Keeley J. Pratt

Promising insights into the health related quality of life for children with severe obesity

BackgroundChildhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity.MethodsThe pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile.Results136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05).ConclusionsChildren and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life.

Camp-Based Immersion Treatment for Obese, Low Socioeconomic Status, Multi-Ethnic Adolescents

BACKGROUND Immersion treatment (IT) provided in a camp setting has been shown to promote short-term improvements in weight and health status in obese adolescents. However, evidence of ITs long-term efficacy and efficacy for multi-ethnic and lower socioeconomic status (SES) adolescents is limited. METHODS This was a cohort study with a pre/post design and longitudinal follow-up. The intervention was a 19-day camp-based IT program comprising (1) a nutrition curriculum and ad-lib access to a nutritious diet, (2) several hours of physical activity daily, (3) group therapy, and (4) cognitive-behavioral therapy (CBT). This analysis included 52 low-SES adolescents that participated in 2009 and 2010. A subgroup of 33 campers and their families was offered follow-up monthly for 10 months. Primary outcome measures were change in weight-related parameters immediately postcamp and after 10 months of follow-up. RESULTS Campers had significant short-term improvements in mean waist circumference (mean [M], 2.6; standard deviation [SD], 3.2 cm), weight (M, 2.6; SD, 1.9 kg), BMI (M, 1.1; SD, 0.9 kg/m2), BMI z-score (M, 0.06; SD, 0.07), and percent overweight (M, 6.1; SD, 4.7). Campers offered follow-up had a modest increase in mean percent overweight (M, 2.0; SD, 8.4) during 10 months of follow-up. However, 33% experienced continuing decline in percent overweight during follow-up, and long-term follow-up was associated with significant overall (precamp vs. end of follow-up) improvements in percent overweight (M, 4.9; SD, 7.2). CONCLUSIONS Camp-based IT with CBT is a promising intervention for improving short- and long-term weight status of low-SES adolescents. Additional research is needed to increase long-term efficacy.

Quality of life and BMI changes in youth participating in an integrated pediatric obesity treatment program

BackgroundChanges in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL.MethodsA sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate.ResultsOverall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression.ConclusionsWe encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth’s BMI changes, but also psychosocial changes including QOL.

Camp Golden Treasures: a multidisciplinary weight-loss and a healthy lifestyle camp for adolescent girls.

Camp Golden Treasures, (CGT) the first non-profit weight loss camp for overweight adolescent girls in the nation, was held for six weeks from June 24 to August 3, 2007 at the East Carolina University campus in Greenville, NC. The primary goal was to support campers to lose weight, raise self esteem, and to learn the tools necessary to lead a healthy lifestyle while reducing risks for developing chronic disease or mitigating the effects of existing obesity-related conditions (sleep apnea, insulin resistance, hypertension, lower extremity dysfunction, etc.). While at CGT, campers learned about the importance of physical activity and proper nutrition through workshops, discussion groups and hands-on activities. Additionally campers were taught the necessary tools and strategies needed to make concrete, positive lifestyle changes so they can achieve a healthy weight. Due to the nature of a chronic disease such as obesity, multidisciplinary collaborators including physical therapy, nutrition, health education, management, family therapy, risk management, fundraising, public relations, medical, nursing, and physician coverage were involved in designing, planning, and implementing CGT.

Supervision in Behavioral Health: Implications for Students, Interns, and New Professionals

Behavioral health providers (BHPs) are trained by their respective programs and professions on the importance of communicating with other professionals around patient care, yet few are trained on how to provide collaborative care and work as part of a team. New clinical innovation models, such as integrated care, punctuate the need to further develop training methods to best equip the next generation of BHPs to work in collaborative settings. Supervision is a tool that students, interns, and new professionals can use to help them navigate new and unfamiliar territory in health care settings. This manuscript will describe the steps of choosing a supervisor, provide elements that must be considered when developing a supervision contract, offer a template for crafting a document that will assist with assessing fidelity to one’s practice and maximize consistency and productivity in the supervision process, and detail the potential supervision dynamics in different levels of clinical collaboration. Supervision that is tailored to the BHPs level of clinical collaboration in their given practice setting can provide a structure for the supervision process.Behavioral health providers (BHPs) are trained by their respective programs and professions on the importance of communicating with other professionals around patient care, yet few are trained on how to provide collaborative care and work as part of a team. New clinical innovation models, such as integrated care, punctuate the need to further develop training methods to best equip the next generation of BHPs to work in collaborative settings. Supervision is a tool that students, interns, and new professionals can use to help them navigate new and unfamiliar territory in health care settings. This manuscript will describe the steps of choosing a supervisor, provide elements that must be considered when developing a supervision contract, offer a template for crafting a document that will assist with assessing fidelity to one’s practice and maximize consistency and productivity in the supervision process, and detail the potential supervision dynamics in different levels of clinical collaboration. Supervision that is tailored to the BHPs level of clinical collaboration in their given practice setting can provide a structure for the supervision process.

