers of youth between 2–9 years of age with type 1 diabetes (T1D). Cronbach’s alpha for the 8-item measure demonstrated adequate internal consistency (α = 0.84). Criterion-related validity was established. Higher scores on the PSESDM were associated with better glycemic control and quality of life in children. These preliminary findings provide support for the reliability and validity of the PSESDM, which may be a useful screening measure of diabetes-related parental self-efficacy for young children.

Quality of life and psychosocial functioning of children with cardiac arrhythmias.

Childhood cardiac arrhythmias may have a long-lasting impact on a family and typically require long-term medical follow-up. Whereas some arrhythmias are benign, others can be life threatening and require significant medical care. As with many chronic illnesses, it is important to study the potential psychosocial effects of childhood arrhythmias and how they may impact a childs quality of life. The purpose of this study was to create a quality of life measure specific to childhood arrhythmias and to describe the current psychosocial functioning of this population. A total of 46 families participated in a one-time paper and pencil assessment during their regularly scheduled clinic visits. Results indicated promise for the validity and reliability of this new measure. Children in the current sample also demonstrated a high degree of resiliency. Additional analyses with larger samples will be needed to verify the psychometric properties of this measure. Overall, the high functioning of many of these children despite medical trauma is promising. Future studies should consider using some screening measures to decide which children may be most in need of intervention.

Clinic attendance and health outcomes of youth with type 2 diabetes mellitus

Abstract This study assessed whether clinic attendance was related to health outcomes for youth with type 2 diabetes mellitus (type 2 DM). Medical records of pediatric patients with type 2 DM were retrospectively reviewed. Clinic attendance was much more infrequent than recommended by physicians, and 42% of the sample withdrew from medical care. Patients who had a history of not showing during appointments had higher HbA1c levels than those who attended regularly scheduled visits; however, contrary to our hypotheses, average number of clinic visits was not associated with HbA1c levels or zBMI. Given the increased risk for health complications, new strategies are needed to keep patients engaged with medical care.

Obesity in Adolescence

This chapter reviews research addressing obesity during adolescence. Epidemiologic findings indicate that obesity has increased dramatically in adolescents during the past several decades so that currently approximately one-third of adolescents in the United States are overweight, with about 17 % considered obese. Rates of obesity are greater among youth from ethnic minority and lower-income families. Overweight adolescents have a high likelihood of remaining overweight as adults. Etiologic factors indicate the important role of hereditary, early growth, and environmental factors, with behavioral factors of excessive caloric intake and decreased energy expenditure resulting in positive energy balance and increased adiposity over time. Review of the correlates of obesity reveals that adolescents have increased risk for several physical health disorders, including high blood pressure, high cholesterol, metabolic syndrome, type 2 diabetes, orthopedic problems, sleep apnea, asthma, and fatty liver disease. Psychosocial correlates of obesity in adolescents include increased risk for problems related to body image problems, self-esteem, social isolation and discrimination, depression, and reduced quality of life. Research on interventions for obesity in adolescents reveals the challenges of weight control over time; however there is some support for the efficacy of behavioral interventions targeting reduced caloric intake, increased physical activity, and reduced sedentary behavior. Medical interventions including pharmacological and surgical approaches have shown some efficacy, but more research is needed to demonstrate their safety and acceptability, as well as long-term effects. In recent years, Internet-delivered behavioral interventions have shown some promise and these approaches will likely be needed in order to more effectively reach the population of overweight adolescents. Given the tremendous challenge in successfully treating obesity during adolescence, and the costs of its continuation into adulthood, a public health approach is needed to address the environmental factors that are responsible for the increased incidence of obesity in youth.