Kathryn A. Ambler

Predictors of Metabolically Healthy Obesity in Children

OBJECTIVE To determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status. RESEARCH DESIGN AND METHODS This cross-sectional study included 8–17 year olds with a BMI ≥85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005–2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR) and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs. RESULTS The prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [95% CI 0.18–0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [95% CI 0.31–0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24–2.62]; P = 0.002) was the strongest independent predictor of MHO-CR. CONCLUSIONS Up to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.

Parents as Agents of Change (PAC) in pediatric weight management: The protocol for the PAC randomized clinical trial

BackgroundThere is an urgent need to develop and evaluate weight management interventions to address childhood obesity. Recent research suggests that interventions designed for parents exclusively, which have been named parents as agents of change (PAC) approaches, have yielded positive outcomes for managing pediatric obesity. To date, no research has combined a PAC intervention approach with cognitive behavioural therapy (CBT) to examine whether these combined elements enhance intervention effectiveness. This paper describes the protocol our team is using to examine two PAC-based interventions for pediatric weight management. We hypothesize that children with obesity whose parents complete a CBT-based PAC intervention will achieve greater reductions in adiposity and improvements in cardiometabolic risk factors, lifestyle behaviours, and psychosocial outcomes than children whose parents complete a psycho-education-based PAC intervention (PEP).Methods/DesignThis study is a pragmatic, two-armed, parallel, single-blinded, superiority, randomized clinical trial. The primary objective is to examine the differential effects of a CBT-based PAC vs PEP-based PAC intervention on children’s BMI z-score (primary outcome). Secondary objectives are to assess intervention-mediated changes in cardiometabolic, lifestyle, and psychosocial variables in children and parents. Both interventions are similar in frequency of contact, session duration, group facilitation, lifestyle behaviour goals, and educational content. However, the interventions differ insofar as the CBT-based intervention incorporates theory-based concepts to help parents link their thoughts, feelings, and behaviours; these cognitive activities are enabled by group leaders who possess formal training in CBT. Mothers and fathers of children (8–12 years of age; BMI ≥85th percentile) are eligible to participate if they are proficient in English (written and spoken) and agree for at least one parent to attend group-based sessions on a weekly basis. Anthropometry, cardiometabolic risk factors, lifestyle behaviours, and psychosocial health of children and parents are assessed at pre-intervention, post-intervention, 6-, and 12-months follow-up.DiscussionThis study is designed to extend findings from earlier efficacy studies and provide data on the effect of a CBT-based PAC intervention for managing pediatric obesity in a real-world, outpatient clinical setting.Trial RegistrationClinicalTrials.gov identifier: NCT01267097

Pediatric weight management programs in Canada: Where, What and How?

Our purpose was to conduct a national environmental scan of pediatric weight management programs in Canada. Data were entered by program representatives regarding the history, structure, and function of their weight management programs using an online survey that our team developed in partnership with the Canadian Obesity Network ( www.obesitynetwork.ca ). Of the 18 programs that were identified, all included multidisciplinary teams that take a family-centred, lifestyle/behavioural therapeutic approach; health services were accessed primarily through physician referral. Most programs were launched in the past five years with public funding and enrolled ∼125 clients/year into one-on-one and/or group-based weight management care. Although many participated in research and were affiliated with academic institutions, most did not systematically evaluate their obesity-related programming. Based on these observations, recommendations related to program evaluation, health services delivery, and network collaborations are provided to inform future directions for research and clinical care that have both domestic and international relevance.

Referrals for pediatric weight management: the importance of proximity

BackgroundLimited access to weight management care can have a negative impact on the health and well-being of obese children and youth. Our objectives were to describe the characteristics of clients referred to a pediatric weight management centre and explore potential differences according to proximity.MethodsAll demographic and anthropometric data were abstracted from standardized, one-page referral forms, which were received by a pediatric weight management centre in Edmonton, AB (Canada) between April, 2005 and April, 2009.ResultsReferrals (n = 555; 52% male; age [mean +/- standard deviation]: 12.4 +/- 2.6 y; BMI: 32.3 +/- 6.8 kg/m2; BMI percentile: 98.4 +/- 1.7; BMI z-score: 2.3 +/- 0.4) were received from 311 physicians. Approximately 95% of referrals were for boys and girls classified as obese or very obese. Based on postal code data, individuals were dichotomized as either living within (local; n = 455) or beyond (distant; n = 100) the Edmonton Census Metropolitan Area. Numerous families resided several hundred kilometres away from our centre. Overall, distant clients were taller, weighed more, and were more overweight than their local counterparts. For distant clients, the degree of overweight was higher in youth versus children.ConclusionPediatric weight management services must be designed to optimize access to health services, especially for distant clients who may be at increased obesity-related health risk.