Bariatric Surgery Candidates’ Peer and Romantic Relationships and Associations with Health Behaviors

BackgroundThe aim was to assess the romantic and peer relationships of bariatric surgery candidates and associations with health behaviors.MethodAdults seeking bariatric surgery (N = 120) completed surveys addressing health behaviors and social relationships at information sessions. Analysis was done to compare male/female differences in peer and romantic relationships and associations with health behaviors. Previously published reference (REF) data on the Relationship Structures questionnaire was used for comparison, and to split our sample into those ≤ or > REF mean for relationship anxiety and avoidance.ResultsOur sample reported higher avoidance and lower anxiety in their close friendships and romantic relationships compared to the REF sample. Men in our sample had higher peer and romantic relationships avoidance compared to the REF sample and had significantly higher close friendship avoidance than women in our sample. Participants with lower anxiety in their romantic relationships (≤ REF) had higher uncontrolled eating and physical activity; those with more anxiety in their romantic relationships (> REF) had a higher BMI.ConclusionsOur findings highlight the potential influence that social relationships may have on health behaviors within the bariatric surgery population. Further investigation is warranted to explore male bariatric surgery candidates’ relationships to inform understanding and intervention development.

Approaches to Weight-Related Problems: A Narrative Intervention for Overweight Youth

Currently in the United States, 31.8% and 16.9% of all youth ages 2–19 are diagnosed as overweight or obese, respectively (Odgen, Carroll, Kit, & Flegal, 2012). Researchers have documented that this population of youth are more likely to struggle with relationship challenges and develop mood, anxiety, personality, and substance-abuse disorders into adulthood (Mather, Cox, Enns, & Sareen, 2008; Petry, Barry, Pietrzak, & Wagner, 2008). Given the high incidence of youth who are overweight in the United States, and the subsequent biological, psychological, and relational comorbidities that can occur, it is likely that clinicians will be working with youth and families who are overweight and struggling with complications. Typically, in discussions about oppression and bias, gender, ethnicity, sexual orientation, and poverty are emphasized; body size is rarely included in the discussion. One family therapy theory that relies heavily on privilege and oppression and working with oppressed populations is narrative therapy (e.g., White & Epston, 1990). Narrative therapy suggests that strong social stigmas and negative societal messages impact the way one perceives oneself, and how one’s life is thus shaped in the future. The main procedural steps of narrative therapy include deconstruction of the dominate story, tracing the history of the problem, reconstructing a healthier narrative or story,

MedFT Supervision in Context

Supervision is a tool that Medical Family Therapy students, interns, and novice professionals can use to help them navigate new and unfamiliar territory in healthcare settings. Supervision is also an invaluable resource for intermediate or advanced level Medical Family Therapists who are often isolated from other behavioral health providers and challenged by patients with complex medical and behavioral health conditions. This chapter describes the process of choosing a supervisor, developing a supervision contract, recognizing potential supervision dynamics across the levels of integrated care, and assessing clinical and supervisorial productivity. The chapter concludes with common supervision challenges, a case study, and reflection questions to assist with the application of the material presented in this chapter for future supervision discussions.

Conceptualising care for childhood obesity: a three‐world view

Purpose – This review paper seeks to conceptualise childhood obesity through clinical, operational, and financial procedures. It informs multiple disciplines about: the trajectory of paediatric obesity and current recommendations; the trends in the clinical, administrative/policy and financial worlds of paediatric obesity; and discusses commonly misunderstood collaborative terms.Design/methodology/approach – The paper is based on analysis of national and international policy documents and research papers in the field.Findings – Paediatric obesity treatment teams, programmes, and providers could all benefit from a document that bridges the disciplines of medicine, other professions, and financial management. A family centred, multidisciplinary approach is necessary at all stages of obesity treatment care and the three‐world model discussed is helpful in achieving this. The clinical, operational, and financial aspects of the service need to be integrated in a way that reduces the barriers to accessing servi...

Mothers’ Perspectives on the Development of Their Preschoolers’ Dietary and Physical Activity Behaviors and Parent-Child Relationship: Implications for Pediatric Primary Care Physicians:

The study explores female caregivers’ reflections on their relationship with their child (2-5 years old) and the development of their child’s dietary and physical activity behaviors. Five, 90-minute semistructured focus groups were conducted to inquire about children’s growth, eating behaviors and routines, physical activity, personality, and the parent-child relationship. Nineteen female caregivers diverse in race/ethnicity, age, and educational attainment participated. Participants reported that they maintained a schedule, but needed to be flexible to accommodate daily responsibilities. Family, social factors, and day care routines were influences on their children’s behaviors. The main physical activity barriers were safety and time constraints. Guidance from pediatric primary care providers aimed at supporting female caregivers to build a positive foundation in their parent-child relationship, and to adopt and model healthy diet and physical activity behaviors that are respectful of schedules and barriers should be a priority for childhood obesity prevention.