Ready, set, go! Motivation and lifestyle habits in parents of children referred for obesity management

Parents play a fundamental role in helping children with obesity to make and maintain healthy lifestyle changes.

Characterizing severe obesity in children and youth referred for weight management

BackgroundSevere obesity (SO) in pediatrics has become increasing prevalent in recent decades.The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers.MethodsA retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99th percentile) and OW/OB (BMI ≥85th and <99th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved.ResultsOf the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > 

Lifestyle Behaviors of Parents of Children in Pediatric Weight Management Are They Meeting Recommendations

50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05).ConclusionChildren and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years.

Talking the Talk or Walking the Walk? Nutrition and Physical Activity Habits of Parents of Children and Youth with Obesity

Objective: Our objective was to examine the lifestyle behaviors of parents of children in pediatric weight management. Methods: Parents were recruited upon presentation of their children (body mass index [BMI] ≥85th percentile) to a pediatric weight management clinic. Parents’ demographic, anthropometric, and lifestyle habit data were collected by self-report. Parents were grouped into weight status categories based on their BMIs; lifestyle data were compared across BMI categories and to national recommendations. Results: Parents (n = 266; 84% women; BMI, mean ± SD, 31.8 ± 7.2 kg/m2) were predominantly overweight/obese (82%), and most did not meet dietary recommendations (71%). Healthy-weight parents reported more daily steps versus parents who were overweight/obese (all P < .05). Most parents (~60%) met guidelines for physical activity, sedentary activity, and sleep. Conclusion: The high prevalence of overweight and obesity combined with suboptimal dietary behaviors highlight the need to address both children’s and parents’ lifestyle habits in pediatric weight management.

Families' Perceptions of and Experiences Related to a Pediatric Weight Management Intervention: A Qualitative Study.

Results: After adjustment for age, sex, ethnicity and living alone status, dog ownership was associated with higher levels of walking in the fall/winter (1172 steps per day, 95% CI 191 to 2154) but not in the spring/summer (307 steps per day, 95% CI -696 to 1310). No associations were observed between dog ownership and BMI (fall/ winter: 0.7 kg/m 2 , 95% CI -1.8 to 3.1; spring/summer: -0.4 kg/m 2 , 95% CI -2.6 to 1.9). Conclusions: This study provides evidence that dog ownership may be an important factor in helping adults with DM2 achieve higher levels of walking in the fall/winter but not in the spring/ summer. Because the effects of dog ownership on BMI may emerge over time, additional longitudinal research is encouraged. Background: Parents help their sons and daughters to develop healthy lifestyle habits, which is particularly important for obesity management. Our purpose was to characterize the weight status, diet, and physical activity of parents of children and youth with obesity. Methods: Cross-sectional waist circumference, height, and weight data were measured in 242 parents of 8e18 years olds with obesity. Relative weight status categories were created using BMI. Parents recorded their dietary intake, physical activity, and leisure time screen time using a food record, pedometer, and physical activity record, respectively. Results: The proportions of parents categorized as normal weight, overweight, and obese were 17.4%, 25.2%, and 57.4%, respectively; 39.6% of parents had abdominal obesity. Based on Canadas Food Guide, 8%, 27%, 45%, and 62% consumed the recommended number of daily servings of Vegetables & Fruit (7-10), Milk & Alternatives (2-3), Grain Products (6-8), and Meat & Alternatives (2-3), respec- tively. Regarding physical activity, 23.2% accumulated � 10,000 steps/day, 48.7% participated in >30 minutes/day, and 46.1% limited leisure time screen time to <120 minutes/day. Conclusion: Parents of children and youth with obesity were predominantly overweight or obese, and most did not achieve current recommendations. Interventions for managing pediatric obesity should attend to the lifestyle habits of children and youth and their parents to optimize family health.